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First Author: A.Yadav INDIA
Co Author(s): H. Sethi S. Rahar V. Gupta
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Vitreous loss is a potential complication during phacoemulsification in cases of subluxated lens. We present a technique of using intracameral pilocarpine intraoperatively to constrict the pupil following engagement of the capsulorhexis margins with capsule / iris hooks. This results in coupling of the iris plane with the anterior capsule, thus limiting any possible vitreous loss from between them. Clear corneal phacoemulsification can then be performed avoiding any vitreous loss.
Safdarjung Hospital, New Delhi, India
Following completion of the capsulorhexis, clear corneal stab incisions are made on the side of the zonular defect. Iris hooks are introduced and are hooked around the capsulorhexis margin to help stabilize the bag. A CTR (simple, or modified cionni depending on the subluxation) is introduced, further helping in stabilizing and centering the bag. Intracameral pilocarpine is now injected, resulting in pupillary constriction, until the iris hooks supporting the capsule are encountered by the contracting pupil. The iris and the capsulorhexis edge are now coupled, fixed as a single unit, eliminating the space in between and compartmentalizing the anterior chamber. This drastically reduces the possibility of any passage of vitreous or OVD through the defect. The phacoemulsification is then completed using low-flow parameters.
We have used this technique in ten cases of phacoemulsification in cases with subluxated cataractous lens with less then five clock hours zonular deficiency ( seven post-traumatic, two pseudoexfoliation syndrome and one high myopia ). The CTR was implanted after capsulorhexis in all cases. Phacoemulsification was completed without intraoperative iris or capsular damage or vitreous loss and the IOL was placed in the capsular sac in all the eyes.
The use of iris hooks to support the capsule in cases of subluxated lens, and to dilate a constricted pupil, has been described before. However, using intracameral pilocarpine as detailed above has not been reported previously in literature. The instillation of pilocarpine intraoperatively results in coupling the iris plane with the anterior capsule plane. This results in significant reduction of the risk of vitreous loss, or passage of OVD posteriorly. Thus we recommend the above described technique of using intracameral pilocarpine after CTR and iris hook insertion during cataract surgery in eyes with a subluxated lens.