1 / 35

Complications of SICS

Complications of SICS. Dr.Haripriya Aravind. Tunnel construction. Approach Placement Length Depth. Placement. Anterior incision Poor self sealing effect Wound leak Astigmatism Management: Suture. Posterior incision Wide tunnel Risk of bleeding Risk of premature entry

yaphet
Download Presentation

Complications of SICS

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Complications of SICS Dr.Haripriya Aravind

  2. Tunnel construction • Approach • Placement • Length • Depth

  3. Placement • Anterior incision Poor self sealing effect • Wound leak • Astigmatism Management: Suture

  4. Posterior incision • Wide tunnel • Risk of bleeding • Risk of premature entry Difficulty in nucleus delivery and instrument manipulation Management: Suture for premature entry

  5. Incision length • Short incision Difficulty in nucleus delivery Endothelial damage ris damage Management: Enlarge incision with keratome

  6. Long incision Poor approximation • Wound leak • Induced ATR astigmatism Management: Suture

  7. Incision Depth • Premature entry • Button holing • Scleral disinsertion

  8. Descemet’s Stripping • Main wound Instruments • Paracentesis VES/Fluids • Treatment • Air • Viscoelastics

  9. Paracentesis • Site • Size Too central Too peripheral Too small Too big

  10. Capsulotomy CAPSULORHEXIS • Peripheral extension/ Run away rhexis Post capsule tear Management • Reform AC with VES • Pull flap centrally • Cut capsule just ahead of peripherally extending rhexis • Continue in reverse direction • Canopener

  11. Inappropriate size • Too small Management: Enlarge the rhexis by 2 or 3 relaxing incisions • Too big

  12. Large rhexis Decenteration

  13. Hydrodissection • Incomplete hydro • Forceful hydro • PPC Complications • Inadequate cortical-capsular bag separation • Fluid misdirection syndrome • Zonular damage • Posterior capsular tear • Nucleus drop • Capsular block syndrome

  14. Nucleus prolapse Difficult situations • Incomplete hydroprocedure • Small rhexis • Mid-iris synechiae • Very soft nucleus • Hard brown wodden nucleus • Small pupil

  15. Complications • Endothelial Damage • Iridodialysis/Damage to Iris • Zonular Dialysis • PCR

  16. Nucleus Delivery • Endothelial damage • Zonular dialysis/PCR • Iris Sandwich

  17. Iris injury • Sphincter tear • Iridodialysis <1 hr : no intervention >1 hr : suture • Iris prolapse Careful repositioning Suture tunnel Post op steroids & NSAIDs

  18. Iridodialysis McCannel Suture

  19. Hyphema • From tunnel • Posterior tunnel • Deep tunnel • From Iris • Iris handling • Iridodialysis

  20. Intraoperative Miosis • Avoid iris touch • VES • Pharmacological • Spincterotomy • Hook

  21. Zonular dialysis Can be pre/intra operative • Approach • Bimanual prolapse of nucleus • Phacosandwich • IOL 1quad – sulcus (perpendicular to the dialysis) 2quad - CTR >2quad - ACIOL/aphakia

  22. Posterior capsular tear • Seal the tear using visco (don’t hydrate) • Automated ant vitrectomy • Residual cortex - dry aspiration Post op inflammation Obstruct visual axis Secondary glaucoma

  23. Bimanual automated vitrectomy At the start of vitrectimy Completed vitrectomy

  24. Dropped nucleus • If anterior : inject visco : deliver with vectis • Deep into the vitreous : Retinal surgeon intervention

  25. Expulsive Haemorrhage • Tissue prolapse • Hard globe • Loss of red glow • Choroidal haemorrhage • CRAO Rx : Suture IV Mannitol Post segment assessed

  26. Immediate post op complications Wound Dehiscence Etilology • Excessive episcleral cautrey • Premature entry • Button holing • Nuclear or cortical fragment in tunnel • Postoperative IOP rise • Collagen vascular diseases • Leaking paracentesis wound

  27. Treatment • Patch the eye • Cycloplegics • Exploration of wound and suturing

  28. Corneal complications • Corneal edema • Striate keratopathy • Bullous keratopathy

  29. Corneal complications Management : Control inflammation Antiglaucoma drugs Treat epithelial defect Cycloplegics

  30. Post op Iritis • Excess manipulation during nucleus prolapse & delivery • Residual cortex Management • Topical steroids & antibiotics • Cycloplegics • Topical NSAIDs

  31. Post op increase in IOP • Retained viscoelastics • Over distention of AC while reforming Rx: antiglaucoma medications

  32. Late complications • Corneal complications • Uveitis • Capsular bag complications • PCO • IOL malformations • CME • Endophthalmitis

  33. Post segment complications • RD • Lost lens syndrome • Vitreous hemorrhage • Vitritis

  34. Successful management • Recognition • Knowledge • Skill • Judgement

  35. THANK YOU

More Related