Fig. 8.18 The ßuid needle lifts a dislocated lens fragment from the retina to the centre of the vitreous cavity where it can be cut with the vitreous cutter without danger to the retina

If you perform this procedure without ßuid needle (only with the fragmatome), there is a risk that during the frequent aspiration of the lens fragments with the fragmatome, you may injure the retina (retinal break) or the choroid (choroidal haemorrhage). In addition, the frequent aspiration of the lens fragments clogs the vitreous cutter. If the suction is not working properly, it is even easier to induce damage to the retina or choroid. At the end, the PFCL has to be removed.

Pits & Pearls No. 47

Dropped nucleus and PFCL: In cases of vitrectomy for dropped nucleus, beware of injecting PFCL into eyes with blood in the vitreous cavity or on the retina (either from the sclerotomies or from retinal injuries). The mixture of lens fragments, blood and PFCL can form a type of ÔsuperglueÕ that can stick lens fragments to the retina, which are virtually impossible to remove without signiÞcant retinal injury. Make sure that all blood is cleared before injecting PFCL in such cases.

7. Implantation of an IOL

If more than two-third of the anterior capsule is intact, the lens is implanted into the sulcus (Ôhaptic out, optic inÕ) (Fig. 8.19). If not, Þxate a lens to the sclera or to the iris (e.g. PMMA Verisyse) (Fig. 8.20).

8. Removal of PFCL Aspirate the PFCL and perform an internal serach for retinal breaks

Fig. 8.19 The IOL is implanted in the sulcus in an eye with posterior capsular defect. The haptics are placed in the sulcus, and the optic is pressed with the push-pull instrument behind the anterior capsule

Fig. 8.20 Constriction of the pupil with Miochol.

Implantation of an iris-Þxated Verisyse PMMA behind

the pupil