Revista de cirugía ocular y de cataratas Acceso abierto

Abstracto

Primary Hydroexpulsion of posterior Dislocated Nucleus and â??Fragments during phacoemulsification

Khaled G Abu Eleinen                                                                                                                                   

Primary Hydroexpulsion of posterior Dislocated Nucleus and ‎Fragments during phacoemulsification

Khaled G Abu Eleinen                                                                                                                                   

Cairo University, Egypt 

Abstract

Purpose: To assess the outcome of eyes that underwent hydroexpulsion and instantaneous anterior ‎vitrectomy for nuclear fragments dislocated during phacoemulsification. ‎

Patients and methods: retrospective assessment of case series. The study included 21 cases ‎complicated with dropped nuclei during phacoemulsification that underwent instantaneous ‎hydroexpulsion of the dislocated nuclei and anterior vitrectomy. Patients' demographic data, ‎preoperative and postoperative vision and intraoperative and postoperative complications were ‎recorded. The study was conducted in Cairo University Hospital (Kasr El Eini) between January 2010 ‎and April 2018. Immediately when the nucleus passed through the posterior capsule into the vitreous ‎cavity, the surgeons were instructed not to inject any fluid or air into the anterior chamber to avoid ‎further pushing the nucleus backward in the vitreous cavity and to postpone anterior vitrectomy after ‎nuclear fragment expulsion. Infusion cannula was applied 3.5 mm from the limbus in the inferior ‎temporal quadrant. The infusion was opened and the corneal incision was opened by pressing its ‎posterior lip to create fluid stream from the vitreous cavity to the anterior chamber. Once the nucleus ‎appeared through the pupillary plane, the wound was widened with the keratome enough to ‎accommodate the expressed nucleus (Video 1). Following nucleus extraction, triamcinolone was ‎injected into the anterior chamber according to surgeon preference to enhance visualization of the ‎vitreous. Anterior vitrectomy was done to clear the anterior chamber and pupillary plane. Sulcus Pc IOL ‎was implanted in 17cases, Ac IOL was implanted in 4 eyes due to deficient capsule. Follow up period ‎ranged from 8 to 24 months. ‎

Results: Sixteen cases (76.2%) were operated by residents and fellows, 5 eyes by senior staff. Six eyes ‎were myopic with axial length above 26 mm. Nuclear cataract grade 3 (LOCSIII classification) was ‎recorded in 17 eyes, 4 eyes had nuclear grade 4 and cortical cataract. The ages of the patients ranged ‎from 58 to 78, 12 cases were females and 9 were males. This technique succeeded in expression of 19 ‎‎(90.4%) dropped nuclei, 2 cases required pars plana vitrectomy. One myopic eye (4.8%) with axial ‎length 28 mm developed retinal detachment 3 weeks later. Another case (4.8%) developed ‎intraoperative suprachoroidal hemorrhage during anterior vitrectomy after nucleus expression, which ‎was aborted by immediate closure without intraocular lens implantation. Fundus examination ‎revealed localized temporal suprachoroidal hematoma that was absorbed within 6 weeks and anterior ‎chamber intraocular lens was implanted 2 weeks later.  Two cases (9.5%) developed self-limiting ‎hyphema related to transient hypotony. Transient corneal edema developed in 4 eyes (19%) that ‎resolved within 1 week. Transient rise of IOP below 30 mmHg developed in 2eyes (9.6%) that were ‎controlled with anti-glaucoma drops that were discontinued within 1 week. No case developed ‎endophthalmitis.‎

Conclusion: Primary hydroexpulsion can spare the patient a second vitrectomy operation. It can be ‎done by the anterior segment surgeon without special training.

Biography:

Khaled G Abu Eleinen is a renowned Ophthalmology Professor. Khaled G Abu Eleinen is working in Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, ‎Egypt and Department of Ophthalmology, Fayoum eye hospital, Fayoum, Egypt . He publishes many articles in reputed journals.     

29^th International Conference on Insights in Ophthalmology; Webinars- June 17-18, 2020

Abstract Citation:

Khaled G Abu Eleinen, Primary Hydroexpulsion of posterior Dislocated Nucleus and ‎Fragments during phacoemulsification, 29^th International Conference on Insights in Ophthalmology; Webinars- June 17-18, 2020 (https://ophthalmology.insightconferences.com/abstract/2020/primary-hydroexpulsion-of-posterior-dislocated-nucleus-and-fragments-during-phacoemulsification  )