IOL exchange in a simple way- Iris Clawed IOL (Artisan)

王嘉康 Jia-Kang WangTaiwan Moderator

許粹剛 Tsui-Kang HsuTaiwan Speaker When the Capsule Gives Way: Winning the Posterior Rupture BattleCataract surgery is the most commonly performed operation in ophthalmology and despite tremendous instrumental and technological advancements, posterior capsular rupture (PCR) still occurs. PCR occurs both in all eye surgeons, although with a higher frequency in the newer starter group. Additionally, certain types of cataracts are prone to this development. If handled properly in a timely method, the eventual outcome may be no different from that of an uncomplicated case. However, improper management may lead to serious complications with a higher incidence of permanent visual impairment. The speech disclose the management of PCR from two perspectives: 1. Identifying patients with higher risk and know the sign of early PCR, and measures to manage such patients by surgical maneuver, and 2. Intraoperative management of posterior capsular rupture with anterior vitrectomy with different setting and various case scenarios to prevent further long-term complications. Solution for Residual Large Lens Material with PCRCompromise of the posterior capsule can occur in the hands of both new and experienced surgeons. Learning how to prevent, avoid, or efficiently manage posterior capsular rupture (PCR) is important. If PCR is present with residual lens material and vitreous loss, it is important to disentangle the vitreous from any nuclear/cortical fragments to ensure their safe removal without creating vitreous traction in case of retinal detachment. The vitreous can be stained by using preservative-free triamcinolone to delineate its presence in the anterior chamber and any incarceration in the wound. Anterior vitrectomy can be performed to remove the vitreous from the anterior segment properly. Alternatively, suppose the surgeon is comfortable with a pars plana approach which is better route. In that senario, a pars plana vitrectomy can be done, which helps to pull the vitreous back to the posterior segment, and avoids excessive anterior chamber manipulation. The pars plana approach may also permit better access to residual lens material—the vitrector may be used to clear nuclear and cortical material with a change in settings. At the end of the case, the wounds should be checked carefully to ensure no vitreous is present. A suture or more if necessary, depending on wound size, should be placed at the primary wound. Pupillary miosis should be done to inspect the pupil. If the pupil is peaked, there is likely vitreous still present in the anterior chamber and possibly in the wound. Once the vitreous is adequately cleared, one may carefully resume phacoemulsification and insert an IOL in various methods.