Complications of SICS Dr Haripriya Aravind Tunnel construction

Complications of SICS Dr. Haripriya Aravind

Tunnel construction z. Approach z. Placement z. Length z. Depth

Placement z. Anterior incision Poor self sealing effect • Wound leak • Astigmatism Management: Suture

z. Posterior incision x. Wide tunnel x. Risk of bleeding x. Risk of premature entry Difficulty in nucleus delivery and instrument manipulation Management: Suture for premature entry

Incision length z. Short incision Difficulty in nucleus delivery Endothelial damage ris damage Management: Enlarge incision with keratome

z. Long incision Poor approximation x. Wound leak x. Induced ATR astigmatism Management: Suture

Incision Depth z. Premature entry z. Button holing z. Scleral disinsertion

Descemet’s Stripping z Main wound Instruments z Paracentesis VES/Fluids z Treatment x. Air x. Viscoelastics

Paracentesis z. Site Too central Too peripheral z. Size Too small Too big

Capsulotomy CAPSULORHEXIS z Peripheral extension/ Run away rhexis Post capsule tear Management x. Reform AC with VES x. Pull flap centrally x. Cut capsule just ahead of peripherally extending rhexis x. Continue in reverse direction x. Canopener

Inappropriate size z. Too small Management: Enlarge the rhexis by 2 or 3 relaxing incisions z. Too big

Large rhexis Decenteration

Hydrodissection z Incomplete hydro z Forceful hydro z PPC Complications y. Inadequate cortical-capsular bag separation y. Fluid misdirection syndrome y. Zonular damage y. Posterior capsular tear y. Nucleus drop y. Capsular block syndrome

Nucleus prolapse Difficult situations z. Incomplete hydroprocedure z. Small rhexis z. Mid-iris synechiae z. Very soft nucleus z. Hard brown wodden nucleus z. Small pupil

Complications z. Endothelial Damage z. Iridodialysis/Damage to Iris z. Zonular Dialysis z. PCR

Nucleus Delivery z. Endothelial damage z. Zonular dialysis/PCR z. Iris Sandwich

Iris injury z. Sphincter tear z. Iridodialysis <1 hr : no intervention >1 hr : suture z. Iris prolapse Careful repositioning Suture tunnel Post op steroids & NSAIDs

Iridodialysis Mc. Cannel Suture

Hyphema z. From tunnel y. Posterior tunnel y. Deep tunnel z. From Iris y. Iris handling y. Iridodialysis

Intraoperative Miosis z. Avoid iris touch z. VES z. Pharmacological z. Spincterotomy z. Hook

Zonular dialysis Can be pre/intra operative z. Approach z. Bimanual prolapse of nucleus z. Phacosandwich z. IOL 1 quad – sulcus (perpendicular to the dialysis) 2 quad - CTR >2 quad - ACIOL/aphakia

Posterior capsular tear z. Seal the tear using visco (don’t hydrate) z. Automated ant vitrectomy z. Residual cortex - dry aspiration Post op inflammation Obstruct visual axis Secondary glaucoma

Bimanual automated vitrectomy At the start of vitrectimy Completed vitrectomy

Dropped nucleus z If anterior : inject visco : deliver with vectis z Deep into the vitreous : Retinal surgeon intervention

Expulsive Haemorrhage z. Tissue prolapse z. Hard globe z. Loss of red glow z. Choroidal haemorrhage z. CRAO Rx : Suture IV Mannitol Post segment assessed

Immediate post op complications Wound Dehiscence Etilology x. Excessive episcleral cautrey x. Premature entry x. Button holing x. Nuclear or cortical fragment in tunnel x. Postoperative IOP rise x. Collagen vascular diseases x. Leaking paracentesis wound

Treatment x. Patch the eye x. Cycloplegics x. Exploration of wound and suturing

Corneal complications z. Corneal edema z. Striate keratopathy z. Bullous keratopathy

Corneal complications Management : Control inflammation Antiglaucoma drugs Treat epithelial defect Cycloplegics

Post op Iritis z. Excess manipulation during nucleus prolapse & delivery z. Residual cortex Management y. Topical steroids & antibiotics y Cycloplegics y Topical NSAIDs

Post op increase in IOP z. Retained viscoelastics z. Over distention of AC while reforming Rx: antiglaucoma medications

Late complications z. Corneal complications z. Uveitis z. Capsular bag complications z. PCO z. IOL malformations z. CME z. Endophthalmitis

Post segment complications z. RD z. Lost lens syndrome z. Vitreous hemorrhage z. Vitritis

Successful management z. Recognition z. Knowledge z. Skill z. Judgement