Wieger’s ligament insufficiency: risk factor for intraoperative complications during phacoemulsification

Session Details

Session Title: Cataract
Session Date/Time: Saturday 16/02/2019 | 08:30-11:00
Paper Time: 08:54
Venue: Hall Trianti

First Author: N.Anisimova RUSSIA
Co Author(s): N. Shilova  A. Belodedova  B. Malyugin   -   -  - -  

Abstract Details

Purpose:

To confirm the presence of incomplete vitreolenticular adhesion by visualizing the retained lens material via microscope-integrated intraoperative OCT during cataract surgery and in the early postoperative period via spectral domain OCT.

Setting:

S. Fyodorov Eye Microsurgery State Institution, Moscow, Russia

Methods:

15 patients (15 eyes) undergone cataract surgery. Clinical characteristics and surgical video were documented. The real-time integrated into the surgical microscope intraoperative optical coherence tomography (iOCT) (Rescan ™ 700, Carl Zeiss Meditec Inc.) was directed by the operating surgeon at predetermined surgical time points. Postoperatively the OCT was performed with spectral domain RTVue-100 OCT (Optovue, Inc., Fremont, CA).

Results:

The presence of the Berger space was identified in 12 cases intraoperatively via iOCT In the early postoperative period the hyaloid-capsular interspace was identified in 14 cases via stationary OCT with the variation of depth size. The hyperreflective dots and areas of different shape and size were documented within the Berger space in 10 cases both intra- and postoperatively. Intraoperatively two cases required triamcinolone acetonide injection into the anterior chamber for vitreous identification. After subsequent aspiration/irrigation no vitreous visualized, the hyperreflective dots were identified in the Berger space with no penetration into the vitreous body.

Conclusions:

The iOCT confirms the penetration of microfragments of the crystalline lens, cellular material or medical suspension into the space between the posterior capsular lens and the anterior hyaloid membrane therefore it defines the the inconsistency of the lenticular ligaments and vitreocapsular adhesion. The defect in Wieger's ligament (vitreocapsular adhesion) can be a source of excessive hydration of Berger's space due to acute aqueous misdirection syndrome during phacoemulsification, which can lead to anterior chamber collapse and displacement of the posterior capsule of the lens anteriorly, increasing the risk of its rupture.

Financial Disclosure:

... travel has been funded, fully or partially, by a competing company