Outcome of combined phacoemulsification and transpupillary silicone oil removal under topical anesthesia

Session Details

Session Title: Cataract Surgery Special Cases II

Session Date/Time: Monday 15/09/2014 | 16:30-18:30

Paper Time: 17:58

Venue: Auditorium

First Author: : N.Khater EGYPT

Co Author(s): :    N. Abou Hussein   A. A Abdel-Kader           

Abstract Details

Purpose:

To evalute the safety, intra-operative difficulties and the outcome following combined phacoemulsification and transpupillary silicone oil removal under topical anesthesia.

Setting:

Al Oyoun Al Dawli, Dokki, Giza - Egypt

Methods:

The study included 50 eyes of 49 patients in a prospective randomized clinical trial. All patients underwent surgery under topical anesthesia using Benox 0.4% (benoxinate hydrochloride) combined with topical xylocaine gel. Cataract surgery was performed using a 2.2 mm clear corneal incision, followed by a planned posterior capsulorrhexis. Silicone oil was actively removed using suction by a 20 gauge cannula through the posterior capsulorrhexis, followed by the implantation of an injectable intraocular lens into the capsular bag. All Patients were operated on by the same surgeon. Intraoperative parameters such as pain, discomfort and operative time and complications were recorded. Post operative outcome included changes in best corrected visual acuity (BCVA), Intraocular pressure (IOP), incidence of retinal redetachment, dispersed vitreous hemorrhage, residual silicone oil and Intraocular lens (IOL) decentration. Patients had a mean postoperative follow up period of 7 months.

Results:

All patients completed surgery under topical anesthesia without switching to any other form of anesthesia. Only minimal pain was noted in 10 eyes (20%). Extension of posterior capsulorrhexis occurred in 5 eyes (10%); in those patients the IOL was implanted on the anterior capsule (ciliary sulcus). Mean operative time was 20 mins +/- 3 mins. BCVA improved in 47 eyes (94%). Preoperatively, 25 eyes (50%) had elevated intraocular pressure in spite of antiglaucoma therapy. Postoperatively, only 5 eyes (10%) continued to receive topical antiglaucoma therapy. Retinal redetachment occurred in 3 eyes (6%), for which silicone oil was reinjected. Dispersed vitreous hemorrhage lasting for less than one week occurred in 15 eyes (30%). All cases cleared spontaneously without any secondary intervention. Visually insignificant residual silicone oil was observed in 4 eyes (8%). Asymptomatic IOL decentration occurred in 4 eyes (8%), while symptomatic IOL decentration occurred in 2 eyes (4%) and required surgical correction.

Conclusions:

Combined phacoemulsification and transpupillary silicone oil removal under topical anesthesia is a safe, fast and effective technique; it offers the advantage of minimal surgical intervention and faster postoperative visual recovery.

Financial Interest:

NONE