complications of sics dr.haripriya aravind. tunnel construction zapproach zplacement zlength zdepth

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Complications of SICS Dr.Haripriya Aravind

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Page 1: Complications of SICS Dr.Haripriya Aravind. Tunnel construction zApproach zPlacement zLength zDepth

Complications of SICS

Dr.Haripriya Aravind

Page 2: Complications of SICS Dr.Haripriya Aravind. Tunnel construction zApproach zPlacement zLength zDepth

Tunnel construction

Approach

Placement

Length

Depth

Page 3: Complications of SICS Dr.Haripriya Aravind. Tunnel construction zApproach zPlacement zLength zDepth

Placement

Anterior incision

Poor self sealing effect

•Wound leak•Astigmatism

Management: Suture

Page 4: Complications of SICS Dr.Haripriya Aravind. Tunnel construction zApproach zPlacement zLength zDepth

Posterior incision

Wide tunnel Risk of bleeding Risk of premature entry

Difficulty in nucleus deliveryand instrument manipulation

Management: Suture for premature entry

Page 5: Complications of SICS Dr.Haripriya Aravind. Tunnel construction zApproach zPlacement zLength zDepth

Incision length

Short incision

Difficulty in nucleus delivery

Endothelial damageris damage

Management: Enlarge incision with keratome

Page 6: Complications of SICS Dr.Haripriya Aravind. Tunnel construction zApproach zPlacement zLength zDepth

Long incision

Poor approximation

Wound leak Induced ATR astigmatism

Management: Suture

Page 7: Complications of SICS Dr.Haripriya Aravind. Tunnel construction zApproach zPlacement zLength zDepth

Incision Depth

Premature entry

Button holing

Scleral disinsertion

Page 8: Complications of SICS Dr.Haripriya Aravind. Tunnel construction zApproach zPlacement zLength zDepth

Descemet’s Stripping

Main wound Instruments

Paracentesis VES/Fluids

TreatmentAirViscoelastics

Page 9: Complications of SICS Dr.Haripriya Aravind. Tunnel construction zApproach zPlacement zLength zDepth

Paracentesis

Site

Size

Too central

Too peripheral

Too small

Too big

Page 10: Complications of SICS Dr.Haripriya Aravind. Tunnel construction zApproach zPlacement zLength zDepth

Capsulotomy

CAPSULORHEXIS Peripheral extension/ Run away rhexis

Post capsule tear

ManagementReform AC with VESPull flap centrallyCut capsule just ahead of peripherally extending rhexisContinue in reverse directionCanopener

Page 11: Complications of SICS Dr.Haripriya Aravind. Tunnel construction zApproach zPlacement zLength zDepth

Inappropriate size

Too small

Management: Enlarge the rhexis by

2 or 3 relaxing incisions

Too big

Page 12: Complications of SICS Dr.Haripriya Aravind. Tunnel construction zApproach zPlacement zLength zDepth

Large rhexis Decenteration

Page 13: Complications of SICS Dr.Haripriya Aravind. Tunnel construction zApproach zPlacement zLength zDepth

Hydrodissection

Incomplete hydroForceful hydroPPCComplications

Inadequate cortical-capsular bag separation Fluid misdirection syndrome Zonular damage Posterior capsular tear Nucleus drop Capsular block syndrome

Page 14: Complications of SICS Dr.Haripriya Aravind. Tunnel construction zApproach zPlacement zLength zDepth

Nucleus prolapse

Difficult situationsIncomplete hydroprocedureSmall rhexisMid-iris synechiaeVery soft nucleusHard brown wodden nucleusSmall pupil

Page 15: Complications of SICS Dr.Haripriya Aravind. Tunnel construction zApproach zPlacement zLength zDepth

ComplicationsEndothelial Damage

Iridodialysis/Damage to Iris

Zonular Dialysis

PCR

Page 16: Complications of SICS Dr.Haripriya Aravind. Tunnel construction zApproach zPlacement zLength zDepth

Nucleus Delivery

Endothelial damage

Zonular dialysis/PCR

Iris Sandwich

Page 17: Complications of SICS Dr.Haripriya Aravind. Tunnel construction zApproach zPlacement zLength zDepth

Iris injury

Sphincter tearIridodialysis

<1 hr : no intervention>1 hr : suture

Iris prolapseCareful repositioningSuture tunnelPost op steroids & NSAIDs

Page 18: Complications of SICS Dr.Haripriya Aravind. Tunnel construction zApproach zPlacement zLength zDepth

Iridodialysis

McCannel Suture

Page 19: Complications of SICS Dr.Haripriya Aravind. Tunnel construction zApproach zPlacement zLength zDepth

Hyphema

From tunnel Posterior tunnel Deep tunnel

From Iris Iris handling Iridodialysis

Page 20: Complications of SICS Dr.Haripriya Aravind. Tunnel construction zApproach zPlacement zLength zDepth

Intraoperative Miosis

Avoid iris touchVESPharmacologicalSpincterotomyHook

Page 21: Complications of SICS Dr.Haripriya Aravind. Tunnel construction zApproach zPlacement zLength zDepth

Zonular dialysis

Can be pre/intra operativeApproachBimanual prolapse of nucleusPhacosandwichIOL

1quad – sulcus (perpendicular to the dialysis)2quad - CTR>2quad - ACIOL/aphakia

Page 22: Complications of SICS Dr.Haripriya Aravind. Tunnel construction zApproach zPlacement zLength zDepth

Posterior capsular tear

Seal the tear using visco (don’t hydrate)

Automated ant vitrectomyResidual cortex - dry aspiration

Post op inflammationObstruct visual axisSecondary glaucoma

Page 23: Complications of SICS Dr.Haripriya Aravind. Tunnel construction zApproach zPlacement zLength zDepth

Bimanual automated vitrectomy

Completed vitrectomy

At the start of vitrectimy

Page 24: Complications of SICS Dr.Haripriya Aravind. Tunnel construction zApproach zPlacement zLength zDepth

Dropped nucleus

If anterior : inject visco : deliver with vectis

Deep into the vitreous : Retinal surgeon intervention

Page 25: Complications of SICS Dr.Haripriya Aravind. Tunnel construction zApproach zPlacement zLength zDepth

Expulsive HaemorrhageTissue prolapseHard globeLoss of red glowChoroidal haemorrhageCRAO

Rx : Suture IV Mannitol Post segment assessed

Page 26: Complications of SICS Dr.Haripriya Aravind. Tunnel construction zApproach zPlacement zLength zDepth

Immediate post op complications

Wound DehiscenceEtilology

Excessive episcleral cautreyPremature entryButton holingNuclear or cortical fragment in tunnelPostoperative IOP riseCollagen vascular diseasesLeaking paracentesis wound

Page 27: Complications of SICS Dr.Haripriya Aravind. Tunnel construction zApproach zPlacement zLength zDepth

TreatmentPatch the eyeCycloplegicsExploration of wound and suturing

Page 28: Complications of SICS Dr.Haripriya Aravind. Tunnel construction zApproach zPlacement zLength zDepth

Corneal complications

Corneal edemaStriate keratopathyBullous keratopathy

Page 29: Complications of SICS Dr.Haripriya Aravind. Tunnel construction zApproach zPlacement zLength zDepth

Corneal complications

Management : Control inflammation Antiglaucoma drugs

Treat epithelial defectCycloplegics

Page 30: Complications of SICS Dr.Haripriya Aravind. Tunnel construction zApproach zPlacement zLength zDepth

Post op Iritis

Excess manipulation during nucleus prolapse & delivery

Residual cortexManagement

Topical steroids & antibiotics Cycloplegics Topical NSAIDs

Page 31: Complications of SICS Dr.Haripriya Aravind. Tunnel construction zApproach zPlacement zLength zDepth

Post op increase in IOP

Retained viscoelasticsOver distention of AC while

reforming

Rx: antiglaucoma medications

Page 32: Complications of SICS Dr.Haripriya Aravind. Tunnel construction zApproach zPlacement zLength zDepth

Late complications

Corneal complicationsUveitisCapsular bag complicationsPCOIOL malformationsCMEEndophthalmitis

Page 33: Complications of SICS Dr.Haripriya Aravind. Tunnel construction zApproach zPlacement zLength zDepth

Post segment complications

RD

Lost lens syndrome

Vitreous hemorrhage

Vitritis

Page 34: Complications of SICS Dr.Haripriya Aravind. Tunnel construction zApproach zPlacement zLength zDepth

Successful management

RecognitionKnowledgeSkillJudgement

Page 35: Complications of SICS Dr.Haripriya Aravind. Tunnel construction zApproach zPlacement zLength zDepth