Cataract Surgery > Challenging Cases , Phacoemulsification
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Phacoemulsification in the Presence of Very Shallow Anterior Chambers
by I. Howard Fine,
MD
Eugene, Oregon
USA
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.
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1. Phacoemulsification in the Presence of Very Shallow Anterior Chambers
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2. High Myopia
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3. Bimanual posterior polar cataract
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4. Switching phaco hands
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5. Posterior subluxed cataract
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6. Mature cataract with zonular dialysis during phaco
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7. A punctured posterior capsule
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8. Pseudoexfoliation post glaucoma in filtration surgery
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9. Rock Hard Nuclei
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10. Rock Hard Nucleus (Case 2)
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11. Micro cornea and iris coloboma
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12. Phaco post malignant melanoma excision
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13. Hydroexpression of the lens in IFIS
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14. The use of Healon 5 with bimanual microincision phaco
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15. Every small pupil must be viewed as a potential IFIS
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16. Iris Bombe
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17. Bimanual microincision RLE
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18. Intraocular cautery
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19. Late recentering of IOL and insertion of CTR
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20. Late reopening of fibrosed capsule
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Luca (50 days ago) Could this technique be associated with an increased incidence of Retinal Detachment? How long was the follow up for these patients?
Hillenius (162 days ago) 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. Pre op the patient had mannitol, diamox and eyedrops during 1 day. I don't remember cornea edema problems and I might have used iris retraction hooks.
Tal Raviv (254 days ago) 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.