Complications During and After Cataract Surgery: A Guide to Surgical Management

350 Pages·2014·20.28 MB·English

by  Ulrich Spandau

Complications
During and After
Cataract Surgery
A Guide to
Surgical
Management
Ulrich Spandau
Gabor Scharioth
123
Complications During and After
Cataract Surgery

Ulrich Spandau (cid:129) Gabor Scharioth

Complications During
and After Cataract Surgery
A Guide to Surgical Management
Ulrich Spandau Gabor Scharioth
Department of Ophthalmology Aurelios Augenzentrum
Uppsala University Hospital Recklinghausen
Uppsala Germany
Sweden
Department of Ophthalmology
University of Szeged
Korányi
Szeged
Germany
Videos to this book can be accessed at h ttp://www.springerimages.com/videos/978-3-642-
54448-4
ISBN 978-3-642-54448-4 ISBN 978-3-642-54449-1 (eBook)
DOI 10.1007/978-3-642-54449-1
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Pref ace
How to manage a posterior capsule rupture? How to operate a dropped nucleus?
What to do with a subluxated IOL? If you are seeking answers to these questions,
then you found the right book. In this book, these questions and many, many more
will be answered.
Here, the operations are described like in a cookbook – fi rst the ingredients and
then the step-by-step preparations. These steps are illustrated with many pictures
and drawings, followed by several surgical videos.
In my opinion, there are three parameters that make a good surgeon. They are
surgical skill, experience, and mastery of different surgical techniques.
T he outstanding quality of the modern phaco and vitrectomy machines is a bless-
ing and curse at the same time – blessing because these machines manage over 90 %
of all cases and curse because you rely too much on the machines and too little on
your hands. As a complete cataract surgeon, you need to be able to perform an
ECCE in case of zonular lysis or a rock-hard nucleus, implant an iris-fi xated or
intrascleral-fi xated IOL, or manage a posterior capsule defect without trauma and
function loss.
T he book is divided into two main parts. The fi rst part describes complication
management with the use of a phacoemulsifi cation machine, and the second part
describes complication management requiring a vitrectomy machine. We try to
solve as many complications as possible with the phaco machine. We will in addi-
tion demonstrate a trocar technique which increases the surgical spectrum of a cata-
ract surgeon immensely.
Every surgeon is afraid of complications. This book takes the cataract surgeon’s
fear of complications by giving him a clear scheme in his hand after which he must
proceed. Complications cannot be avoided, but you can learn to master them. And
at the same time, you will also become a better surgeon.
I wish you much fun in the OR!
Uppsala, Sweden Ulrich Spandau
Recklinghausen, Germany Gabor Scharioth
v

Abbreviations
ECCE Extracapsular cataract extraction
G Gauge
I/A Irrigation and aspiration
ICCE Intracapsular cataract extraction
IOL Intraocular lens
PCO Posterior capsular opacifi cation
PFCL Perfl uorocarbon liquid
PPV Pars plana vitrectomy
PVD Posterior vitreous detachment
SICS Small incision cataract surgery
vii

Contents

Part I Complication Management Using a Phacoemulsifi cation Machine
1 Basics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.1 Diffi culty of Cataract Surgery in Relation to Density of Nucleus . . 4
1.2 Diffi culty of Cataract Surgery in Relation to Other Factors. . . . . . . 4
1.3 Anatomy of Different IOL Implantation Sites . . . . . . . . . . . . . . . . . 4
1.4 Small-Gauge Vitrectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
1.5 SICS: The Modifi ed ECCE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
2 Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
2.1 Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
2.2 Standard Instruments for Anterior Segment Procedures . . . . . . . . . 22
3 Planning for Surgical Complications. . . . . . . . . . . . . . . . . . . . . . . . . . . 33
3.1 Different Cases for Surgical Planning . . . . . . . . . . . . . . . . . . . . . . . 40
3.2 Correct IOL Choice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
4 General Surgical Techniques for Anterior Segment Surgery . . . . . . . 47
4.1 Anaesthesia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
4.2 Standard Instruments for Phacoemulsifi cation. . . . . . . . . . . . . . . . . 48
4.3 Phacoemulsifi cation of an Easy Cataract . . . . . . . . . . . . . . . . . . . . . 54
4.4 Phacoemulsifi cation of a Diffi cult Cataract . . . . . . . . . . . . . . . . . . . 78
4.4.1 Small Pupil: Implantation of Iris Retractors
and Malyugin Ring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
4.4.2 Problems During Capsulorhexis. . . . . . . . . . . . . . . . . . . . . . 88
4.4.3 Problems During Hydrodissection . . . . . . . . . . . . . . . . . . . . 94
4.4.4 Complications During Phacoemulsifi cation. . . . . . . . . . . . . 98
4.4.5 Problems During I/A: Implantation of Capsular
Tension Ring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
4.4.6 Problems During IOL Implantation . . . . . . . . . . . . . . . . . . . 104
4.4.7 Problems During Final Steps . . . . . . . . . . . . . . . . . . . . . . . . 108
ix