Complications of SICS
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Transcript Complications of SICS
Complications of SICS
Dr.Haripriya Aravind
Tunnel construction
Approach
Placement
Length
Depth
Placement
Anterior incision
Poor self sealing effect
• Wound leak
• Astigmatism
Management: Suture
Posterior incision
Wide tunnel
Risk of bleeding
Risk of premature entry
Difficulty in nucleus delivery
and instrument manipulation
Management: Suture for premature entry
Incision length
Short incision
Difficulty in nucleus delivery
Endothelial damage
ris damage
Management: Enlarge incision with
keratome
Long incision
Poor approximation
Wound leak
Induced ATR astigmatism
Management: Suture
Incision Depth
Premature entry
Button holing
Scleral disinsertion
Descemet’s Stripping
Main wound
Instruments
Paracentesis
VES/Fluids
Treatment
Air
Viscoelastics
Paracentesis
Site
Too central
Too peripheral
Size
Too small
Too big
Capsulotomy
CAPSULORHEXIS
Peripheral extension/ Run away rhexis
Post capsule tear
Management
Reform AC with VES
Pull flap centrally
Cut capsule just ahead of peripherally
extending rhexis
Continue in reverse direction
Canopener
Inappropriate size
Too small
Management: Enlarge the rhexis by
2 or 3 relaxing incisions
Too big
Large rhexis Decenteration
Hydrodissection
Incomplete hydro
Forceful hydro
PPC
Complications
Inadequate cortical-capsular bag separation
Fluid misdirection syndrome
Zonular damage
Posterior capsular tear
Nucleus drop
Capsular block syndrome
Nucleus prolapse
Difficult situations
Incomplete hydroprocedure
Small rhexis
Mid-iris synechiae
Very soft nucleus
Hard brown wodden nucleus
Small pupil
Complications
Endothelial Damage
Iridodialysis/Damage to Iris
Zonular Dialysis
PCR
Nucleus Delivery
Endothelial damage
Zonular dialysis/PCR
Iris Sandwich
Iris injury
Sphincter tear
Iridodialysis
<1 hr : no intervention
>1 hr : suture
Iris prolapse
Careful repositioning
Suture tunnel
Post op steroids & NSAIDs
Iridodialysis
McCannel Suture
Hyphema
From tunnel
Posterior tunnel
Deep tunnel
From Iris
Iris handling
Iridodialysis
Intraoperative Miosis
Avoid iris touch
VES
Pharmacological
Spincterotomy
Hook
Zonular dialysis
Can be pre/intra operative
Approach
Bimanual prolapse of nucleus
Phacosandwich
IOL
1quad – sulcus (perpendicular to the
dialysis)
2quad - CTR
>2quad - ACIOL/aphakia
Posterior capsular tear
Seal the tear using visco (don’t hydrate)
Automated ant vitrectomy
Residual cortex - dry aspiration
Post op inflammation
Obstruct visual axis
Secondary glaucoma
Bimanual automated vitrectomy
At the start of vitrectimy
Completed vitrectomy
Dropped nucleus
If anterior : inject visco
: deliver with vectis
Deep into the vitreous : Retinal surgeon intervention
Expulsive Haemorrhage
Tissue prolapse
Hard globe
Loss of red glow
Choroidal haemorrhage
CRAO
Rx : Suture
IV Mannitol
Post segment assessed
Immediate post op
complications
Wound Dehiscence
Etilology
Excessive episcleral cautrey
Premature entry
Button holing
Nuclear or cortical fragment in tunnel
Postoperative IOP rise
Collagen vascular diseases
Leaking paracentesis wound
Treatment
Patch the eye
Cycloplegics
Exploration of wound and suturing
Corneal complications
Corneal edema
Striate keratopathy
Bullous keratopathy
Corneal complications
Management : Control inflammation
Antiglaucoma drugs
Treat epithelial defect
Cycloplegics
Post op Iritis
Excess manipulation during nucleus
prolapse & delivery
Residual cortex
Management
Topical steroids & antibiotics
Cycloplegics
Topical NSAIDs
Post op increase in IOP
Retained viscoelastics
Over distention of AC while reforming
Rx: antiglaucoma medications
Late complications
Corneal complications
Uveitis
Capsular bag complications
PCO
IOL malformations
CME
Endophthalmitis
Post segment complications
RD
Lost lens syndrome
Vitreous hemorrhage
Vitritis
Successful management
Recognition
Knowledge
Skill
Judgement