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The Usage of Anterior Chamber Maintainer with Pars Plana Vitrectomy in the Extraction of Dislocated Nucleus and Intraocular Lens

Year 2011, Volume: 18 Issue: 3, 168 - 173, 01.06.2011

Burak Turgut Tamer Demir Orhan Aydemir

Abstract

Objective: To evaluate the technique and complications of the usage of anterior chamber maintainer (ACM) with pars plana vitrectomy (PPV) in the removal of dislocated intraocular lens (IOL) and nucleus. Materials and Method: The medical and surgical records of the eyes with nucleus and IOL dislocation into the vitreous which underwent surgery were inspected retrospectively. Records were divided into two groups. Group 1 (26 eyes) was included that the patients undergone three ports standard PPV for the removal of nucleus and IOL, while Group 2 (23 eyes) was included the patients which undergone the removal of nucleus and IOL using two ports PPV and an ACM for infusion. The rates of the complication, surgical techniques and surgery times were compared between two groups. Results: The mean follow-up time was 7,2±1.4 months (range, 4 to 17 months). The mean patient age was 72,23±7.6 (range, 64 to 80 years) in Group 1 and 71,30±7.3 (range, 60 to 81 years) in Group 2 and there was no difference among the two groups (p>0.05). Anterior chamber intraocular lens (IOL) in 9 (18.37%) cases and posterior chamber IOL in 31 (63.26%) cases were implanted. The remaining 9 (18.37%) cases could not implant IOL, and these cases were rehabilitated with contact lenses. The complication rate between two groups was no significantly different (p>0.05). Mean surgery time in PPV with ACM infusion was statistically lesser than that of standard three-port PPV (p=0.026). Conclusion: Removal of dislocated nucleus and IOL with ACM technique and two ports PPV seems as an easy, safe and rapid procedure. Key words: Intraocular Lens; Lens; Vitrectomy; Anterior Chamber Maintainer.

Keywords

Intraocular Lens; Lens; Vitrectomy; Anterior Chamber Maintainer.

References

  • Aasuri MK, Kompella VB, Majji AB. Risk factors for and management of dropped nucleus during phacoemulsification. J Cataract Refract Surg 2001; 27: 1428–32.
  • Kageyama T, Ayaki M, Ogasawara M, Asahiro C, Yaguchi S. Results of vitrectomy performed at the time of phacoemulsification complicated by intravitreal lens fragments. Br J Ophthalmol 2001; 85: 1038-40.
  • Mathai A, Thomas R. Incidence and management of posteriorly dislocated nuclear fragments following phacoemulsification. Indian J Ophthalmol 1999; 47: 173–6.
  • Irvine WD, Flynn HW Jr, Murray TG, Rubsamen PE. Retained lens fragments after phacoemulsification manifesting as marked intraocular inflammation with hypopyon. Am J Ophthalmol 1992; 114: 610-4.
  • Kim JE, Flynn HW Jr, Rubsamen PE, Murray TG, Davis JL, Smiddy WE. Endophthalmitis in patients with retained lens fragments after phacoemulsification. Ophthalmology 1996; 103: 575-8.
  • Agustin AL, Miller KM. Posterior dislocation of a plate-haptic silicone intraocular lens with large fixation holes. J Cataract Refract Surg 2000; 26: 1428-9.
  • Schneiderman TE, Johnson MW, Smiddy WE, Flynn HW Jr, Bennett SR, Cantrill HL. Surgical management of posteriorly dislocated silicone plate haptic intraocular lenses. Am J Ophthalmol 1997; 123: 629-35.
  • Williamson TH. Vitreoretinal Surgery. In: Chapter 11: Complications of Anterior Segment Surgery, Marion Philipp, ed. Heidelberg; Springer-Verlag 2008: 179-83.
  • Rossetti A, Doro D. Retained intravitreal lens fragments after phacoemulsification: complications and visual outcome in vitrectomized and nonvitrectomized eyes. J Cataract Refract Surg 2002; 28: 310-5.
  • Kaynak S, Durak İ, Eryıldırım S, Bozkurt F. Lens luksasyonlarında pars plana vitrektomi. Türkiye Klinikleri J Ophthalmol 1994; 3: 85-9.
  • Akıncı A, Batman C, Özalp S, Çıtırık M, Zilelioğlu O. Travmaya bağlı lens subluksasyonu ve kataraktı olan olgularda pars plana vitrektomi ve pars plana lensektomi sonuçları. Turkiye Klinikleri J Ophthalmol 2008; 17: 233-7.
  • Blumenthal M, Assia EI, Chen V, Avni I. Using an anterior chamber maintainer to control intraocular pressure during phacoemulsification. J Cataract Refract Surg 1994; 20: 93-6.
  • Blumenthal M, Assia E, Schochot Y. Lens anatomical principles and their technical implications in cataract surgery. Part I: The lens capsule. J Cataract Refract Surg 1991; 17: 205-10.
  • Blumenthal M, Assia E, Neuman D. Lens anatomical principles and their technical implications in cataract surgery. Part II: The lens nucleus. J Cataract Refract Surg 1991; 17: 211-7.
  • Chawla HB, Adams AD. Use of the anterior chamber maintainer in anterior segment surgery. J Cataract Refract Surg 1996 ;22: 172-7.
  • Kurt E. Efficiency and Safety of the Vacuum and Needle Capsulorhexis in Cataract Surgery Using Anterior Chamber Maintainer. Turkiye Klinikleri J Med Sci 2009; 29: 681-6.
  • Jonas JB, Budde WM, Panda-Jonas S. Cataract surgery combined with transpupillary silicone oil removal through planned posterior capsulotomy. Ophthalmology 1998; 105: 1234-7.
  • Larkin GB, Flaxel CJ, Leaver PK. Phacoemulsification and silicone oil removal through a single corneal incision. Ophthalmology 1998; 105: 2023-7.
  • Frau E, Lautier-Frau M, Labétoulle M, Hutchinson S, Offret H. Phacoemulsification combined with silicone oil removal through the posterior capsulorhexis tear. Retina 2002; 22: 158-62.
  • Biro Z. Silicone oil removal through a posterior capsulorhexis simultaneously with phacoemulsification. J Cataract Refract Surg 2002; 28: 5.
  • Boscia F, Cardascia N, Sborgia L, et al. Evaluation of corneal damage by combined phacoemulsification and passive efflux of silicone oil in vitrectomized eyes. J Cataract Refract Surg 2003; 29: 1120-6.
  • Krepler K, Mozaffarieh M, Biowski R, Nepp J, Wedrich A. Cataract surgery and silicone oil removal: visual outcome and complications in a combined vs. two step surgical approach. Retina 2003; 23 :647-53.
  • Qin B, Zhao T, Huang L. Removal of silicone oil from aphakia: use of a self-sealing corneal incision. Am J Ophthalmol 2004; 138: 1055-7.
  • Holladay JT. Proper method for calculating average visual acuity. J Refract Surg 1997; 13(4): 388-91.
  • Wallace RT, McNamara JA, Brown G, et al. The use of perfluorophenanthrene in the removal of intravitreal lens fragments. Am J Ophthalmol 1993; 116: 196-200.
  • Kapran Z. 23 ve 25-Gauge Transkonjonktival Sütürsüz Vitrektomi: Teknik, Enstrümentasyon, Endikasyon, Sınırlamalar ve Komplikasyonlar. Türkiye Klinikleri oftalmoloji 2009; 2(2): 18- 23.
  • Şerif N, Özdek Ş, Gürelik G, Akata F, Hasanreisoğlu B. Vitreusa disloke intraoküler lenslerde cerrahi tedavi yaklaşımları ve sonuçlarımız. Retina-Vitreus 2006; 14: 181-4.
  • Demir MN, Acar MA, Ünlü N, Kocaoğlan H, Sargın M, Örnek F. Vitreus içine lükse nükleus parçalarının çıkarılmasında fakofragmantasyon ve Crushing yöntemleri. Retina-Vitreus 2006; 14: 189-192.
  • Akça Bayar S, Yılmaz G. Katarakt cerrahisi sırasında vitreusa düşen lens parçaları ve GİL luksasyonları. Retina-Vitreus 2010; 18: 1-7.
  • Schechter RJ. Glass slide vitrectomy for use by the cataract surgeon. Am J Ophthalmol 1991; 112: 100.
  • Gonvers M. New approach to managing vitreous loss and dislocated lens fragments during phacoemulsification. J Cat Ref Surg 1994; 20: 346-9.
  • Michels RG, Shacklett DE. Vitrectomy technique for removal of retained lens material. Arch Ophthalmol 1977; 95: 1767-73.
  • Rowson NJ, Bacon AS, Rosen PH. Perflourocarbon heavy liquids in the management of posterior dislocation of the lens nucleus during phacoemulsification. Br J Ophthalmol 1992; 76: 169-70.
  • Movshovich A, Berrocal M, Chang S. The protective properties of liquid perflourocarbons in phacofragmentation of dislocated lenses. Retina 1994; 14: 457-62.
  • Peyman GA, Schulman JA. Intravitreal Surgery: Principles and Practice, 2nd ed. Norwalk; Appleton &. Lange 1994: 813-29.
  • Tardif YM, Schepens CL, Tolentino FI. Vitreous surgery. XIV. Complications from sclerotomy in 89 consecutive cases. Arch Ophthalmol 1977; 95: 229-34.
  • Tardif YM, Schepens CL. Closed vitreous surgery: XV. Fibrovascular ingrowth from the pars plana sclerotomy. Arch Ophthalmol 1977; 95: 235-9.
  • Steinert RF. Complications of cataract surgery. In: Albert DM, Jakobiec FA, eds. Principles and Practice of Ophthalmology. 2nd ed. Philadelphia; WB Saunders 2000: 1551-98.
  • Androudi S, Brazitikos PD, Papadopoulos NT, et al. Posterior capsule rupture and vitreous loss during phacoemulsification with or without the use of an anterior chamber maintainer. J Cataract Refract Surg 2004; 30: 449-52.

Vitreusa Disloke Nükleus ve Göziçi Lensinin Çıkarılmasında Pars Plana Vitrektomi ile Birlikte Ön Kamara Koruyucunun Kullanımı

Year 2011, Volume: 18 Issue: 3, 168 - 173, 01.06.2011

Burak Turgut Tamer Demir Orhan Aydemir

Abstract

Amaç: Vitreusa disloke olmuş nükleus ve göziçi lensi (GİL)'nin çıkarılmasında pars plana vitrektomi (PPV) ile birlikte ön kamara koruyucu (ÖKK) kullanımının teknik ve komplikasyonlarını değerlendirmek. Gereç ve yöntem: Vitreusa disloke olmuş nükleus ve GİL nedeniyle cerrahi tedavi yapılan toplam 49 hastanın 49 gözüne ait tıbbi ve cerrahi kayıtlar geriye dönük olarak incelendi. Kayıtlar iki gruba ayrıldı. Grup 1 (26 göz) nükleus veya GİL'nin çıkarımında standart üç girişli PPV uygulanan hastaları, Grup 2 ise (23 göz) iki girişli PPV ile birlikte infüzyon için ÖKK kullanılarak nukleus veya GİL'leri çıkarılan hastaları kapsadı. Komplikasyon oranları, cerrahi teknik ve cerrahi süreleri iki grup arasında kıyaslandı. Bulgular: Ortalama takip süresi 7,2±1.4 ay (4 ile 17 ay arası) idi. Ortalama yaşlar Grup 1'de 72,23±7.6 (64 ile 80 yıl arasında), Grup 2'de 71,30±7.3 (60 ile 81 yıl arasında) idi ve iki grup arasında istatistiksel farklılık göstermiyordu (p>0.05). Dokuz olguda (%18.37) ön kamara göziçi lensi (GİL), 31 olguda (%63.26) arka kamara GİL yerleştirildi. Diğer 9 olguda ise (%18.37) GİL yerleştirilemedi ve bu olgular kontakt lenslerle rehabilite edildi. İki grup arasındaki komplikasyon oranları arasında anlamlı bir fark yoktu (p>0.05). ÖKK infüzyonlu PPV'de ortalama cerrahi süresi standart üç girişli PPV'dekinden istatistiksel olarak daha kısaydı (p = 0.026). Sonuç: Ön kamara koruyucu tekniği ve iki girişli PPV ile, disloke olmuş nükleus ve GİL'nin çıkarımı kolay, güvenli ve hızlı bir prosedür gibi görünmektedir. Anahtar kelimeler: Göziçi Lens; Lens Nukleusu; Vitrektomi; Ön Kamara Koruyucu.

Keywords

Göziçi Lens; Lens Nukleusu; Vitrektomi; Ön Kamara Koruyucu.

References

  • Aasuri MK, Kompella VB, Majji AB. Risk factors for and management of dropped nucleus during phacoemulsification. J Cataract Refract Surg 2001; 27: 1428–32.
  • Kageyama T, Ayaki M, Ogasawara M, Asahiro C, Yaguchi S. Results of vitrectomy performed at the time of phacoemulsification complicated by intravitreal lens fragments. Br J Ophthalmol 2001; 85: 1038-40.
  • Mathai A, Thomas R. Incidence and management of posteriorly dislocated nuclear fragments following phacoemulsification. Indian J Ophthalmol 1999; 47: 173–6.
  • Irvine WD, Flynn HW Jr, Murray TG, Rubsamen PE. Retained lens fragments after phacoemulsification manifesting as marked intraocular inflammation with hypopyon. Am J Ophthalmol 1992; 114: 610-4.
  • Kim JE, Flynn HW Jr, Rubsamen PE, Murray TG, Davis JL, Smiddy WE. Endophthalmitis in patients with retained lens fragments after phacoemulsification. Ophthalmology 1996; 103: 575-8.
  • Agustin AL, Miller KM. Posterior dislocation of a plate-haptic silicone intraocular lens with large fixation holes. J Cataract Refract Surg 2000; 26: 1428-9.
  • Schneiderman TE, Johnson MW, Smiddy WE, Flynn HW Jr, Bennett SR, Cantrill HL. Surgical management of posteriorly dislocated silicone plate haptic intraocular lenses. Am J Ophthalmol 1997; 123: 629-35.
  • Williamson TH. Vitreoretinal Surgery. In: Chapter 11: Complications of Anterior Segment Surgery, Marion Philipp, ed. Heidelberg; Springer-Verlag 2008: 179-83.
  • Rossetti A, Doro D. Retained intravitreal lens fragments after phacoemulsification: complications and visual outcome in vitrectomized and nonvitrectomized eyes. J Cataract Refract Surg 2002; 28: 310-5.
  • Kaynak S, Durak İ, Eryıldırım S, Bozkurt F. Lens luksasyonlarında pars plana vitrektomi. Türkiye Klinikleri J Ophthalmol 1994; 3: 85-9.
  • Akıncı A, Batman C, Özalp S, Çıtırık M, Zilelioğlu O. Travmaya bağlı lens subluksasyonu ve kataraktı olan olgularda pars plana vitrektomi ve pars plana lensektomi sonuçları. Turkiye Klinikleri J Ophthalmol 2008; 17: 233-7.
  • Blumenthal M, Assia EI, Chen V, Avni I. Using an anterior chamber maintainer to control intraocular pressure during phacoemulsification. J Cataract Refract Surg 1994; 20: 93-6.
  • Blumenthal M, Assia E, Schochot Y. Lens anatomical principles and their technical implications in cataract surgery. Part I: The lens capsule. J Cataract Refract Surg 1991; 17: 205-10.
  • Blumenthal M, Assia E, Neuman D. Lens anatomical principles and their technical implications in cataract surgery. Part II: The lens nucleus. J Cataract Refract Surg 1991; 17: 211-7.
  • Chawla HB, Adams AD. Use of the anterior chamber maintainer in anterior segment surgery. J Cataract Refract Surg 1996 ;22: 172-7.
  • Kurt E. Efficiency and Safety of the Vacuum and Needle Capsulorhexis in Cataract Surgery Using Anterior Chamber Maintainer. Turkiye Klinikleri J Med Sci 2009; 29: 681-6.
  • Jonas JB, Budde WM, Panda-Jonas S. Cataract surgery combined with transpupillary silicone oil removal through planned posterior capsulotomy. Ophthalmology 1998; 105: 1234-7.
  • Larkin GB, Flaxel CJ, Leaver PK. Phacoemulsification and silicone oil removal through a single corneal incision. Ophthalmology 1998; 105: 2023-7.
  • Frau E, Lautier-Frau M, Labétoulle M, Hutchinson S, Offret H. Phacoemulsification combined with silicone oil removal through the posterior capsulorhexis tear. Retina 2002; 22: 158-62.
  • Biro Z. Silicone oil removal through a posterior capsulorhexis simultaneously with phacoemulsification. J Cataract Refract Surg 2002; 28: 5.
  • Boscia F, Cardascia N, Sborgia L, et al. Evaluation of corneal damage by combined phacoemulsification and passive efflux of silicone oil in vitrectomized eyes. J Cataract Refract Surg 2003; 29: 1120-6.
  • Krepler K, Mozaffarieh M, Biowski R, Nepp J, Wedrich A. Cataract surgery and silicone oil removal: visual outcome and complications in a combined vs. two step surgical approach. Retina 2003; 23 :647-53.
  • Qin B, Zhao T, Huang L. Removal of silicone oil from aphakia: use of a self-sealing corneal incision. Am J Ophthalmol 2004; 138: 1055-7.
  • Holladay JT. Proper method for calculating average visual acuity. J Refract Surg 1997; 13(4): 388-91.
  • Wallace RT, McNamara JA, Brown G, et al. The use of perfluorophenanthrene in the removal of intravitreal lens fragments. Am J Ophthalmol 1993; 116: 196-200.
  • Kapran Z. 23 ve 25-Gauge Transkonjonktival Sütürsüz Vitrektomi: Teknik, Enstrümentasyon, Endikasyon, Sınırlamalar ve Komplikasyonlar. Türkiye Klinikleri oftalmoloji 2009; 2(2): 18- 23.
  • Şerif N, Özdek Ş, Gürelik G, Akata F, Hasanreisoğlu B. Vitreusa disloke intraoküler lenslerde cerrahi tedavi yaklaşımları ve sonuçlarımız. Retina-Vitreus 2006; 14: 181-4.
  • Demir MN, Acar MA, Ünlü N, Kocaoğlan H, Sargın M, Örnek F. Vitreus içine lükse nükleus parçalarının çıkarılmasında fakofragmantasyon ve Crushing yöntemleri. Retina-Vitreus 2006; 14: 189-192.
  • Akça Bayar S, Yılmaz G. Katarakt cerrahisi sırasında vitreusa düşen lens parçaları ve GİL luksasyonları. Retina-Vitreus 2010; 18: 1-7.
  • Schechter RJ. Glass slide vitrectomy for use by the cataract surgeon. Am J Ophthalmol 1991; 112: 100.
  • Gonvers M. New approach to managing vitreous loss and dislocated lens fragments during phacoemulsification. J Cat Ref Surg 1994; 20: 346-9.
  • Michels RG, Shacklett DE. Vitrectomy technique for removal of retained lens material. Arch Ophthalmol 1977; 95: 1767-73.
  • Rowson NJ, Bacon AS, Rosen PH. Perflourocarbon heavy liquids in the management of posterior dislocation of the lens nucleus during phacoemulsification. Br J Ophthalmol 1992; 76: 169-70.
  • Movshovich A, Berrocal M, Chang S. The protective properties of liquid perflourocarbons in phacofragmentation of dislocated lenses. Retina 1994; 14: 457-62.
  • Peyman GA, Schulman JA. Intravitreal Surgery: Principles and Practice, 2nd ed. Norwalk; Appleton &. Lange 1994: 813-29.
  • Tardif YM, Schepens CL, Tolentino FI. Vitreous surgery. XIV. Complications from sclerotomy in 89 consecutive cases. Arch Ophthalmol 1977; 95: 229-34.
  • Tardif YM, Schepens CL. Closed vitreous surgery: XV. Fibrovascular ingrowth from the pars plana sclerotomy. Arch Ophthalmol 1977; 95: 235-9.
  • Steinert RF. Complications of cataract surgery. In: Albert DM, Jakobiec FA, eds. Principles and Practice of Ophthalmology. 2nd ed. Philadelphia; WB Saunders 2000: 1551-98.
  • Androudi S, Brazitikos PD, Papadopoulos NT, et al. Posterior capsule rupture and vitreous loss during phacoemulsification with or without the use of an anterior chamber maintainer. J Cataract Refract Surg 2004; 30: 449-52.
There are 39 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

Burak Turgut This is me

Tamer Demir This is me

Orhan Aydemir This is me

Publication Date June 1, 2011
Published in Issue Year 2011 Volume: 18 Issue: 3

Cite

APA Turgut, B., Demir, T., & Aydemir, O. (2011). Vitreusa Disloke Nükleus ve Göziçi Lensinin Çıkarılmasında Pars Plana Vitrektomi ile Birlikte Ön Kamara Koruyucunun Kullanımı. Journal of Turgut Ozal Medical Center, 18(3), 168-173.
AMA Turgut B, Demir T, Aydemir O. Vitreusa Disloke Nükleus ve Göziçi Lensinin Çıkarılmasında Pars Plana Vitrektomi ile Birlikte Ön Kamara Koruyucunun Kullanımı. J Turgut Ozal Med Cent. June 2011;18(3):168-173.
Chicago Turgut, Burak, Tamer Demir, and Orhan Aydemir. “Vitreusa Disloke Nükleus Ve Göziçi Lensinin Çıkarılmasında Pars Plana Vitrektomi Ile Birlikte Ön Kamara Koruyucunun Kullanımı”. Journal of Turgut Ozal Medical Center 18, no. 3 (June 2011): 168-73.
EndNote Turgut B, Demir T, Aydemir O (June 1, 2011) Vitreusa Disloke Nükleus ve Göziçi Lensinin Çıkarılmasında Pars Plana Vitrektomi ile Birlikte Ön Kamara Koruyucunun Kullanımı. Journal of Turgut Ozal Medical Center 18 3 168–173.
IEEE B. Turgut, T. Demir, and O. Aydemir, “Vitreusa Disloke Nükleus ve Göziçi Lensinin Çıkarılmasında Pars Plana Vitrektomi ile Birlikte Ön Kamara Koruyucunun Kullanımı”, J Turgut Ozal Med Cent, vol. 18, no. 3, pp. 168–173, 2011.
ISNAD Turgut, Burak et al. “Vitreusa Disloke Nükleus Ve Göziçi Lensinin Çıkarılmasında Pars Plana Vitrektomi Ile Birlikte Ön Kamara Koruyucunun Kullanımı”. Journal of Turgut Ozal Medical Center 18/3 (June 2011), 168-173.
JAMA Turgut B, Demir T, Aydemir O. Vitreusa Disloke Nükleus ve Göziçi Lensinin Çıkarılmasında Pars Plana Vitrektomi ile Birlikte Ön Kamara Koruyucunun Kullanımı. J Turgut Ozal Med Cent. 2011;18:168–173.
MLA Turgut, Burak et al. “Vitreusa Disloke Nükleus Ve Göziçi Lensinin Çıkarılmasında Pars Plana Vitrektomi Ile Birlikte Ön Kamara Koruyucunun Kullanımı”. Journal of Turgut Ozal Medical Center, vol. 18, no. 3, 2011, pp. 168-73.
Vancouver Turgut B, Demir T, Aydemir O. Vitreusa Disloke Nükleus ve Göziçi Lensinin Çıkarılmasında Pars Plana Vitrektomi ile Birlikte Ön Kamara Koruyucunun Kullanımı. J Turgut Ozal Med Cent. 2011;18(3):168-73.