Occlusion Controlled Phaco and Shallow Anterior ChamberDr. Bekir Sıtkı AslanTOBB ETU HospitalAnkaraTurkey

Financial Interest-Alcon Speakers Bureau

Purpose Cataracts with shallow anterior chamber is a

challenge for surgeons, due to lacking space. Anterior chamber fluctuation may contribute to

increase the fragility of the tissues in the anterior chamber.

We looked the added benefits of “Occlusion Controlled Phaco” in cataracts with a shallow chamber.

Methods Prospective analysis of 12 cases with cataracts of

varying density and shallow anterior chambers Patients anterior chambers 2.0 mms ≤ were

assigned. Anterior chambers were measured with

immersion A-scan. All cases were operated with torsional energy with

vacuum sensitive longitudinal energy delivery.

Methods Videoanalysis ;

Configuration of incision, The nucleus removal times, Amount of energy dispersed, Amount of fluid used, Number of surges during nucleus removal were

recorded. Pre and post operative visual acuities and eye

pressures , corneal edema and iris defects were noted.

Shallow Anterior ChambersHyperopic Eyes 5

After Filtration Surgery

2

Crystalline LensSwelling

3

Acute Angle Closure Glaucoma

2

Clinical Condition AC Depth Axial Length Vitreous TapHyperopic 1,93 21,53  Hyperopic 1,86 21,61  After Filtration Surgery 1,38 22,11  Crystalline Lens Swelling 1,45 22,12 YesAcute Angle Closure 1,21 23,89 YesCrystalline Lens Swelling 1,79 23,89  Hyperopic 1,43 21,95 YesHyperopic 1,63 21,83  Acute Angle Closure 1,38 22,45 YesAfter Filtration Surgery 1,34 22,41  Hyperopic 1,91 21,03  Crystalline Lens Swelling 1,50 21,85  

Cataract Surgery Challenge Wound construction, Capsulorhexis, Endothelial Trauma

Cataract Surgery Challenge-Control Smaller wound construction, Viscoadaptive use for capsulorhexis, Occlusion Controlled Phaco for Endothelial Trauma ( A

small percent of vacuum sensitive Longitudinal energy is added to push back the nuclear material when the shearing activity stops with torsional because of occlusion.)

Clinical Condition CDE

Nucl Removal

TimeAmount of Fluid Used

n of clogging

Hyperopic 16,53 4,51 86 7Hyperopic 32,68 6,03 90 21After Filtration Surgery 19,52 5,41 85 10Crystalline Lens Swelling 12,61 4,39 59 12Acute Angle Closure 23,98 6,56 115 12Crystalline Lens Swelling 11,95 4,21 69 7Hyperopic 18,45 4,1 72 11Hyperopic 21,74 3,39 64 9Acute Angle Closure 17,28 2,39 44 6After Filtration Surgery 15,02 3,26 59 8Hyperopic 19,52 5,41 85 10Crystalline Lens Swelling 14,55 4,57 89 10

Clinical Condition

Incision Problems With 2.2 mm Slit

LogMar Pre-op

VA

LogMar 1 month Post-Op

VAPre-op

IOPPost-op

IOP

Cornea Clarity Post-op

Day 1Iris

Trauma RemarksHyperopic   0,7 0,1 21 18      Hyperopic   0,5 0,1 22 17      After Filtration Surgery Yes 1 0,3 14 20 Edema   cosoptCrystalline Lens Swelling   1,5 0,1 14 12   Yes  Acute Angle Closure Yes 1 0,4 27 20 Edema Yes cosoptCrystalline Lens Swelling   1,4 0,7 25 17      Hyperopic   0,4 0,7 15 15   Yes  Hyperopic   1 0 15 17     AmbliopicAcute Angle Closure   1,6 1,4 28 18 Edema Yes  After Filtration Surgery   0,5 0,4 12 12 Edema Yes  Hyperopic   1 1 23 20      Crystalline Lens Swelling   0,5 0 21 21      

Conclusions Immature entry into the Anterior Chamber may lead to shorter tunnels, Previous surgery and acute angle closure may jeopordize endothelial

resistance, Iris trauma is inevitable in cases with shallower anterior chambers, Vitreous tap may be needed if anterior chamber cannot be deepened

with viscoadaptive viscoelastics, Low flow, low infusion bottle yields succesful lens removal with very

acceptable energy and fluid use, Good visual outcomes can be achieved, Eye pressures have the tendancy to drop whereas some slight pressure

rise should be controlled with topical antiglaucomatous drops.