http://www.tvrs.gr/

1. Treating Cataract Complications
E. Parikakis1 – E. Gotzaridis2
1“Ophthalmiatreio” Eye Hospital, Athens, Greece
2 Vitreoretinal Surgeon, OMMA, Athens, Greece

2. 1. Capsular rupture & Vitreous loss
2. Dropped nucleus / fragments
3. IOL dislocation
4. Endophthalmitis
5. Iris trauma / aphakia
6. Need for IOL exchange / IOL opacification (open
posterior capsule)
Common Cataract Complications
Treating Cataract Complications

3. 1. Control the environment (consider subtenon anesthesia)
2. Do not let AC collapse. Use OVD to prevent vitreous
prolapse.
3. Try to maintain the rest of the capsule
4. Always work in a close environment
5. Keep fluidic stability, use AC maintainer
6. Use separate incisions for vitrectomy. Remove the vitreous
using a 25ga sclerotomy and a high-speed cut vitrector
7. Use the side ports (consider bimanual irrigation/aspiration)
Pearls for Capsular ruprure / Vitreous loss
Treating Cataract Complications

4. 1. Remove the nucleus with the vitrector (± PFCL ±
forceps) (25/23 gauge technique)
2. Use the phacofragmatome (20 gauge technique)
3. Fill with PFCL and bring the lens to anterior segment
(AC procedure)
4. Other method (Ozil phaco probe?)
Dropped nucleus/ fragments
Treating Cataract Complications
Treatment Modalities

5. Dropped nucleusDropped nucleus –– Other ?Other ?

6. Dropped nucleus / fragmentsDropped nucleus / fragments
((OZil versus FragmatomeOZil versus Fragmatome))
ConvetionalConvetional 2020--
gauge fragmatomegauge fragmatome
OZil torsionalOZil torsional
handpiece withouthandpiece without
silicone sleevesilicone sleeve
22,5 mm22,5 mm
OZil torsional phacoOZil torsional phaco
handpiecehandpiece
20,5 mm20,5 mm

7. IOL Repositioning
 Assessment whether is sufficient capsular support
 Makes the refraction 0,5 – 1 diopter more myopic
 Single-piece acrylic lens are designed for in-the-bag
implantation & can lead to dislocation, iris inflammation
 Better option: three-piece acrylic lens, (PMMA with holes)
Ciliary Sulcus repositioning
1. Posterior Capsule Defect

8. Management of IOL Dislocation
A. Anterior (limbal) approach
 If the IOL is still supported by the capsular remnants
B. Posterior (pars plana) approach
 More complete and controlled vitreous removal
 Better access to the vitreous cavity
 Ability to treat potential intraoperative complications
(tear, hemmorrhage, IOL vitreous dislocation)

9. IOL Repositioning
 The Posterior Segment Approach
 Useful maneuver to bring 1 haptic into the AC
 The IOL to be rotated before placing the 2nd haptic
Ciliary Sulcus repositioning
1. Posterior Capsule Defect

10. IOL Repositioning - Posterior (p. p.) approach
 Αύξηση IOP για έλεγχο αιμορραγίας
Dislocated IOL & RD
PFCL useful to stabilize the retina and to float the IOL
anteriorly and to manipulate the IOL into the sulcus

11. IOL Vitreous Dislocation – IOL Exchange – Iris-claw IOL
The Posterior Segment Approach

12. ΕVS – Treatment modalities
VITRECTOMY: 3port ppv, 0.2-0.5 cc undiluted vitreous
core vitrectomy (do not force for PVD, target: gel removal > 50%)
ΤΑP: 0.1-0.3cc vitreous, βελόνη 22-25g or portable vitrector
Intravitreal: Vancomycin (1mg/0.1cc) + Amikacin (0.4mg/0.1cc)
S/Conj: Vancomycin (25mg/0.5cc) + Ceftazidime (100mg/0.5cc)
+ Dexamethasone (6mg/0.25cc)
Fortified drops: Vancomycin (50mg/ml) + Amikacin (20mg/ml) + cyclo + predn
P.O. ?: Prednisone 30mg bid , Moxifloxacin

13. VA<ΗΜ 60cm → 25g VIT + iVIT vanco, ceftazidime,
(dexamethasone)
VA>HM 60cm (diabetics) or rapid progression/pain →
VIT + …
VA>HM 60cm → TAP + iVIT vanco, ceftazidime,
(dexamethasone)
+ PO moxifloxacin, prednisone (not in diabetics)
+ fortified drops, dexamethazone, cyclo
Treating Cataract Complications -
Endophthalmitis

14. Vitreous biopsy with a needle or
cutting/aspirating probe
 (Parabulbar anesthesia may be necessary)
 Povidone-iodine 5% solution -rinsed thoroughly with
sterile BSS or normal saline to remove residual
antiseptic from the ocular surface
 Surgical drape, lid speculum, (operating microscope)
 30-gauge needle attached to a tuberculin syringe is
inserted through the limbus into the anterior chamber
and through the pp into the vitreous cavity
 Vitrectomy probe attached to a tuberculin syringe
is inserted into the vitreous cavity through a
sclerotomy incision
 Approximately 0.1–0.3 ml of vitreous is removed
 Automated cutting mechanism of the probe and
slow, manual aspiration into the syringe

15. Treating Cataract Complications –Iris trauma - Aphakia
PPV & Iris Reconstuction & Artisan/Verisyse AC

16. Treating Cataract Complications
1. Control the environment (consider anesthesia)
2. Maintain the integrity of the capsular bag and remove the
old lens from the capsular bag to the AC (consider haptic
ampulation)
3. Use OVD to prevent vitreous prolapse, to protect the
capsule & the cornea & to dissect
4. Insert the new lens before removing the old one
5. Use a new wire loop snare
6. Dissect slowly or cut the lens > 50%
7. Choose a 3 –piece acrylic lens for sulcus implantation
Pearls for IOL exchange in Open Posterior Capsule

17. Treating Cataract Complications -Need for IOL Exchange
IOL Exchange in Open Posterior Capsule

18. Treating Cataract Complications
E. Parikakis1 – E. Gotzaridis2
1“Ophthalmiatreio” Eye Hospital, Athens, Greece
2 Vitreoretinal Surgeon, OMMA, Athens, Greece
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