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Bouncing Anterior Segment (BASS) of Post-Vitrectomized Eyes During Cataract Surgery

Bouncing Anterior Segment (BASS) of Post-Vitrectomized Eyes During Cataract Surgery. Jason Hade, MD; Nina Ni; Suqin Guo*, MD Correspondence to Suqin Guo*, MD: Assistant Professor, Ophthalmology, The Institute of Ophthalmology and Visual Science, New Jersey Medical School.

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Bouncing Anterior Segment (BASS) of Post-Vitrectomized Eyes During Cataract Surgery

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  1. Bouncing Anterior Segment (BASS) of Post-Vitrectomized Eyes During Cataract Surgery Jason Hade, MD; Nina Ni; Suqin Guo*, MD Correspondence to Suqin Guo*, MD: Assistant Professor, Ophthalmology, The Institute of Ophthalmology and Visual Science, New Jersey Medical School

  2. Financial Interest Disclaimer None of the authors have any financial relationships or interests related to this study

  3. Floppy Iris Syndrome • Previously first described by Campbell and Chang as a triad of iris billowing and floppiness, iris prolapse into incisions and progressive miosis • Seen in patients using systemic alpha-1 antagonists such as tamsulosin (Flomax), doxazosin (Cardura), terazosin (Hytrin) and alfuzosin (Uroxatral) which work on alpha-1 receptors found in both the prostate and iris dilator muscle • Associated with increased rate of complications during cataract surgery.

  4. Bouncing Anterior Segment Syndrome (BASS) • Eyes which have had previous vitrectomy pose several challenges similar to and in some ways more difficult to handle that eyes with floppy iris syndrome • Removal of vitreous eliminates the posterior support of the vitreous causing the entire anterior chamber to “bounce” in the anterior-posterior plane as well as horizontal plane. • In cases of eyes which have had vitreoretinal surgery lens zonule strength and integrity is often weakened making zonular dehiscence more likely

  5. Purpose • This series aims to describe and suggest management strategies for the bouncing anterior segment syndrome (BASS) of vitrectomized eyes during cataract surgery. The bouncing movement of the entire anterior segment during cataract surgery in vitrectomized eyes (iris, chambers and lens capsule) occurs in both the horizontal and vertical directions.

  6. Methods • Medical records of patients with history of prior pars plana vitrectomy who underwent subsequent cataract extraction between September 1, 2007 & February 29, 2008 were reviewed to collect data • Seven patients who had previous pars plana vitrectomy and underwent cataract extraction and intraocular lens implantation were identified and included in the study. • The diameter of the pupils were measured at the beginning, during, and the end of the surgery. • Use of management strategies during cases was noted, namely sole use of intracameral phenylephrine and iris retractor hooks • All surgeries performed or supervised by same surgeon (SG)

  7. Results • Seven cases who qualified our inclusion criteria were included in the study • Average pupil size in 7 patients varied from 7 mm to 8 mm at the beginning of the cataract surgery • The pupil size in all 7 patients reduced by 2 mm to 3 mm during and at the end of the cataract surgery. • Bouncing of the iris plane and anterior chamber depth throughout the surgery occurred in all cases included

  8. Conclusion • Floppy iris syndrome (first reported by Drs. Chang and Campbell) poses challenges largely in the iris plane, whereas in BASS the entire anterior segment is unstable. • Our study showed that intraoperative intracameral phenylephrine provide some degree of stabilization of the iris plane and iris retractors offer the most reliable solution in keeping the pupil stable in BASS.

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