Transcript Nucleous drop

PC Rent with
Nucleus / IOL Drop
Sr.Panchavarnam
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Definition:
The whole or partial nucleus drop into
the vitreous
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Occurrence
Small capsula Rhexis
Subluxated lens
During excess hydro
Rhexis extention
dissection
i. PPC (Posterior Polar Cataract)
During nucleus delivery
Hard Nucleus
Weak Zonulers
If Hydro dissection is done
ii. Traumatic Cataract
PHACO Sculpting
PXF
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Signs of nucleus drop
AC deep – Anterior chamber will be deep
Difficulty in delivering nucleus with
Sinske –suspect impending PCR Nucleus drop
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Management
If the nucleus drops occur, instruments should not be used to
take it out, because this will affect the retina (eg. i. Retinal
detachment ii.Choroid Detachment)
Immediately approach the Retina specialist.
Retina specialist will do Vitrectomy and bring out the nucleus if
there is small posterior capsule rent PC IOL could be placed
If the posterior capsule is ruptured, PC IOL cannot be
implanted. Patient can be reviewed after 1 month, and corneal
status assessed and decided for secondary IOL
If necessary after three months AC IOL could be implanted.
This could be avoided for old age people, corneal problem
patients.
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Complications (Post Operative)
Retinal Detachment
Chordial detachment
Vitreous Haemorrhage
Aphakic Glaucoma or Pseudo Aphakic
Glaucoma
Inflammation
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IOL Drop
During the cataract surgery if the
implanted lens drops into the vitreous
the condition is called as IOL drop
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Reasons
Posterior capsule rent
IOL dialing
Zonular dialysis
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Management
If there is vitreous disturbance Vitrectomy has to be
done
Retina surgeon is to be called to remove the lens
If the lens could be placed in the sulcus it could be done
otherwise leave it aphakic.
After one month, if the inflammation is reduced, we can
check whether the IOL could be placed.
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