Intraoperative conversion from phacoemulsification to manual extracapsular cataract extraction

Abstract

Multiple 10-0 nylon sutures may be required to close the main wound and the side port. Seidel testing of the wounds and segment junctions is performed and additional sutures added to ensure a watertight seal. CASE REPORTThe importance of wound placement is demonstrated in a patient who had cataract surgery 4 years after keratolimbal allograft and tube-shunt surgery. Based on the tube location and efforts to avoid an inferiorly placed wound, the main wound was made adjacent to a keratolimbal allograft junction. After the IOL was inserted, the edge of 1 segment became elevated. Four 10-0 nylon sutures were required to reappose the 2 segments to prevent leakage at the junction, and 3 sutures were required at the main wound to ensure Seidel negative testing ( Figure 3). DISCUSSIONA customized approach is necessary when performing cataract surgery in eyes with prior surgeries, especially in complex cases of congenital aniridia or congenital aniridia variant after keratolimbal allograft. Improved surgical outcomes and optimization of visual potential is achieved by careful recognition of the considerations we have highlighted: use of visualization enhancement measures (capsular staining and iris hooks), careful wound placement, appreciation of anterior capsule fragility, and diligent wound closure to prevent hypotony. REFERENCES 1. Nelson LB, Spaeth GL, Nowinski TS, Margo CE, Jackson L. Aniridia. A review. Surv Ophthalmol 1984; 28:621-642 2. Skeens HM, Brooks BP, Holland EJ. Congenital aniridia variant: minimally abnormal irides with severe limbal stem cell deficiency. In press, Ophthalmology 2011 3. Holland EJ, Djalilian AR, Schwartz GS. Management of aniridic keratopathy with keratolimbal allograft: a limbal stem cell transplantation technique. Ophthalmology 2003; 110:125-130 4. Neuhann IM, Neuhann TF. Cataract surgery and aniridia. Curr Opin Ophthalmol 2010; 21:60-64 5. Schneider S, Osher RH, Burk SE, Lutz TB, Montione R. Thinning of the anterior capsule associated with congenital aniridia.Despite the high success rate of phacoemulsification cataract extraction, there are times when continuing the planned operation is no longer desirable. The cataract surgeon must then choose between converting to manual extracapsular cataract extraction (ECCE) or referring the patient for cataract extraction through a pars plana approach. Several studies have looked at the outcomes of pars plana vitrectomy for retained lens material. 1 However, few or no studies have examined the outcome of phacoemulsification cataract extraction converted to ECCE. We performed a retrospective case-note review to evaluate indications for and visual results of phacoemulsification cataract extractions converted to ECCE at our hospital. PATIENTS AND METHODSPatients were identified from electronic operative records from 2005 through 2009. All operations were performed or supervised by surgeons who had trained when ECCE was performed routinely.

Intra-Operative Phacoemulsification Conversion to Extracapsular Cataract Extraction: Risk Factors and Visual Outcome

“…While study done by Mercieca Karl et al, reported common risk for intraoperative conversion in their centre was due to dense nucleus and capsulorhexis extension (5). There…”