Posters

Posterior capsule rent (PCR) management with anterior chamber maintainer (ACM), 23 gauge vitrector, posterior rhexis and IOL optic capture

Poster Details

First Author: S.Chaudhary INDIA

Co Author(s):    R. Chaudhary   S. Jindal                 

Abstract Details

Purpose:

A PCR with a phaco tip usually causes a gaping hole in the posterior capsule (PC) with torn edges on either side, ready to run out to the periphery. We evaluated a technique with which we could maintained a stable environment with an ACM to do vitrectomy, tease out the cortex from the capsule, rounding off the torn edges of the posterior capsule preventing its spread, inserting an IOL without visco-elastic cover so that visco does not drop in the vitreous cavity and finishing off with an optic capture.

Setting:

Eye7 group of eye hospitals, New Delhi, India

Methods:

On detecting a PCR, the AC is stabilised with an ACM with a bottle height of 21 cm, maintaining an IOP of 16mmhg. The vitreous is stained with triamcinolone. It is cut in front and behind the tear with 23 gauge vitrector. Cortex is teased out of the bag with the same vitrector in an I.A mode. In the Cut mode the cortex along with any vitreous tags is cut and aspirated. Posterior rhexis rounds off the torn edges of the PC. Three-piece IOL is injected over the iris and then tucked into the sulcus followed by an optic capture.

Results:

With a physiological IOP of 16mmhg maintained with an ACM, the AC was stable at all times. This kept the vitreous at bay after the vitrectomy. The same vitrector worked as an aspiration cannula to tease out the cortex without letting the rent edges spread. Once the torn edges of the PC became clearly visible, the rounding off manoeuvre became safe and simple. With this level of control, a lens implantation manoeuvre seemed simple and risk free.

Conclusions:

ACM with a low bottle height should be the first step to stabilise the AC after a PCR. Dry aspiration with a Simcoe cannula under cover of viscoelastic seems a thing of the past. Cortex removal with a vitrector is as comfortable as using a Bi-manual I.A. system, with the added advantage that attached vitreous tags to the cortex can be cut in the same manoeuvre, reducing risk of retinal detachment. Viscoelastic should preferably never be used at any stage, as it drops in the vitreous cavity causing post-op inflammation and secondary rise of pressure.

Financial Disclosure:

None