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 deliveryand instrument manipulation

Management: Suture for premature entry

Incision length

Short incision

Difficulty in nucleus delivery

Endothelial damageris 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

TreatmentAirViscoelastics

Paracentesis

Site

Size

Too central

Too peripheral

Too small

Too big

Capsulotomy

CAPSULORHEXIS Peripheral extension/ Run away rhexis

Post capsule tear

ManagementReform AC with VESPull flap centrallyCut capsule just ahead of peripherally extending rhexisContinue in reverse directionCanopener

Inappropriate size

Too small

Management: Enlarge the rhexis by

2 or 3 relaxing incisions

Too big

Large rhexis Decenteration

Hydrodissection

Incomplete hydroForceful hydroPPCComplications

Inadequate cortical-capsular bag separation Fluid misdirection syndrome Zonular damage Posterior capsular tear Nucleus drop Capsular block syndrome

Nucleus prolapse

Difficult situationsIncomplete hydroprocedureSmall rhexisMid-iris synechiaeVery soft nucleusHard brown wodden nucleusSmall pupil

ComplicationsEndothelial Damage

Iridodialysis/Damage to Iris

Zonular Dialysis

PCR

Nucleus Delivery

Endothelial damage

Zonular dialysis/PCR

Iris Sandwich

Iris injury

Sphincter tearIridodialysis

<1 hr : no intervention>1 hr : suture

Iris prolapseCareful repositioningSuture tunnelPost op steroids & NSAIDs

Iridodialysis

McCannel Suture

Hyphema

From tunnel Posterior tunnel Deep tunnel

From Iris Iris handling Iridodialysis

Intraoperative Miosis

Avoid iris touchVESPharmacologicalSpincterotomyHook

Zonular dialysis

Can be pre/intra operativeApproachBimanual prolapse of nucleusPhacosandwichIOL

1quad – sulcus (perpendicular to the dialysis)2quad - CTR>2quad - ACIOL/aphakia

Posterior capsular tear

Seal the tear using visco (don’t hydrate)

Automated ant vitrectomyResidual cortex - dry aspiration

Post op inflammationObstruct visual axisSecondary glaucoma

Bimanual automated vitrectomy

Completed vitrectomy

At the start of vitrectimy

Dropped nucleus

If anterior : inject visco : deliver with vectis

Deep into the vitreous : Retinal surgeon intervention

Expulsive HaemorrhageTissue prolapseHard globeLoss of red glowChoroidal haemorrhageCRAO

Rx : Suture IV Mannitol Post segment assessed

Immediate post op complications

Wound DehiscenceEtilology

Excessive episcleral cautreyPremature entryButton holingNuclear or cortical fragment in tunnelPostoperative IOP riseCollagen vascular diseasesLeaking paracentesis wound

TreatmentPatch the eyeCycloplegicsExploration of wound and suturing

Corneal complications

Corneal edemaStriate keratopathyBullous keratopathy

Corneal complications

Management : Control inflammation Antiglaucoma drugs

Treat epithelial defectCycloplegics

Post op Iritis

Excess manipulation during nucleus prolapse & delivery

Residual cortexManagement

Topical steroids & antibiotics Cycloplegics Topical NSAIDs

Post op increase in IOP

Retained viscoelasticsOver distention of AC while

reforming

Rx: antiglaucoma medications

Late complications

Corneal complicationsUveitisCapsular bag complicationsPCOIOL malformationsCMEEndophthalmitis

Post segment complications

RD

Lost lens syndrome

Vitreous hemorrhage

Vitritis

Successful management

RecognitionKnowledgeSkillJudgement