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Common Vitreoretinal Procedures
Published in Pradeep Venkatesh, Handbook of Vitreoretinal Surgery, 2023
In early postsurgery IOL dislocation, it is highly probable for the cataract wound to have been left sutureless or with a solitary suture. When this is encountered, it is safe to first secure the wound by passing additional sutures under topical anaesthesia and only then administer peribulbar or retrobulbar block. Application of super-pinkie or digital massage is absolutely contraindicated. In patients in whom no corneal wound is visible, one must look for the presence of a scleral wound under the conjunctiva. This is a likelihood when the demographics and circumstances indicate the possible surgery as being manual small incision cataract surgery rather than phacoemulsification.
Continuous Curvilinear Capsulorhexis – A Practical Review
Published in Seminars in Ophthalmology, 2022
The ideal size of the capsulorhexis may change from case to case, depending on the cataract properties, surgery technique, pupil size, and IOL type.5,13,16 For example, the required diameter for endolenticular phacoemulsification is 4 to 5 mm, and for extracapsular cataract extraction, at least 6 mm.5,13 Another technique in wide use for cataract extraction, which also requires a well-sized capsulotomy, is the manual small incision cataract surgery (MSICS).20 In this procedure, a small, self-sealing, scleral tunnel is created, through which CCC is performed, and the lens’ nucleus is hydrodissected end extracted.20,21 MSICS is cheaper and is performed faster than phacoemulsification, and is therefore in wide use mostly in the developing world.20,21 When performing an MSICS, a rhexis sized 5 mm or more is crucial for safe nucleus prolapsing.21 Advanced brunescent cataracts will usually require a larger capsulorhexis for easier manipulation within the capsule and to lower the risk of complications.21,22 It is important to note that the circumference of the rhexis can usually be stretched by up to 60% during surgery without tearing the capsule, and it tends to contract postoperatively.13 Moreover, the rhexis size should not be larger than two-thirds of the IOL optic. All these factors should be taken into consideration when planning the capsulorhexis diameter.
Ocular complications in Ebola virus disease survivors: the importance of continuing care in West Africa
Published in Expert Review of Ophthalmology, 2019
Duncan E. Berry, Alexa L. Li, Steven Yeh, Jessica G. Shantha
The reported prevalence of cataracts in EVD survivors ranges from 6.7% to 10% [3,8,29]. Given that EBOV has been reported to persist in the aqueous humor, there is the potential risk of EBOV exposure and transmission to health-care workers during invasive ophthalmic surgery such as cataract extraction. As such, the aforementioned EVICT study was undertaken to evaluate safe and effective measures of performing invasive ophthalmic surgery in EVD survivors [23]. All had previously undergone rigorous pre-surgical screening including testing of aqueous humor and conjunctiva for EBOV RNA by RT-PCR. All testing and surgical procedures were performed in a special facility was designed adhering to World Health Organization (WHO) guidelines, and all practitioners donned full personal protective equipment (PPE) for aqueous humor sampling, followed by modified-PPE for surgery. Thirty-four patients who tested negative for EBOV underwent manual small incision cataract surgery. Median presenting VA was hand motions with improvement to a median VA of 20/30 at 3 months postoperative follow-up [23]. While these findings are promising, further research is needed to establish the safety of surgery at earlier time points in the recovery period.
Viscoless Manual Small Incision Cataract Surgery with Trabeculectomy
Published in Seminars in Ophthalmology, 2018
Aparna Rao, Debananda Padhy, Gopinath Das, Sarada Sarangi
Manual small incision cataract surgery (MSICS) is a very cost-effective procedure for cataract surgery in developing countries.1-3 It offers several advantages over other manual cataract surgery techniques like extracapsular cataract extraction, which include minimal postoperative astigmatism, safer and water-tight compartment during surgery, small incision size, and reduced intra/postoperative complications. Its use in developing countries also extends into combined cataract and glaucoma surgery, where it is used as an alternative to phacoemulsification. While most studies have evaluated the efficacy of either isolated MSICS or trabeculectomy,2,3 few studies have focused on combined triple procures using the MSICS technique.4,5 One of the most important step in glaucoma or combined triple surgery is maintenance of the anterior chamber and protecting the endothelium with the use of ophthalmic viscoelastic devices (OVD). These viscoelastics are crucial in preventing collapse of the anterior chamber (AC), which may be counterproductive to a good visual outcome in both cataract and glaucoma surgery. Yet, retained viscoelastic can be a significant cause of raised IOP and AC reaction in the postoperative period, which may compromise the bleb status by inducing inflammation.