Index. E Egger s line, 17 Endophthalmitis, 201, 219 clinical presentation, 250 higher risk of, 7

Transcription

1 A Alcon Infiniti system, 51 Anterior chamber intraocular lenses (AC-IOLs), 189 complications, 180 contraindications for endothelial cell count, 196 eye disease/condition, 197 glaucoma, 197 iris neovascularization, 197 severe diabetic retinopathy, 197 shallow anterior chamber depth, 196 uveitis, vitreous in AC and papillary plane, 196 factors, 192 history of Boberg-Ans four-loop lens, 190, 191 bullous keratopathy, 190, 192, 193 Cogan s variation, 190, 191 modern flexible open-loop, 193, 194 indications, 179 intraoperative complications intraoperative hemorrhage, 200 reverse orientation of, 200 iridectomy, 201 postoperative complications corneal edema, 201 endophthalmitis, 201 retinal detachment, suture erosion, iridodialysis and pseudophakic bullous keratopathy, 201 prerequisites, 179 primary and secondary implantation, pupil ovalization/eccentric pupil, 201 selection of, 180 surgical techniques anterior vitrectomy, biometry, 198 iridectomy, 200 OVD, 200 wound, 198 Anterior segment complications early postoperative complications endophthalmitis, 250 glaucoma, striate keratopathy and corneal edema, uveitis and fibrinous reaction, 250 late postoperative complications epithelial downgrowth, anterior chamber, 251 pseudophakic bullous keratopathy, Anterior segment surgeon, pars plana anterior vitrectomy. See Pars plana anterior vitrectomy Aspiration flow rate (AFR), 98, 100, 103 B Balanced salt solution (BSS), 38, 70, 80, 84, 85, 95, 96, 113, 114, 122, 123, 139, 155, 232 Beiko and Steinert technique, 239, 240 Best-corrected visual acuity (BCVA), 4, 6, 189 Bimanual anterior vitrectomy, 50, 71, 103, 132, 134, 162, 164, 254, 255 Biometry, 198 Brunescent/black cataract, 27, 28 C Capsular tension rings (CTRs), 38 39, 51 Capsulorhexis correct termination of, 94, 96 intact anterior capsulorhexis, premium lenses anterior optic capture, 153, 154 reverse-optic capture, 153 sulcus placement, 153 intact posterior capsulorhexis, premium lenses, 154 PCCC (see Posterior continuous curvilinear capsulorhexis (PCCC)) Chronic endophthalmitis, 265, 266 Cloquet/hyaloid canal, 17 Corneal epithelial toxicity, 28, 29 Cortical cleaving hydrodissection, 38 Cyclooxygenase, 262 Cystoid macular edema (CME), 7, 175, 215, 242, 260 E Egger s line, 17 Endophthalmitis, 201, 219 clinical presentation, 250 higher risk of, 7 Springer India 2017 A. Chakrabarti (ed.), Posterior Capsular Rent, DOI /

2 274 Endophthalmitis vitrectomy study (EVS), 265 Epiretinal membrane (ERM), 197 Erggelet s space, 17 European Society of Cataract and Refractive Surgeons (ESCRS), 129 Exaggerated Bell s phenomenon, 24, 25 Extracapsular cataract extraction (ECCE), 5, 91, 167 AC-IOLs, 196 phacoemulsification, 4, 47 Extraocular factors corneal opacities, visibility issues, 24, 25 deep set eye, 24, 25 exaggerated Bell s phenomenon, 24, 25 F Femtosecond laser-assisted cataract surgery (FLACS), 38, 143, complicated cataracts intumescent cataract, posterior polar cataract, 147 subluxated cataract, 147 femtosecond laser capsulotomy anterior capsule rip, 145, 148 anterior radial tear, 144, 148 capsulotomy tag and bridge, 144, 148 corneal folds, 144 gas bubble formation, 144 incomplete capsulotomy, 144, 148 patient movement, 144 hydrodissection, 145, 149 insertion of IOL, 146 irrigation/aspiration of cortex, 146, 149 management early identification, 147 IOL implantation, nuclear fragment, removal of, 147 patient counseling, 148 of vitreous, 147 nuclear fragmentation, Femtosecond laser-assisted phacoemulsification, 5 FLACS. See Femtosecond laser-assisted cataract surgery (FLACS) G Glaucoma patient anterior vitrectomy, bimanual anterior vitrectomy, 162 pars plana vitrectomy, 162, 163 cortical aspiration, 161 dispersive viscoelastics, 160 intraocular lens, placement of, 162, 163 open-angle glaucoma, 164 primary angle-closure glaucoma status, 164 residual nuclear matter, 161 risk factors pupillary dilatation, Grieshaber hooks, 160 stretch pupilloplasty, Kuglen hooks, 160 special situations, 160 Glued intraocular lens (Glued IOL) complications of, 239, 240 CME, 242 decentration of IOL, haptic break/kink, 241 inadequate haptic externalization, 241 IOL drop, 241 postoperative hypotony, 241 retinal detachment, 242 glued surgery, modifications in Beiko and Steinert technique, 239, 240 NAT, Ohta s Y-fixation technique, 239 preoperative workup corneal endothelial assessment, 236 fundus examination, 236 intraocular pressure, 236 OCT analysis, 236 ultrasound biomicroscopy, 236 visual acuity, special considerations aniridia glued IOL, 242 keratoplasty, scaffold technique, 243 vertical glued IOL, 242 surgical technique handshake technique, 237 postoperative medications, 238 pupilloplasty, 237, 238 H Healon 5, 87 Helsinki cannula, 64 Horizontal white-to-white corneal diameter (HWWCD), 180 Human crystalline lens anatomy development, 13, 14 location and attachments, 13, 14 structure anterior subcapsular epithelium, 14, 15 lens capsule, 14 lens substance, 14, 15 Hyalocytes, 19 Hyaluronan. See Hyaluronic acid Hyaluronic acid, 19 Hydrodelineation, 38 Hydrodissection, 94 cortex-cleaving hydrodissection, 95, 96 FLACS, 145, 149 small round central PCR, 95, 97 Hydroxypropyl methyl cellulose (HPMC), 173 Hyphema, 249 I Inflammatory glaucoma, 249 Intracapsular cataract extraction (ICCE), 91 Intralenticular gas bubbles, 145, 149

3 Intraocular factors cataract type, 27, 28 excessive anterior chamber depth, pseudoexfoliation, 27, 29 reduced work space shallow anterior chamber, 26 small pupil/intraoperative miosis, 26 Intraocular lens (IOL), 6, 98, AC-IOL implantation, indications for (see Anterior chamber intraocular lenses (AC-IOLs)) anterior capsule support, 105, 106 in-the-bag IOL complications, 184 indications, 184 prerequisites, 184 selection of, 184 in capsular bag, 110, capsulozonular complex, 51, 52 choice and position, 71 FLACS, glaucoma patients, glued intrascleral haptic fixation (see Glued intraocular lens (Glued IOL)) intraoperative management of PCR, iris fixation of, 218 complications, 181, 219 indications, 181 McCannel suture technique, 217, 218 OVD, 217 prerequisites, 181 selection of, 181 Siepser slipknot technique, 219 manual IOL injectors, 39 optic capture, 71 PC-IOL (see Posterior chamber intraocular lens (PC-IOL)) posterior capsule support, 106 PPCCC, scleral-fixated IOL, ab interno/ab externo surgical approach, haptic suturing, indications, prerequisites, 183 selection of, 183 sutures complications, secondary IOL implantation, outcomes of, 185 selection and placement, site and technique of, 51 small central PCR, 105 small peripheral PCR, 105 sulcus-fixated IOL complications, 182 indications, 181 prerequisites, 181 selection of, 182 Intraocular pressure (IOP), 7, 236 Intraoperative factors fluid imbalance, radial tear, small capsulorhexis, capsulorhexis block, 29 topical anesthesia, corneal epithelial toxicity of, 28, 29 Intraoperative floppy iris syndrome (IFIS), 26 Intraoperative management anterior chamber (AC) large nuclear lens fragment, 125 small nuclear lens fragment, soft lens matter, 124 anterior vitrectomy aim of, 121 low-volume local anesthetic (LA) block, 122 peripheral clear corneal wound, 122 phaco wounds, 122 radial vitrector wounds, 122 self-retaining AC maintainer, 122 triamcinolone, diluted suspension of, vitrector wounds, 123 cellulose sponges, 123 dispersive OVDs, 121 dropped nuclear fragments, vitreous cavity, 125 IOL, operating room/theater staff, 121, 123 posterior segment complications, vitreoretinal (VR) surgeon, 121 INTREPID AutoSert IOL Injector handpiece, 39 Iridectomy, 192, 194, Iris claw intraocular lens, 205 fixation of, 208, 209 long-term results, pediatric cases, primary surgery, postoperative problems, 209 primary implantation, long oval capsulotomy, secondary iris claw lens implantation, Iris-sutured intraocular lens, 211 ab externo approach, 212 advantages, 214 disadvantages, Kuglen hook, 212, 213 learning curve, 214 McPherson forceps, 212, 213 meticulous bimanual automated anterior vitrectomy, 212 ophthalmic viscosurgical device, 212 paracentesis, 212 PCIOL, 214, 215 PMMA IOL, 213 sclerocorneal tunnel, 212, 214 suture loops, 212, 213 Irrigation-aspiration-cut (IAC) mode, 103, 104 Irrigation-cut-aspiration (ICA) mode, 103 M Management of posterior capsule rupture/rent, , , anterior vitrectomy instrumentation, machine settings, principles, 104

4 276 Management of posterior capsule rupture/rent (Cont.) anterior vitreous disturbance, 111, 112 Aurocort suspension, 113 clinical case, 116 cortex removal, 104 dispersive viscoelastic, injection of, 109, 110 hydrodissection, 105 intraoperative management of PCR (see Intraoperative management) IOL (see Intraocular lens (IOL)) MSICS, 102 nuclear fragment, removal of, 104 pars plana vs. limbal approach, anterior vitrectomy, 115 PCCC (see Posterior continuous curvilinear capsulorhexis (PCCC)) postoperative management (see Postoperative management) postoperative management of PCR (see Postoperative management) preexisting PCR anterior approach, phacoemulsification (see Phacoemulsification) anterior segment OCT, 45 ECCE, 47 etiology of, pars plana vitrectomy, 47 preoperative surgical considerations, 46 prognosis, 52 Scheimpflug imaging, slit-lamp biomicroscopy examination, 44, 45 ultrasound B-scan and ultrasound biomicroscopy, 45 preoperative management of PCR (see Preoperative management) preservative-free triamcinolone acetonide, sculpting, 104 triamcinolone acetonide-assisted anterior vitrectomy, with vitreous prolapse, without vitreous prolapse, Manual small-incision cataract surgery (MSICS), 98, 102, 168 anesthesia, conversion of phacoemulsification clear corneal phaco wound, 169, 170 HPMC, 173 loss of rhexis, brown cataract, 170, 171 OVD, , 175 postoperative care, 175 sclerocorneal tunnels, sclerocorneal wound, sculpting, nucleus, 171, 172 Sinskey hook, triamcinolone acetonide (TA), 173 McCannel suture technique, 217, 218 Megalocornea, 207 Microcornea, 206, 207 Microvitreoretinal (MVR) blade, 77, 83, 84, 122, 132, 133, 237 Miochol E, 87 N No-assistant technique (NAT) conjunctival peritomy, 238, 239 fibrin glue, 239, 240 principle, 238 scleral pockets, 239, 240 side-port incision, 238, 239 Nonsteroidal anti-inflammatory drugs (NSAIDS), 256, 262, 263 O Ohta s Y-fixation technique, 239 Ophthalmic viscosurgical device (OVD), 36 39, 60, 61, 80, 81, 99, , 254 AC-IOL implantation, 200 in anterior chamber, 65 in Berger s space, 64, 65 dry vitrectomy, 255 gel-gel technique, 139 removal of, 87 residual nuclear fragments, posterior capsule anterior capsule, sulcus placed IOL, damaged anterior capsulorhexis, residual capsular rim, 140 intact anterior capsulorhexis, 140 Rycroft cannula tip, 64 simple round capsular hole, tri-soft shell techniques, 137, 139, 141 Optical coherence tomography (OCT), 45, 236, 261, 262 P Pars plana anterior vitrectomy, anesthesia, biaxial incisions, 77 clear corneal incision, 76, 83 completion of, 85 damage control, 82 direct-entry sclerotomy, 77 early response, 81 guiding principles, endophthalmitis prophylaxis, 75 high to low pressure, 74 incision site, visualization of, 75 preparation, visual and medical-legal outcomes, 74, 75 visual rehabilitation, 74 inspect prior to implantation, 86 IOL selection and placement, irrigation, 77, 78 machine settings cutting rate and flow, 79 irrigation inflow, 80 linear vs. fixed vacuum setting, particulate staining, postoperative care, 87 principles, 116 process of, 85 removal of OVD, 87

5 residual cortex removal, 86 signs of complication, 76 sponging and sweeping incisions, sutured direct pars plana sclerotomy incision, sutureless pars plana trocar system insertion, vitrectomy mode, 78 79, vitreous prolapses, 76, 77 PCCC. See Posterior continuous curvilinear capsulorhexis (PCCC) PCME. See Pseudophakic cystoid macular edema (PCME) Perfluorocarbon liquid (PFCL), 257, 260, 261 Phacoemulsification, management of anterior chamber configuration, 48 congenital cataract, 49 epinucleus, cortex and posterior capsule, hydroprocedures, 48 IOL-capsulozonular complex, 51, 52 IOL implantation, site and technique of, 51 nuclear material, luxation of, 50 posterior polar and traumatic cataract, vitreous, 50 wound closure and removal of viscoelastic, 51, 52 MSICS, conversion of phacoemulsification (see Manual small-incision cataract surgery (MSICS)) slow-motion phacoemulsification, 39 Photorefractive keratectomy, 209 Pneumatic retinopexy, 264 Polymethylmethacrylate (PMMA) IOL, 182, 183, 197, 198, 211, 213, 221, 222, 247 Posterior-assisted levitation (PAL) technique, 6, 136 advantages of, 135 bimanual anterior vitrectomy, 132, 134 microvitreoretinal (MVR) blade, 132, 133 nucleus removal, 134 as planned procedure, 135 Sheet s glide, 132, 134 VISCOAT, Posterior capsular opacification (PCO), 63, 64 Posterior capsule rupture/rent (PCR) AC signs, 120 anterior segment complications (see Anterior segment complications) bright red glow and darker margins, 92 capsulorhexis, 94, 96 complications of, 6 7 comprehensive preoperative evaluation documentation and counseling, 35 examination, 34 history, 34 ocular risk factors, systemic risk factors, 34 consequences of, 107 converging wrinkles, 60, 61 cortex aspiration, 97, 98 deeper aspect of lens, 60 failure of rotation, FLACS (see Femtosecond laser-assisted cataract surgery (FLACS)) fundal glow, brightening of, 60 in glaucoma patient (see Glaucoma patient) hydrodissection, incidence of, 33 age, 4 ECCE, 4 experienced surgeons, 4 femtosecond laser-assisted phacoemulsification, 5 grade of cataract, 4 5 high myopia, 5 nondilating pupils, 5 preexisting glaucoma, 5 preoperative BCVA, 4 prior vitrectomy, 4, 5 pseudoexfoliation syndrome, 5 racial difference, 4 residents, 4 stage of surgery, 5 intraoperative risk factors, 59 intraoperative signs of, 120 intraoperative surgical tips anterior capsular management, cortical cleaving hydrodissection, 38 depth and coaxiality, microscope, 36 harder nuclei, chopping for, 38 hydrodelineation, 38 IOL insertion, 39 irrigation-aspiration (I/A), 39 nondilating pupil, management of, phacoemulsification tip/sleeve, proper selection of, 36 premium IOL, patient planning for, slow-motion phacoemulsification, 39 subluxated lenses, surgical drape and speculum, 35 trenching, 38 visibility, intraoperative maintenance of, 36 wound, IOL implantation, 98 iris-sutured intraocular lens, surgical technique (see Iris-sutured intraocular lens) irrigation and aspiration, 60 management strategies, phacoemulsification surgery, cortex removal, low flow, 71 dispersive viscoshield barrier, low fluidics, 68 staff training and complication devices, 67 vitreous detection, triamcinolone (see Triamcinolone) nucleus removal, 97 onion ring cataract, positive Singh sign, 206 OVD strategy (see Ophthalmic viscosurgical device (OVD)) paradoxical movement, 92 posterior segment complications (see Posterior segment complications) predisposing factors (see Predisposing factors)

6 278 Posterior capsule rupture/rent (PCR) (Cont.) preexisting PCR, management strategies (see Management of posterior capsule rupture/rent) premium lenses (see Premium lenses) preoperative preparation anesthesia, 35 pupillary dilation, 35 preoperative risk factors, 59 pseudo PCR, 60, 61 pupillary snap sign, 59, 92, 93 significance of anterior vitrectomy, 6 need for second surgery, 6 recovery period, 5 6 visual acuity, 6 wound construction, wound hydration, 98 Posterior chamber intraocular lens (PC-IOL), 91, 189, 195, 196, 198, 201, 211 dislocated PC-IOL, 261 sutureless intrascleral haptic-fixated posterior chamber intraocular lens glued IOL and modifications, 230, 231 intrascleral haptic fixation and multifocal IOL, 231 results and complications, surgical technique, Posterior continuous curvilinear capsulorhexis (PCCC), 91, 139 advantages of, 110 anterior vitreous disturbance, 112 central, small PCCC, 111, 112 indications for, 110 intraocular lens capsular bag, 110 secondary IOL implantation, 115 microincision capsulorhexis forceps, long handle, 111 microrhexis forceps, 101 Utrata forceps, 50 Posterior lenticonus, 27 Posterior optic buttonholing (POBH), 64 Posterior polar cataracts (PPCs), 27, 43, 106 Posterior segment complications, 253, 254 definitive surgery AC IOL implant, 258 corneal edema, 259 cystoid macular edema, 260 dislocated IOL, retained lens material, 260 glaucoma, 259 intraocular inflammation, 259 retinal detachment (see Retinal detachment (RD)) retropupillary/anterior chamber iris claw lens, 258 scleral-fixated PC IOLs, 258, 259 surgical procedure, 257, 258 timing of, visual outcomes, 260 vitreous hemorrhage, 260 dislocated posterior chamber intraocular lens, 261 intraoperative management, cataract surgeon bimanual anterior vitrectomy, 254 dry vitrectomy, 255 IOL implantation, OVD, 254, 255 posterior-assisted levitation, 254 preservative-free triamcinolone acetonide, 255 medical management, 256 PCME diagnosis and clinical course, 262 fluorescein fundus angiographic appearance, 261, 262 OCT evaluation, 261, 262 therapeutic interventions, postoperative endophthalmitis, Posterior vitreous detachment (PVD), 257, 261, 264 Postoperative endophthalmitis, Postoperative management, 107 clinical review, 127 medication, 127 patient communication, Post-vitrectomy cataract, 27, 28 PPCCC. See Primary posterior continuous curvilinear capsulorhexis (PPCCC) Predisposing factors high-volume camp surgery, 28 intraoperative factors, learning curve and surgeon inexperience, 28 machine/devices-related factors, 30 patient-related factors extraocular factors (see Extraocular factors) general factors, intraocular factors (see Intraocular factors) Preexisting glaucoma, 5, 248, 249 Premium lenses one-piece premium lenses, strategies for, anterior capsulorhexis, sulcus placement, hydrophobic lenses, capsular bag, 155 reverse-optic capture, 155 scleral fixation, 156 prevalence of, reported posterior capsular tears and outcomes, 152 sulcus/iris clip premium lenses, 156 three-piece premium lenses, strategies for capsular membrane suture fixation, 154 intact anterior capsulorhexis, intact posterior capsulorhexis, 154 iris suture and scleral fixation, 154 Preoperative management clinical assessment, operating lists and trainees, consent process, 120 Primary posterior continuous curvilinear capsulorhexis (PPCCC) intraocular lens, PCO, high risk of, 63 small central posterior capsular rent, 65 special considerations, surgical procedure Berger s space, OVD in, 64, 65 Helsinki cannula, 64 microforceps, 64, 65 puncturing of posterior capsule, 64 small central opening, posterior capsule, 64, 65

7 Pseudoexfoliation syndrome, 5 Pseudophakic bullous keratopathy (PBK), Pseudophakic cystoid macular edema (PCME) diagnosis and clinical course, 262 fluorescein fundus angiographic appearance, 261, 262 OCT evaluation, 261, 262 therapeutic interventions carbonic anhydrase inhibitors, 263 cyclooxygenase, 262 randomized controlled clinical trials, 262 topical corticosteroids, 263 topical NSAIDs, 262, 263 R Rayner Sulcoflex series, 156 Retinal detachment (RD), 6 7 AC-IOL, glued IOL, 242 incidence of, 260, 263 pneumatic retinopexy, 264 pseudophakic RD, 263, 264 PVD, 264 and retinal tears, 260 Swedish capsule rupture study, 263 Rubeosis iridis, 197 S Scheimpflug imaging, Scleral-fixated intraocular lens, ab interno/ab externo surgical approach, haptic suturing polypropylene suture, 223 ring suture, 222, 224 subluxated hydrophilic acrylic IOL, 222, 223 Z-suture, 222 indications, prerequisites, 183 selection of, 183 sutures complications Gore-Tex material, 224 Hoffman-type scleral pocket, 225 iridoscleral four-point fixation, 224, 225 suture erosion and exposure, 224 Siepser slipknot technique, 219 Slit-lamp examination, 52 Small capsulorhexis, 29 Small-incision cataract surgery (SICS), 4 Soft lens matter (SLM), 124 Space of Martegiani, 17 S-shaped fluid-filled canal, 17 Sub-Tenon s anesthesia, 167, 169 Sulcus-fixated intraocular lens complications, 182 indications, 181 prerequisites, 181 selection of, 182 Sutureless intrascleral haptic-fixated posterior chamber intraocular lens glued IOL and modifications, 230, 231 intrascleral haptic fixation and multifocal IOL, 231 results and complications, surgical technique anterior chamber maintainer, 227, 228 corneal incision, 228, 229 curved Scharioth forceps, G forceps, 228, G sharp cannula, 227, 228 intrascleral tunnel, , 231 second ciliary sulcus sclerotomy, 227, 228 sharp cannula, 227, 229 three-piece intraocular lens, 228, 229 Swedish Capsule Rupture Study group, T Topical anesthesia (TA), 28, 29 Topical steroids, 256 Toric, multifocal and accommodating lenses. See Premium lenses Toxic anterior segment syndrome (TASS), 248, 266, 267 Trans pars plana vitrectomy (TPPV)-lensectomy, 135 Traumatic cataract, 27 Triamcinolone diluted suspension of, triamcinolone acetonide, vitreous detection irrigation/aspiration, 70 safe zone, lens emulsification in, separated closed system anterior vitrectomy, Triamcinolone acetonide (TA), 18, , 173, 237, 255 Tri-soft shell techniques, 137, 139, 141 U Ultrasound biomicroscopy (UBM), 45, 179, 236 V VISCOAT, 69 Vitreous anatomy, 102 adhesion, age-related changes, 19 biochemical composition, 19 macroanatomy anterior hyaloid face/membrane, 17 central zone, outer zone, 18 Vitreous infusion suction cutters (VISC), 92 W Weiss ring, 18 White cataract, 27, 28 Z Z-suture, 222