Posters

Delayed removal of Malyugin ring following phacoemulsification complicated by suprachoroidal haemorrhage

Poster Details

First Author: N. Stanojcic UNITED KINGDOM

Co Author(s):    V. Kesharaju   S. Ghazi-Nouri                 

Abstract Details

Purpose:

To describe an additional feature of a pupil-dilating device (Malyugin ring, MST MicroSurgical Technology) that was not originally intended by the manufacturer. This novel feature may help ophthalmologists manage complications encountered during phacoemulsification when Malyugin ring is used.

Setting:

Operating theatre in a District General Hospital in the UK. An elective phacoemulsification was performed under sub-Tenon's local anaesthesia.

Methods:

We report a case of phacoemulsification complicated by an intraoperative suprachoroidal haemorrhage where a Malyugin ring was left in the eye for one week. Pre-operative corrected distance visual acuity of the operated eye (right) was 0.52 logMAR (~6/19 Snellen). The pupil poorly dilated with our standard pre-operative topical treatment: cyclopentolate 1% and phenylephrine 2.5% (Minims, Bausch & Lomb UK Limited). Hence Malyugin ring was used. During irrigation and aspiration, the eye became very firm with loss of anterior chamber. There was no vitreous loss. Further surgery was abandoned and the Malyugin ring was left in the eye.

Results:

B-scan revealed a temporal suprachoroidal haemorrhage in the operated eye (right). The suprachoroidal haemorrhage was monitored closely and resolved within a couple of days. An uneventful secondary operation was performed a week later. A single-piece intraocular lens implant (Tecnis ZCB00, Abbott Medical Optics, Abbott Laboratories Inc. Abbott Park, Illinois, USA) was placed in the capsular bag and the Malyugin ring was removed. One week later uncorrected visual acuity (UCVA) in the operated eye was 1.06 logMAR (~6/75). Patient required careful post-operative monitoring and rigorous management of intraocular inflammation, corneal oedema and high intraocular pressure. One month after the second surgery, UCVA of the operated eye was 0.1 logMAR (6/7.5 Snellen).

Conclusions:

Our case demonstrates that the Malyugin ring can be left in the eye safely for a week in cases of intraoperative suprachoroidal haemorrhage. This is an example where an additional feature of a pupil-dilating device that was not originally intended was implemented. We believe that for other complications of phacoemulsification such as posterior capsule rupture or posterior displacement of nuclear fragments requiring a vitreoretinal procedure within a few days, Malyugin ring may be left in the eye until such procedure was performed.

Financial Disclosure:

NONE