Combined clear corneal phacoemulsification and transpupillary removal of silicone oil
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Combined clear corneal phacoemulsification and transpupillary removal of silicone oil. Y ü ksel Totan , Ramazan Ya ĝ c ı , Zeynel Arslany ı lmaz , U ĝ urcan Keskin The authors have no financial interest. Introduction.

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Combined clear corneal phacoemulsification and transpupillary removal of silicone oil

Combined clear corneal phacoemulsification and transpupillary removal of silicone oil

Yüksel Totan, Ramazan Yaĝcı, Zeynel Arslanyılmaz, Uĝurcan Keskin

Theauthorshave no financialinterest


Introduction
Introduction

  • Cataract is a frequentcomplication of siliconeoiltamponadeusedin themanagement of proliferativevitreoretinopathyandadvanceddiabeticretinopathycomplications.

  • Weaimed to evaluate clinical results of clear corneal phacoemulsification combined with transpupillarysilicone oil removal.


Patient s and methods
Patients and methods

  • A retrospectivestudy

  • 20 patients; 13 males, 7 females

  • Agerange; 14-75 years, meanage 53 yrs

  • Thesamesurgeon(YT) performedalltheoperations.

  • Thereasonsforprimaryvitreoretinalsurgery:

    • Proliferativevitreoretinopathy in 13 eyes,

    • Retinaldetachmentwithgianttear in 2 eyes

    • Retinaldetachmentwithmacular hole in 1 eye,

    • Proliferativediabeticretinopathycomplications in 4 eyes.


Patient s and methods1
Patients and methods

  • Type of cataract

    • Posteriorsubcapsularopacitiescombinedwithnuclearsclerosis

  • Biometry

    • SRK/T formulausingtrueaxiallength(AL)

    • True AL wasestimatedbymultiplyingmeasured AL bytheconversionfactor of 0.71

  • Type of anesthesia

    • Topical (10 eyes),

    • Peribulbar (9 eyes),

    • General anesthesia (1 eye-14 yearsold)


Patient s and methods2
Patients and methods

  • Surgicalsteps;

    • A superiorclearcornealincision

    • Phacoemulsification (quickchoptechnique)

    • Anteriorchambermaintainerplacementforinfusion

    • Posteriorcapsulotomy

    • Siliconeoilremovalthroughtheposteriorcapsulotomywith a 16 gaugecannulaconnectedto a 10 mL syringe

    • Retinalexaminationwith a wide-angleviewingsystem

    • IOL implantation in thecapsularbagorsulcus.


Results

Results

Visualacuity(BCVA)

Aftervitreoretinalsurgery:

Handmotion in 2 eyes,

Fingercounting in 5 eyes,

0.05 to0.7 (Snellenschart) in 13 eyes

Aftercombinedphacoemulsificationplussilicone oil removal

Fingercounting in 3 eyes,

0.1 to1.0 (Snellenschart) in 17 eyes

“Mean BCVA increase is 2 Snellenslines”


Results1

Results

Opticalcorrection:

IOL implantation in 18 eyes,

2 eyesleftaphakicaccordingtothepreopbiometry

Typeof IOL implantation:

Capsularbag in 12 eyes

Ciliarysulcus in 6 eyes.

IOL type

HydrophilicacrylicmonoblocIOL in 14 eyes,

HydrophobicacrylicmonoblocIOL in 4 eyes


Results2

Results

Follow-upperiod:

Mean, 12 months(range, 4-36 months)

Postoperativerefractiveerror (sphericalequivalent):

Themeandeviation,-1.0 ± 1.84 D (range, +2.0 to-5.0 D)

A total of 90% waswithin± 2 D

45% had a deviation of ± 1 D

“No significantsurgicalcomplicationleadingtodecreasedvisionwasencounteredduringthefollow-upperiod”.


Discussion

Discussion

Cataract is a commoncomplicationfollowingvitreoretinalsurgerywithsiliconeoiltamponade.

Combinedphacoemulsificationandsiliconeoilremovalthrough a clearcornealincision has someadvantages :

Reducednumber of surgicalprocedures,

Reducedoperation time,

Lessor no posteriorpressureduringphacoemulsificaiton,

No sclerotomy,

No posteriorcapsularopacification,

Reduced risk of retinaldetachmentandvitreoushemorrhage (Because ora serrata is spared)


Discussion1

Discussion

Somepotentialdisadvantages of combinedsurgery:

Lesspredictablepostoperativerefraction,

Increaseddifficulty of in-thebagIOL implantation (particularlyfor mono-blochydrophilicIOLs),

Relativehypotonyaftersiliconeoilremoval,

No chance of membranepeelingorretinalstabilization.

Potentialsubluxation of the IOL in case of inadvertentlargeposteriorcapsulotomy

Angiographicmacularedema


Conclusion

Conclusion

Combinedphacoemulsificationandsiliconeoilremovalthrough a clearcornealincision is a safeandeffectivetechnique, but must be reservedin selectedcases in which retina is permanentlystabilizedwith no significantepiretinalorsubretinalmembranes.


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