Yüksel Totan, Ramazan Yaĝcı, Zeynel Arslanyılmaz, Uĝurcan Keskin

The authors have no financial interest

Combined clear corneal phacoemulsification and transpupillary

removal of silicone oil

Cataract is a frequent complication of silicone oil tamponade used in the management of proliferative vitreoretinopathy and advanced diabetic retinopathy complications.

We aimed to evaluate clinical results of clear corneal phacoemulsification combined with transpupillary silicone oil removal.

Introduction

A retrospective study

20 patients; 13 males, 7 females

Age range; 14-75 years, mean age 53 yrs

The same surgeon (YT) performed all the operations.

The reasons for primary vitreoretinal surgery:Proliferative vitreoretinopathy in 13 eyes, Retinal detachment with giant tear in 2 eyes Retinal detachment with macular hole in 1 eye, Proliferative diabetic retinopathy complications in 4 eyes.

Patients and methods

Type of cataract

Posterior subcapsular opacities combined with nuclear sclerosis

Biometry

SRK/T formula using true axial length(AL)

True AL was estimated by multiplying measured AL by the

conversion factor of 0.71

Type of anesthesia

Topical (10 eyes),

Peribulbar (9 eyes),

General anesthesia (1 eye-14 years old)

Patients and methods

Surgical steps;

A superior clear corneal incision

Phacoemulsification (quick chop technique)

Anterior chamber maintainer placement for infusion

Posterior capsulotomy

Silicone oil removal through the posterior capsulotomy with a

16 gauge cannula connected to a 10 mL syringe

Retinal examination with a wide-angle viewing system

IOL implantation in the capsular bag or sulcus.

Patients and methods

Visual acuity (BCVA)

After vitreoretinal surgery:Hand motion in 2 eyes, Finger counting in 5 eyes, 0.05 to 0.7 (Snellens chart) in 13 eyes

After combined phacoemulsification plus silicone oil removal

Finger counting in 3 eyes, 0.1 to 1.0 (Snellens chart) in 17 eyes

“Mean BCVA increase is 2 Snellens lines”

Results

Optical correction:IOL implantation in 18 eyes, 2 eyes left aphakic according to the preop biometry

Type of IOL implantation:Capsular bag in 12 eyes Ciliary sulcus in 6 eyes.

IOL type Hydrophilic acrylic monobloc IOL in 14 eyes, Hydrophobic acrylic monobloc IOL in 4 eyes

Results

Follow-up period:

Mean, 12 months (range, 4-36 months)

Postoperative refractive error (spherical equivalent):

The mean deviation, -1.0 ± 1.84 D (range, +2.0 to -5.0 D)

A total of 90% was within ± 2 D

45% had a deviation of ± 1 D

“No significant surgical complication leading to decreased

vision was encountered during the follow-up period”.

Results

Cataract is a common complication following vitreoretinal surgery with silicone oil tamponade.

Combined phacoemulsification and silicone oil removal through a clear corneal incision has some advantages :

Reduced number of surgical procedures, Reduced operation time,Less or no posterior pressure during phacoemulsificaiton,No sclerotomy,No posterior capsular opacification,Reduced risk of retinal detachment and vitreous hemorrhage (Because ora serrata is spared)

Discussion

Some potential disadvantages of combined surgery:

Less predictable postoperative refraction,Increased difficulty of in-the bag IOL implantation (particularly for mono-bloc hydrophilic IOLs),Relative hypotony after silicone oil removal,No chance of membrane peeling or retinal stabilization.Potential subluxation of the IOL in case of inadvertent large posterior capsulotomyAngiographic macular edema

Discussion

Combined phacoemulsification and silicone oil

removal through a clear corneal incision is a safe

and effective technique, but must be reserved in

selected cases in which retina is permanently

stabilized with no significant epiretinal or subretinal

membranes.

Conclusion