Abstract
Purpose. To describe the characteristics of intraocular fluidics during cataract surgery in swine eyes with prior vitrectomy. Methods. We prepared three groups of enucleated swine eyes (nonvitrectomized, core, and totally vitrectomized). Irrigation and aspiration were performed (2.7 mm conventional sleeved phacosystem) using a balanced saline solution mixed with a water-soluble radiopaque contrast medium at 1 : 1 ratio. We imaged the eyes using a digital fluoroscopy system (DFS) during phacoemulsification and compared the characteristics of the intraocular fluid dynamics between the groups. Results. The anterior chamber depth (ACD) after the commencement of irrigation differed between groups (2.25 ± 0.06 mm; 2.33 ± 0.06 mm; 3.17 ± 0.11 mm), as well as the height of the fluid flowing from the anterior chamber into the posterior cavity that was identified by lifting up the iris to correct the infusion deviation syndrome (0.00 ± 0.00 mm; 0.41 ± 0.04 mm; 2.19 ± 0.35 mm). Conclusions. DFS demonstrated differences in fluid dynamics during phacoemulsification in swine eyes with or without prior vitrectomy. In completely vitrectomized eyes, the large ACD, which developed during phacoemulsification, could be reduced by lifting the iris and allowing the fluid to shift to the posterior cavity. Recognizing the differences in fluidics of vitrectomized eyes as compared to those of the nonvitrectomized eyes may reduce the frequency of intraoperative complications.
Highlights
With progressive refinements in vitreoretinal surgical techniques, an increasing number of posterior segment disorders are being successfully managed with pars plana vitrectomy
Nine swine eyes were divided into three groups of three eyes each to compare the intraocular fluid dynamics according to the degree of vitrectomy
When the iris was lifted with the second instrument, irrigation fluid did not pass into the posterior cavity (Figure 3(b))
Summary
With progressive refinements in vitreoretinal surgical techniques, an increasing number of posterior segment disorders are being successfully managed with pars plana vitrectomy. Wellknown potential complications that may arise from cataract surgery after vitrectomy include poor pupil dilation, posterior synechiae, zonular damage, posterior capsular tears, increased mobility of the iris-lens diaphragm, and altered intraocular fluid dynamics as a result of the absence of the anterior hyaloid surface [1]. Upon first entry of the phacotip into the anterior chamber, characteristically, the iris-lens diaphragm bows posteriorly as soon as irrigation begins, causing the anterior chamber to deepen excessively and the pupil to dilate widely. A phakic, vitrectomized eye has a posterior segment filled with fluid that lacks the properties of a gel due to the absence of collagen and hyaluronic acid [3]
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