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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.

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.

GlucaCarifi (96 months ago)

Could this technique be associated with an increased incidence of Retinal Detachment? How long was the follow up for these patients?

GlucaCarifi (112 months 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.

Hillenius (116 months 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.

Tal Raviv (119 months ago)