Download - Complications of SICS Dr.Haripriya Aravind. Tunnel construction zApproach zPlacement zLength zDepth
Complications of SICS
Dr.Haripriya Aravind
Tunnel construction
Approach
Placement
Length
Depth
Placement
Anterior incision
Poor self sealing effect
•Wound leak•Astigmatism
Management: Suture
Posterior incision
Wide tunnel Risk of bleeding Risk of premature entry
Difficulty in nucleus deliveryand instrument manipulation
Management: Suture for premature entry
Incision length
Short incision
Difficulty in nucleus delivery
Endothelial damageris damage
Management: Enlarge incision with keratome
Long incision
Poor approximation
Wound leak Induced ATR astigmatism
Management: Suture
Incision Depth
Premature entry
Button holing
Scleral disinsertion
Descemet’s Stripping
Main wound Instruments
Paracentesis VES/Fluids
TreatmentAirViscoelastics
Paracentesis
Site
Size
Too central
Too peripheral
Too small
Too big
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
Inappropriate size
Too small
Management: Enlarge the rhexis by
2 or 3 relaxing incisions
Too big
Large rhexis Decenteration
Hydrodissection
Incomplete hydroForceful hydroPPCComplications
Inadequate cortical-capsular bag separation Fluid misdirection syndrome Zonular damage Posterior capsular tear Nucleus drop Capsular block syndrome
Nucleus prolapse
Difficult situationsIncomplete hydroprocedureSmall rhexisMid-iris synechiaeVery soft nucleusHard brown wodden nucleusSmall pupil
ComplicationsEndothelial Damage
Iridodialysis/Damage to Iris
Zonular Dialysis
PCR
Nucleus Delivery
Endothelial damage
Zonular dialysis/PCR
Iris Sandwich
Iris injury
Sphincter tearIridodialysis
<1 hr : no intervention>1 hr : suture
Iris prolapseCareful repositioningSuture tunnelPost op steroids & NSAIDs
Iridodialysis
McCannel Suture
Hyphema
From tunnel Posterior tunnel Deep tunnel
From Iris Iris handling Iridodialysis
Intraoperative Miosis
Avoid iris touchVESPharmacologicalSpincterotomyHook
Zonular dialysis
Can be pre/intra operativeApproachBimanual prolapse of nucleusPhacosandwichIOL
1quad – sulcus (perpendicular to the dialysis)2quad - CTR>2quad - ACIOL/aphakia
Posterior capsular tear
Seal the tear using visco (don’t hydrate)
Automated ant vitrectomyResidual cortex - dry aspiration
Post op inflammationObstruct visual axisSecondary glaucoma
Bimanual automated vitrectomy
Completed vitrectomy
At the start of vitrectimy
Dropped nucleus
If anterior : inject visco : deliver with vectis
Deep into the vitreous : Retinal surgeon intervention
Expulsive HaemorrhageTissue prolapseHard globeLoss of red glowChoroidal haemorrhageCRAO
Rx : Suture IV Mannitol Post segment assessed
Immediate post op complications
Wound DehiscenceEtilology
Excessive episcleral cautreyPremature entryButton holingNuclear or cortical fragment in tunnelPostoperative IOP riseCollagen vascular diseasesLeaking paracentesis wound
TreatmentPatch the eyeCycloplegicsExploration of wound and suturing
Corneal complications
Corneal edemaStriate keratopathyBullous keratopathy
Corneal complications
Management : Control inflammation Antiglaucoma drugs
Treat epithelial defectCycloplegics
Post op Iritis
Excess manipulation during nucleus prolapse & delivery
Residual cortexManagement
Topical steroids & antibiotics Cycloplegics Topical NSAIDs
Post op increase in IOP
Retained viscoelasticsOver distention of AC while
reforming
Rx: antiglaucoma medications
Late complications
Corneal complicationsUveitisCapsular bag complicationsPCOIOL malformationsCMEEndophthalmitis
Post segment complications
RD
Lost lens syndrome
Vitreous hemorrhage
Vitritis
Successful management
RecognitionKnowledgeSkillJudgement