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A novel technique of managing posterior capsule rent (PCR) with trocar cannula as anterior chamber maintainer (ACM) and 23 gauge vitrector

Poster Details

First Author: S.Chaudhary INDIA

Co Author(s):    R. Chaudhary   A. Pandey                 

Abstract Details

Purpose:

Existing techniques of PCR management like dry aspiration with Simcoe cannula under cover of viscoelastic results in incomplete cortex removal, teased out cortex material falling in the vitreous cavity, viscoelastic falling in the vitreous cavity leading to postoperative inflammation and secondary rise of Intra Ocular Pressure(IOP). Instruments in and out of the eye causing Anterior Chamber (AC) fluctuations with further loss of vitreous and enlargement of rents. A technique is needed which makes the procedure simple, reproducible, manages vitreous strands and cortex in one go and does away with the above problems

Setting:

Eye7 eye hospitals, New Delhi, India

Methods:

On detecting a PCR, the AC is stabilised with a Trocar cannula used as an ACM under cover of a viscoelastic. The cannula is attached to a bottle at a height of 21 cm, thus maintaining the IOP at 16mmhg. This prevents AC fluctuations and keeps the vitreous at bay. A 23 gauge Vitrector in an I.A-Cut mode is used to tease out cortical matter from the inflated bag in the IA mode, while in the Cut mode it cuts and aspirates out cortex along with any vitreous tags. Effect of raising Bottle height (BH) to 30 was noted

Results:

10 cases were evaluated with this technique. Entire cortex was removed from the bag in all cases. No viscoelastic fell in the vitreous cavity once the ACM was in position. In one case, a small piece of cortex fell into vitreous cavity. No PCR enlarged at BH 21, while one enlarged at BH 30. No secondary rise of IOP occured. Minimal corneal oedema in one case. IOL without use of viscoelastic placed in the bag or the sulcus in all cases. There was no vitreous prolapse at BH of 21, while two prolapse occurred when BH was raised to 30

Conclusions:

This novel technique takes the fear out of a PCR management. BH of 21 cm equivalent of IOP of 16 mmhg gives stable chamber, maintains good visualization throughout the procedure and makes intraocular manipulations simple and controlled. Minimal manipulations results in clear cornea�â�€�™s on first postoperative day. Negligible complications were noted at a BH of 21mmhg, while BH of 30 cm or more, equivalent to an IOP of 22mmhg or more, resulted in fluid leakages from the incisions, enlarged PCR and vitreous prolapse.

Financial Disclosure:

NONE

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