what are we missing arupeye@gmail.comascrs16.expoplanner.com/handouts_ascrs/001452_37110007... ·...

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LESS-THAN – PERFECT OUTCOMES AFTER UNEVENTFUL CATARACT SURGERY :

WHAT ARE WE MISSING WHAT ARE WE MISSING ??????

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P C O

WHAT ARE WE MISSING?

1. PATIENT SPECIFIC FACTORS2. OCULAR SURFACE DISEASE3. KERATITIS MEDICAMENTOSA4. REFRACTIVE SURPRISES5. EARLY PCO6. DYSPHOTOPSIA7. SUBTLE CORNEAL PATHOLOGIES8. IOL DECENTRATION9. PROBLEMS WITH MF IOLS 10. SUBTLE MACULAR PATHOLOGIES

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PCO

EARLY PCO

ARUP CHAKRABARTICataract & Glaucoma ServicesChakrabarti Eye Care Centre

Trivandrum, Kerala, India

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Financial Interest – NIL

How Do We Manage?

PCO ASSESSMENT

v S/L BiomicroscopyvRetroillumination

v Distant Direct Ophthalmoscopyv Direct Ophthalmoscopy

vClarity of Fundus View

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PCO PROPHYLAXIS

v Complete Removal of LEC

vInhibition of LEC Prolifern / Migration

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v Surgical

v Pharmacologicv Immunologic

v LCOPLaser Capsular Opacity Prevention

Laser Capsular Opacity Prevention (LCOP)ARC Nd:YAG laser photolysis

arupeye@gmail.comJ CATARACT REFRACT SURG - VOL 36, JUNE 2010

Laser Capsular Opacity Prevention (LCOP)ARC Nd:YAG laser photolysis

arupeye@gmail.comJ CATARACT REFRACT SURG - VOL 41, DECEMBER 2015

• WHAT WAS KNOWN• LP is capable of removing LECs from

the Ant Capsule & the capsular bag Fx in an in vitro setting

• LP capsule polishing can be performed safely during in vivo cataract surgery

• WHAT THIS PAPER ADDS• Circumferential LP capsule polishing

provides complete and sustained prevention of PCO in an in vitro setting.

• Thorough ablation of LECs from the capsular bag fornix can be achieved in vitro using a standardized, stepwise surgical approach

Evaluation of laser capsule polishing for prevention of PCO in a human ex vivo model

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PCO PROPHYLAXIS

v Complete Removal of LEC

vInhibition of LEC Prolifern / Migration

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v Surgical

v Pharmacologicv Immunologic

v LCOPLaser Capsular Opacity Prevention

Capsulorhexis :Regular, Round, Well-cent. , 3600 IOL Optic Overlap

PCO PROPHYLAXIS

I & A : Thorough Cortical Clean – up to ¯ S- Ring

Role of Anterior Capsular Polishing :

Hydrodissection : Thorough Cortical Cleaving Hydrodissection

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Role of Posterior Capsular Polishing :

PCO Prophylaxis - CapsulorhexisCapsulorhexis

v Regular,

v Round,

v Well-cent. ,

v 3600 IOL Optic Overlap

v Capsular Sequestration

v “Shrink Wrap” the Capsule Around IOL

Optic

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v Rhexis Dia = 1 mm < IOL Optic Dia≥ 4 mm

v Rhexis Dia = 1 mm < IOL Optic Dia≥ 4 mm

Proper Sizing of the Capsulorhexis

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v Verus Capsulorhexis Device (Mile High Ophthalmics, Denver) -Malik Y Kahook.. JCRS 2014(May)

v Verus Capsulorhexis Device (Mile High Ophthalmics, Denver) -Malik Y Kahook.. JCRS 2014(May)

CapsuLaser Aperture TX - CTC ZeptoRhexis

PCO Prophylaxis – Cortical Cleaving Cortical Cleaving HydrodissectionHydrodissection

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PCO Prophylaxis – Role of PC Role of PC PolishingPolishing

0.31

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PCO Prophylaxis – Role of AC Role of AC PolishingPolishing- Controversial

- Many Would Like to Avoid It

Ring Polishers

Singer’s Sweep

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PCO Prophylaxis – Role of AC Role of AC PolishingPolishing

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PCO Prophylaxis – Role of AC Role of AC PolishingPolishing

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Maximal IOL Optic ContactPosterior Angulated HapticPost. Convexity of the Optic

Adhesive Biomaterial ( Shrink-Wrap)

IOL Optic Geometry- Square, Truncated Edge- Optiedge

• “Biocompatible IOL Material¯ Stimuln of Cellular Prolifern

• “Small Haptic-Optic Junction

IOL IssuesPCO PROPHYLAXIS

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PCO : MANAGEMENT

Decision More Complex in a MF IOL Pt

? Cause of Visual Disability- Early PCO- Other Mechanism- Early PCO + Other Mechanisms

• YAG Capsulotomy for Early PCO (When PCO wasn’t the Cause)

Nonimprovement of SymptomsComplicate Further Mx if IOL Exchange is Needed

YAG Capsulotomy Definitive

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MANAGEMENT : Post YAG Capsulotomy

Guard Against CME & other Retinal Complications

Topical Steroids

NSAIDs

Topical IOP Lowering Agents

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Well Centered + Adequate Size

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WHAT ARE WE MISSING?

6. DYSPHOTOPSIA7. SUBTLE CORNEAL PATHOLOGIES8. IOL DECENTRATION9. PROBLEMS WITH MF IOLS 10. SUBTLE MACULAR PATHOLOGIES

arupeye@gmail.com

1. PATIENT SPECIFIC FACTORS2. OCULAR SURFACE DISEASE3. KERATITIS MEDICAMENTOSA4. REFRACTIVE SURPRISES

5. EARLY PCO

CONCLUSION : MANAGEMENT of EARLY PCO

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• “Early PCO” Assumes Significance in the Context of MFIOL

• Prophylaxis – Good Surgical Technique, Strategy - Appropriate IOL Design

• YAG Capsulotomy is Definitive but the Decision Process is Complex