Managing intraoperative complications in cataract surgery

Current Opinion in Ophthalmology

Volumn 15, Issue 1, 2004, Pages 33-39

  Arbisser, Lisa Brothers ^a,b  

^a Founding Partner Eye Surgs A   (United States)

^b NONE   (United States)

Author keywords

Capsular tension rings; Cataract surgery; Pars plana anterior vitrectomy; Self sealing incisions

Indexed keywords

ANESTHETIC AGENT; BALANCED SALT SOLUTION; CORTICOSTEROID; DYE; GATIFLOXACIN; POLITEF; POLY(METHYL METHACRYLATE); POLYPROPYLENE; QUINOLINE DERIVED ANTIINFECTIVE AGENT; TRIAMCINOLONE ACETONIDE; TRYPAN BLUE;

ADHESION; AGE; ANESTHESIA; ANIRIDIA; ANTIBIOTIC PROPHYLAXIS; BIOMICROSCOPY; CAPSULORHEXIS; CAPSULOTOMY; CATARACT; CATARACT EXTRACTION; CELL COUNT; CELL STRUCTURE; CILIARY DISK; COLOBOMA; CORNEA EDEMA; CORNEA SURGERY; CORTICOSTEROID THERAPY; DIAGNOSTIC VALUE; DISPOSABLE EQUIPMENT; DRUG EFFICACY; DRUG SAFETY; ENDOPHTHALMITIS; ENDOTHELIUM CELL; HUMAN; IMPLANTATION; INCISION; LASER SURGERY; LENS CAPSULE; LENS IMPLANT; LENS IMPLANTATION; LENS LUXATION; LENS SUBLUXATION; MYOPIA; OPTIC NERVE INJURY; PATIENT CARE; PEROPERATIVE COMPLICATION; PHACOEMULSIFICATION; POSTOPERATIVE COMPLICATION; PREOPERATIVE EVALUATION; PRIORITY JOURNAL; PSEUDOEXFOLIATION; PSEUDOPHAKIA; REVIEW; RISK ASSESSMENT; RISK FACTOR; SCLEROTOMY; STAINING; SURGICAL INSTRUMENT; SURGICAL TECHNIQUE; TOPICAL ANESTHESIA; TREATMENT PLANNING; VITRECTOMY; VITREOUS BODY; VITREOUS DISEASE; ZONULOLYSIS;

CATARACT EXTRACTION; HUMANS; INTRAOPERATIVE COMPLICATIONS;

EID: 1342326612     PISSN: 10408738     EISSN: None     Source Type: Journal    
DOI: 10.1097/00055735-200402000-00007     Document Type: Review

References (44)

1. Gimbel HV, Sun R, Ferensowicz M, et al.: Intraoperative management of posterior capsule tears in phacoemulsification and intraocular lens implantation. Ophthalmology 2001, 108:2186-2192. Absolutely the bible of best-case scenario and meticulous care of complications resulting in optimal outcomes. The master of the anterior capsulorhexis explains the maneuver on the posterior capsule.
2. Tan J, Karwatowski WSS: Phacoemulsification cataract surgery and unplanned anterior vitrectomy: is it bad news? Eye 2002, 16:117-120.
3. Quillen DA, Phipps SJ: Visual outcomes and incidence of vitreous loss for residents performing phacoemulsification without prior planned extracapsular cataract extraction experience. Am J Ophthalmol 2003, 135:732-733.
4. Chan FM, Mathur R, Ku JJK, et al.: Short-term outcomes I: eyes with posterior capsule rupture during cataract surgery. J Cataract Refract Surg 2003, 29:537-541.
5. Fine IH, Packer M, Hoffman RS: Management of posterior polar cataract. J Cataract Refract Surg 2003, 29:16-19. A roadmap provided by one of the great masters in the proper technique to manage these common and challenging cases to prevent agenesis of the posterior capsule from resulting in loss of lenticular material into the posterior segment.
6. Hayashi K, Hayashi H, Nakao F, et al.: Outcomes of surgery for posterior polar cataract. J Cataract Refract Surg 2003, 29:45-49.
7. Schneider S, Osher RH, Burk SE, et al.: Thinning of the anterior capsule associated with congenital aniridia. J Cataract Refract Surg 2003, 29:523-525. An academic approach using histology to explain the clinical behavior of the capsular bag in these uncommon anomalies.
8. Vasavada AR, Goyal D, Shastri L, et al.: Corticocapsular adhesions and their effect during cataract surgery. J Cataract Refract Surg 2003, 29:309-314. This article helps us to recognize and deal with the very common phenomenon of adhesion to the equator of the lens, which is the cause of surprise capsular tears when adequate hydrodissection is not performed.
9. Yi DH, Dana MR: Corneal edema after cataract surgery: incidence and etiology. Semin Ophthalmol 2002, 17:110-114.
10. Ishikawa A: Risk factors for reduced corneal endothelial cell density before cataract surgery. J Cataract Refract Surg 2003, 28:1982-1992. We rarely screen for poor endothelial cell reserve beyond specular reflection with the slit-lamp, and this article gives us an understanding of risk factors beyond endothelial dystrophy, allowing us to modify the surgical plan for best outcomes.
11. Khokhar S, Soni A, Pangtey M: Risk factors for and management of dropped nucleus after phacoemulsification. J Cataract Refract Surg 2002, 28:1310.
12. Masket S, Osher RH: Late complications with intraocular lens dislocation after capsulorhexis in pseudoexfoliation syndrome. J Cataract Refract Surg 2002, 28:1481-1484. This article reports and explores a new phenomenon of bag-lens dislocation and how we can help to prevent an epidemic of this devastating condition in the future.
13. Decay Curve Data for PMMA HAPTICS; Alcon Research Labs, April 2001.
14. Jacob S, Agarwal A, Agarwal A, et al.: Efficacy of a capsular tension ring for phacoemulsification in eyes with zonular dialysis. Cataract Refract Surg 2003, 29:315-321. An excellent review of a subject that remains to be mastered by the majority of American surgeons. The endocapsular rings will become an indispensable part of our arsenal in dealing with the most challenging cases: zonular complex anomalies.
15. Moreno-Montanes J, Rodriguez-Conde R: Capsular tension ring in eyes with pseudoexfoliation. J Cataract Refract Surg 2002, 28:2241-2242.
16. Ma PE, Kaur H, Petrovic V, et al.: Technique for removal of a capsular tension ring from the vitreous. Ophthalmology 2003, 110:1142-1144. Although it requires a three-port vitrectomy, this method of using the inserter to remove a ring through a sclerotomy is ideal.
17. Moreno-Montanes J, Sainz C, Maldonado MJ: Intraoperative and postoperative complications of Cionni endocapsular ring implantation. J Cataract Refract Surg 2003, 29:492-497. Another example of the safety and efficacy of the tension ring and why it must be readily available to all.
18. Chang DF: Prevention of bag-fixated IOL dislocation in pseudoexfoliation. Ophthalmology 2002, 109:1951-1952. An ever-practical teacher, the author details the salient issues that should be in our mind whenever we encounter zonular weakness
19. Gabor R: Artisan IOL after phacoemulsification in subluxated lenses. J Cataract Refract Surg 2002, 28:2064.
20. Assia EI, Nemer A, Sachs D: Bilateral spontaneous subluxation of scleral-fixated intraocular lenses. Cataract Refract Surg 2002, 28:2214-2216. This article emphasizes the need for the right materials as well as the right technique. More evidence is presented that we may not be able to trust 10-0 prolene suture material to secure eyelets to the sclera.
21. Mackool RJ: Bipseudophakia. J Cataract Refract Surg 2003, 29:4. The controversy over leaving dislocated implants in the vitreous continues.
22. Chang DF: Viscoelastic levitation of posteriorly dislocated intraocular lenses from the anterior vitreous. Cataract Refract Surg 2002, 28:1515-1519. This is an excellent description of the use of this posterior segment technique for implants as well as previously described for nuclear fragments. It remains controversial among retinologists.
23. Mamalis N: Complications of foldable intraocular lenses requiring explanation or secondary intervention-2001 survey update. J Cataract Refract Surg 2002, 28:2193-2201. We get a much needed overview of how our most often used technology is faring over time. These clearing house studies help us to make informed choices from the wide range of available lenses.
24. Brazitikos PD, Baslidis MO, Tranos P, et al.: Sulcus implantation of a 3-piece, 6.0 mm optic, hydrophobic foldable acrylic intraocular lens in phacoemulsification complicated by posterior capsule rupture. J Cataract Refract Surg 2002, 28:1618-1622.
25. Ozdal PC, Mansour M, Deschenes J: Ultrasound biomicroscopy of pseudophakic eyes with chronic postoperative inflammation. J Cataract Refract Surg 2003, 29:1185-1191. Valuable information from this technology helps us to understand the anatomic relationships that have only been inferred or assumed previously. Understanding the value of these findings explains why this modality must become more widely available in the future.
26. Kim SK, Andreoli CM, Rizzo JF, et al.: Optic neuropathy secondary to sub-Tenon anesthetic injection in cataract surgery. Arch Ophthalmol 2003, 121:907-909. It is important to know that this noninjection technique is not benign and to have a high titer or suspicion of complications so we do not miss a window of opportunity to ameliorate them.
27. Lee MS, Rizzo JF, Lessell S: Neuro-ophthalmologic complications of cataract surgery. Semin Ophthalmol 2002, 17:149-152. Let us be well-rounded in our knowledge of ophthalmology, as the consequences of all we do are far reaching. Traumatic optic neuropathy is treatable within the first 24 hours.
28. Adams W, Morgan SJ: Diplopia following sub-Tenon's infiltration of local anesthesia. J Cataract Refract Surg 2002, 28:1694-1697. Another argument for the value of mastering topical anesthesia.
29. Han SK, Hwang JM: Thyroid disease and vertical rectus muscle overaction after retrobulbar anesthesia. J Cataract Refract Surg 2003, 29:78-84. Thyroid function tests are appropriate in this postoperative strabismus, preventing us from missing the forest for the trees while we fixate on our end organ.
30. Sethi HS, Bhartiya P, Kumar H, et al.: Tearing of intact capsulorhexis during hydrodissection by poorly polished hydrodissection cannula. J Cataract Refract Surg 2002, 28:1492-1493. It is too easy to be lulled into a false sense of security about the durability of our instruments. Particularly if a complication occurs, instruments should be examined under high magnification for defects.
31. Temel M, Osher RH: Posterior capsule tear resulting from faulty instrumentation. J Cataract Refract Surg 2003, 29:619-620.
32. Otto CS, McMann MA, Parmley VC, et al.: Warm balanced salt solution for clearing tear film precipitation during cataract surgery. J Cataract Refract Surg 2002, 28:1318-1319. A nifty technique for an occasionally vexing problem.
33. Kalyanasundaram TS, Hasan M: Corneal-wetting property of lignocaine 2% jelly. J Cataract Refract Surg 2002, 28:1444-1445.
34. Horiguchi M, Nagata S, Yamamoto N, et al.: Kinetics of indocyanine green dye after intraocular surgeries using indocyanine green staining. Arch Ophthalmol 2003, 121:327-331. Indocyanine green dye surprisingly stains the entire tissue and not just the basement membrane. It may remain in the posterior segment tissues for a mean time of 2.7 months, and its safety is unsure. This is more evidence that its only use is as a substitute for trypan blue, which remains largely unavailable in the United States.
35. Waard PWT, Budo CJ, Melles GRJ: Trypan blue capsular staining to "find" the leading edge of a "lost" capsulorhexis. Am J Ophthalmol 2002, 143:271-272. This is a very helpful technique; because trypan blue does not stain cortical material but only basement membrane, it can be used in the setting of an open capsule.
36. Jacob S, Agarwal A, Agarwal A, et al.: Trypan blue as an adjunct for safe phacoemulsification in eyes with white cataract. J Cataract Refract Surg 2002, 28:1819-1825. The safely and efficacy of trypan blue continues to be demonstrated around the world.
37. Horiguchi M, Kojima Y, Shimada Y: Removal of lens material dropped into the vitreous cavity during cataract surgery using an optical fiber-free intravitreal surgery system. J Cataract Refract Surg 2003, 29:1256-1259.
38. Teenan DW, Saunders DC: Phacoemulsification with a blow-out fracture in the early postoperative period. J Cataract Refract Surg 2002, 28:2231-2234. Durability is only one of the advantages of the properly constructed clear corneal self-sealing incision, which is rightly becoming the standard of care.
39. Sandvig KU, Dannevig L: Postoperative endophthalmitis: establishment and results of a national registry. J Cataract Refract Surg 2003, 29:1274-1280. A registry is an important tool to understanding clusters of cases and tracking resistance of microorganisms.
40. Hariprasad SM, Mieler WF, Holz ER: Vitreus and aqueous penetration of orally administered gatifloxacin in humans. Arch Ophthalmol 2003, 121:345-350. The ability of fluoroquinolones to penetrate the blood-retinal barrier will be recognized as increasingly important in our defense against intraocular infection. The oral use of these drugs is effective, obviating the need for intravenous administration. This route of administration should be considered for prophylaxis in penetrating traumatic situations and complicated and prolonged cataract surgery cases.
41. Marcon AS, Rapuano CJ, Jones MR, et al.: Descemet's membrane detachment after cataract surgery: management and outcome. Ophthalmology 2002, 109:2325-2330. We must be aware to prevent this complication every time we enter our incisions or hydrate our stroma. It appears to be more prevalent in the era of clear corneal incision, and its treatment remains controversial.
42. Vargas LG, Vroman DT, Solomon KD, et al.: Epithelial downgrowth after clear cornea phacoemulsification. Ophthalmology 2002, 109:2331-2335. Our awareness of this rare but devastating condition must remain just below the surface at all times. Prevention is our best hope, and any poorly constructed wound must be dealt with decisively.
43. Burk SE, Da Mata AP, Snyder ME, et al.: Visualizing vitreous using Kenalog suspension. J Cataract Refract Surg 2003, 29:645-651. This technique will revolutionize the management of prolapsed vitreous and must be mastered and at the ready for preparation in every operating room until a preservative-free preparation is available. The ability to see the vitreous is invaluable to ensuring meticulous clean-up, which is essential for an uncomplicated postoperative course.
44. Oetting TA: Preventing and managing cataract complications: it takes a village. J Am Soc Ophthalmic Registered Nurses 2003, 28:18-23. We simply cannot do it alone.