Effect of a superficial and a deep scleral pocket incision on the incidence of hyphema

Abstract

Deep tunnel scleral pocket incisions were developed to control surgically induced astigmatism following cataract and intraocular lens implantation surgery. A more superficial, shallow scleral pocket incision was developed to reduce the rate of postoperative hyphema. To test its effectiveness, a randomized prospective clinical study was performed. One hundred twenty-nine eyes of 129 patients were randomized: 66 to receive a deep tunnel pocket and 63 to receive the superficial pocket. In both groups the incision was made 3 mm posterior to the limbus. For the deep pocket cases, a blade setting of 0.27 mm was used and the wound was dissected forward toward the entry site, creating a long, deep, narrow tunnel. For the superficial wound cases, a 0.17 mm blade setting was used and the entire wound was dissected to the edge of the anatomic limbus, creating a thin scleral flap. The left side was then fanned out toward the left with the entry site slightly into clear cornea. At one day after surgery, 22 cases (34%) in the deep pocket group and four cases (6%) in the superficial pocket group had hyphemas. The difference in hyphema rates was statistically significant (P less than .001).

Résultats fonctionnels de la chirurgie de la cataracte parphacoalternative avec implantation enchambre postérieure: à propos de 300 cas à Bobo Dioulasso (Burkina Faso)

“…Lorsque la pré-incision est profonde, le tunnel est profond et il y a risque de traumatisme de l'iris et par conséquent un risque plus élevé de survenu d'hyphéma. John et al ont rapporté 34% de cas d'hyphéma lorsque les tunnels étaient profonds contre 6% lorsqu'ils étaient superficiels [ 20 ]. Aucun cas d'endophtalmie n'a été noté dans notre série.…”

Descemet Membrane Detachment Post- Phacoemulsification

“…A tear may happen during any steps of cataract surgery. Literature has identified that technique of wound creation and instruments manipulation in and out of the eye as among the commonest steps responsible for the initial tear (John et al 1992;Zusman et al 1987;Zeiter et al 1983).…”

Descemet Membrane Detachment During Foldable Intraocular Lens Implantation

“…In addition to cataract surgery, it has been reported to occur after iridectomy, 5 trabeculectomy, 12 viscocanalostomy, 13 penetrating keratoplasty, 14 lamellar keratoplasty, 15 pars plana vitrectomy, 16 and during insertion of foldable and nonfoldable IOL. [17][18][19] Occurrence of DMD after phacoemulsification has been attributed to various factors including shallow anterior chamber, 20 accidental insertion of the instruments between the stroma and the DM, use of blunt microkeratomes, 21 shelved incisions, 22 anteriorly placed incisions, 23 or inadvertent injection of saline, 3 viscoelastic, 19,22,24 or prophylactic antibiotics into the space between the deep stroma and the DM. 25 As compared with manual extracapsular cataract extraction, phacoemulsification requires repeated manipulations at the edge of the incision, secondary to introducing the instrument in and out of the anterior chamber.…”