|Year : 2019 | Volume
| Issue : 3 | Page : 232-234
Case report: Biometry in air-filled eye following retinal surgery
Mukesh Kumar1, Abhishek Varshney2
1 Department of Glaucoma and Refractive Surgeries, C L Gupta Eye Institute, Moradabad, Uttar Pradesh, India
2 Department of Vitreoretina, C L Gupta Eye Institute, Moradabad, Uttar Pradesh, India
|Date of Web Publication||31-Dec-2019|
Dr. Mukesh Kumar
Department of Glaucoma and Refractive Surgeries, C L Gupta Eye Institute, Ram Ganga Vihar Phase II Ext, Moradabad - 244 001, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
A 70-year-old male patient presented with vitreous hemorrhage in his right eye, for which he was advised for pars plana vitrectomy and endolaser. During the surgery, there was inadvertent contact with the crystalline lens with one of the intraocular instruments. This was reported as an intraocular complication. Postoperatively, cataract was developed in his right eye due to lens touch. An early cataract surgery was planned. A scan was done in phakic eye on day three after first surgery, which showed axial length 28.7 mm. On the postoperative day 10, axial length was 22.25 mm using contact method. Surgery was delayed for 4–5 days due to this. No A Scan machine has software for axial length and correct lens power calculation in air-filled eyes following retinal surgeries. A scan machine does not have information or software to calculate intraocular lens power in air-filled eyes after retinal surgery. This information will be helpful in planning early cataract surgeries if required after retinal surgery.
Keywords: Axial length, cataract, complication, lens touch, phacoemulsification, vitrectomy
|How to cite this article:|
Kumar M, Varshney A. Case report: Biometry in air-filled eye following retinal surgery. Kerala J Ophthalmol 2019;31:232-4
| Introduction|| |
Pars plana vitrectomy (PPV) is the most commonly performed vitreoretinal procedure. Lens touch is a frequent complication of PPV in a phakic eye. The incidence of lens touch during PPV reported by previous studies ranged from 1.6% to 3.7%., This complication has the potential to develop early cataract in the postoperative period requiring further surgery to rectify. Replacement of intraocular contents with gas or silicone oil changes the optical characteristics of the eye, including axial length and keratometry.
For cataract extraction following retinal surgeries, intraocular lens power has been calculated according to different retinal tamponades such as silicone oil or heavy silicone oil. To achieve a favorable postoperative visual outcome, accurate preoperative intraocular lens power calculation is crucial, and precise measurement of axial length is the most important element in obtaining accurate estimations of the intraocular lens power calculation., Many studies have been reported the accuracy of intraocular lens power calculation in the silicone oil-filled eyes.,, We report challenge faced in intraocular lens power calculation for early cataract extraction in a patient with lens touch during PPV.
| Case Report|| |
A 70-year-old male patient was presented to our institute with chief complaints of sudden painless diminution of vision for distance in his right eye for the past 5 days. He has no history of trauma. On examination, his best-corrected visual acuity in the right eye was 20/320, and in the left eye was hand movement. He was diagnosed vitreous hemorrhage in his right eye, for which he was advised for PPV and endolaser. His left eye was diagnosed with advanced tractional retinal detachment.
Surgery was performed in the right eye and air was used for intraocular tamponade. During the surgery, there was inadvertent contact with the crystalline lens with one of the intraocular instruments. This was reported as an intraocular complication. On the postoperative day 1, his best-corrected visual acuity in the right eye was hand movement. This was due to cataract development because of lens touch. As patient was one-eyed early cataract surgery was planned for his right eye. A scan was done in phakic eye on day 3 after first surgery, which showed axial length 28.7 mm. On the postoperative day 10, axial length was 22.25 mm using contact method. Phacoemulsification with posterior chamber intraocular lens was performed using intraocular power calculated on the postoperative day 10 [Figure 1].
|Figure 1: Clinical timeline: 70-year-old male diagnosed and surgically treated for vitreous hemorrhage. Early cataract surgery was planned after pars plana vitrectomy. Cataract surgery was delayed because of no availabillity of software for axial length calculation in air-filled eyes|
Click here to view
| Discussion|| |
Elhousseini et al. reported that the median time between PPV and cataract extraction was 4 months. Due to the frequent occurrence of lens touch during PPV, Thompson recommended to perform cataract surgery before or during PPV, especially in those with high risk of postoperative cataract formation in patients older than 50 years.
Since this patient was one eyed, and the development of cataract interferes with his day to day vision. The purpose of the early cataract surgery was to improve his vision as much as possible. Because of myopic change reported at day 3, and there was no sign of myopic fundus during surgery his surgery was delayed for 4–5 days to measure the accurate intraocular lens power for cataract surgery. There was a change in axial length from day 3 to day 10. This change in axial length was because of air-filled vitreous cavity. No A Scan machine have software for axial length and correct lens power calculation in air-filled eyes following PPV surgery.
The air gets absorbed from the vitreous cavity within 1 week. One can wait for cataract surgery in this situation, but as this patient is one eyed and developed cataract within 24 h as a result of surgical complication, early cataract surgery was needed. A scan machine does not have any such information to calculate intraocular lens power in air-filled eyes after retinal surgery. This information will be helpful in planning early cataract surgery if required after retinal surgery.
The authors would like to thank Mr. Lokesh Chauhan for his technical support in preparing this manuscript.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ramulu PY, Do DV, Corcoran KJ, Corcoran SL, Robin AL. Use of retinal procedures in medicare beneficiaries from 1997 to 2007. Arch Ophthalmol 2010;128:1335-40.
Elhousseini Z, Lee E, Williamson TH. Incidence of lens touch during pars plana vitrectomy and outcomes from subsequent cataract surgery. Retina 2016;36:825-9.
Jackson TL, Donachie PH, Sparrow JM, Johnston RL. United Kingdom national ophthalmology database study of vitreoretinal surgery: Report 1; case mix, complications, and cataract. Eye (Lond) 2013;27:644-51.
Afrashi F, Erakgun T, Akkin C, Kaskaloglu M, Mentes J. Conventional buckling surgery or primary vitrectomy with silicone oil tamponade in rhegmatogenous retinal detachment with multiple breaks. Graefes Arch Clin Exp Ophthalmol 2004;242:295-300.
McEwan JR, Massengill RK, Friedel SD. Effect of keratometer and axial length measurement errors on primary implant power calculations. J Cataract Refract Surg 1990;16:61-70.
Olsen T. Sources of error in intraocular lens power calculation. J Cataract Refract Surg 1992;18:125-9.
Murray DC, Durrani OM, Good P, Benson MT, Kirkby GR. Biometry of the silicone oil-filled eye: II. Eye (Lond) 2002;16:727-30.
Symes RJ. Accurate biometry in silico
ne oil-filled eyes. Eye (Lond) 2013;27:778-9.
Elbendary AM, Elwan MM. Predicted versus actual intraocular lens power in silico
n-oil-filled eyes undergoing cataract extraction using automated intraoperative retinoscopy. Curr Eye Res 2012;37:694-7.
Thompson JT. The role of patient age and intraocular gas use in cataract progression after vitrectomy for macular holes and epiretinal membranes. Am J Ophthalmol 2004;137:250-7.