Phacoemulsification in the Presence of Very Shallow Anterior Chambers
In cases of shallow anterior chambers, Dr. Fine suggests performing a 25 G transcleral pars plana vitrectomy prior to cataract removal. The smaller biaxial phaco instruments are particularly beneficial in these circumstances.
19,680 video views and 103,386 series views since 12/17/2008
-
Phacoemulsification in the Presence of Very Shallow Anterior Chambers
-
High Myopia
-
Bimanual posterior polar cataract
-
Switching phaco hands
-
Posterior subluxed cataract
-
Mature cataract with zonular dialysis during phaco
-
A punctured posterior capsule
-
Pseudoexfoliation post glaucoma in filtration surgery
-
Rock Hard Nuclei
-
Rock Hard Nucleus (Case 2)
-
Micro cornea and iris coloboma
-
Phaco post malignant melanoma excision
-
Hydroexpression of the lens in IFIS
-
The use of Healon 5 with bimanual microincision phaco
-
Every small pupil must be viewed as a potential IFIS
-
Iris Bombe
-
Bimanual microincision RLE
-
Intraocular cautery
-
Late recentering of IOL and insertion of CTR
-
Late reopening of fibrosed capsule
Comments (4)
I believe a good ophthalmic surgeon is able to choose the best technique to be employed in each operation. This technique has to be part of the armamentarium of a skilled and expert cataract surgeon. On the other side, it is also true that the Anterior Chamber Depth is almost always enough to enable safe rhexis and phacoemulsification. I personally employ needle-rhexis through a small size corneal incision which allows me to keep the AC formed with the help of cohesive ophthalmic viscosurgical device. Then, of course, phacoemulsification has to be performed within the capsular bag and I can agree some might not find it "confortable". I really would like to commend Dr Fine for sharing his video and teaching us this interesting technique. Gianluca Carifi, MD.
Could this technique be associated with an increased incidence of Retinal Detachment? How long was the follow up for these patients?
In two cases of acute angle closure glaucoma I used a quite similar technique for removing the thick lens and placing an IOL and restoring the anterior segment architecture. Vitrectomy at that time was performed with a 'normal anterior' vitrectoom and the irrigation closed.
Beautiful technique - as you stated, judging the length and amoung of 25gauge PPV or deepening is critical. I do this by keeping an anterior chamber maintener or an irrigating chopper/manipulator on during the PPV, and titrating the PPV to the increasing depth of the chamber.