Complications of SICS

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Complications of SICS

• Dr.Haripriya Aravind

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Tunnel construction

• Approach
• Placement
• Length
• Depth

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Placement

• Anterior incision
• Poor self sealing effect
• Wound leak
• Astigmatism
• Management Suture

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• Posterior incision
• Wide tunnel
• Risk of bleeding
• Risk of premature entry
• Difficulty in nucleus delivery
• and instrument manipulation
• Management Suture for premature entry

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Incision length

• Short incision
• Difficulty in nucleus delivery
• Endothelial damage
• ris damage
• Management Enlarge incision with keratome

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• Long incision
• Poor approximation
• Wound leak
• Induced ATR astigmatism
• Management Suture

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Incision Depth

• Premature entry
• Button holing
• Scleral disinsertion

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Descemets Stripping

• Main wound Instruments
• Paracentesis VES/Fluids
• Treatment
• Air
• Viscoelastics

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Paracentesis

• Site
• Size

Too central
Too peripheral
Too small
Too big
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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

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Inappropriate size

• Too small
• Management Enlarge the rhexis by
• 2 or 3 relaxing incisions
• Too big

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Large rhexis Decenteration
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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

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Nucleus prolapse

• Difficult situations
• Incomplete hydroprocedure
• Small rhexis
• Mid-iris synechiae
• Very soft nucleus
• Hard brown wodden nucleus
• Small pupil

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• Complications
• Endothelial Damage
• Iridodialysis/Damage to Iris
• Zonular Dialysis
• PCR

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Nucleus Delivery

• Endothelial damage
• Zonular dialysis/PCR
• Iris Sandwich

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Iris injury

• Sphincter tear
• Iridodialysis
• lt1 hr no intervention
• gt1 hr suture
• Iris prolapse
• Careful repositioning
• Suture tunnel
• Post op steroids NSAIDs

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Iridodialysis
McCannel Suture
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Hyphema

• From tunnel
• Posterior tunnel
• Deep tunnel
• From Iris
• Iris handling
• Iridodialysis

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Intraoperative Miosis

• Avoid iris touch
• VES
• Pharmacological
• Spincterotomy
• Hook

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Zonular dialysis

• Can be pre/intra operative
• Approach
• Bimanual prolapse of nucleus
• Phacosandwich
• IOL
• 1quad sulcus (perpendicular to the dialysis)
• 2quad - CTR
• gt2quad - ACIOL/aphakia

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Posterior capsular tear

• Seal the tear using visco (dont hydrate)
• Automated ant vitrectomy
• Residual cortex - dry aspiration

Post op inflammation Obstruct visual
axis Secondary glaucoma
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Bimanual automated vitrectomy
At the start of vitrectimy
Completed vitrectomy
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Dropped nucleus

• If anterior inject visco
• deliver with vectis
• Deep into the vitreous Retinal surgeon
  intervention

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Expulsive Haemorrhage

• Tissue prolapse
• Hard globe
• Loss of red glow
• Choroidal haemorrhage
• CRAO
• Rx Suture
• IV Mannitol
• Post segment assessed

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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

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• Treatment
• Patch the eye
• Cycloplegics
• Exploration of wound and suturing

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Corneal complications

• Corneal edema
• Striate keratopathy
• Bullous keratopathy

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Corneal complications

• Management Control inflammation
• Antiglaucoma drugs
• Treat epithelial defect
• Cycloplegics

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Post op Iritis

• Excess manipulation during nucleus prolapse
  delivery
• Residual cortex
• Management
• Topical steroids antibiotics
• Cycloplegics
• Topical NSAIDs

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Post op increase in IOP

• Retained viscoelastics
• Over distention of AC while reforming
• Rx antiglaucoma medications

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Late complications

• Corneal complications
• Uveitis
• Capsular bag complications
• PCO
• IOL malformations
• CME
• Endophthalmitis

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Post segment complications

• RD
• Lost lens syndrome
• Vitreous hemorrhage
• Vitritis

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Successful management

• Recognition
• Knowledge
• Skill
• Judgement

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THANK YOU