Intraoperative Posterior Chamber Irrigation to Enhance Vitreous Cavity Support during Phacoemulsification Cataract Surgery after Vitrectomy

Figure 2

Photographs showing irrigation fluid flow in the posterior chamber irrigation procedure during cataract surgery on a vitrectomized eye. The eye had recurrent retinal detachment after primary vitrectomy and thus required secondary vitrectomy. Fluid flow was visualized using an injection of indocyanine-green solution. The infusion cannula position is shown in Figure 1. (a) A slightly deep anterior chamber was formed with cohesive viscoelastic tamponade. (b-c) Hypotony of vitreous cavity occurred after I/A. Then, the vitreous cavity was infused in the anterior to posterior direction. (b) With low posterior segment pressure, most of the irrigation fluid went posteriorly to the vitreous cavity rather than anteriorly flushing out the viscoelastic. Thus, the anterior chamber did not become shallow during irrigation. (c) As the vitreous pressure increased, reflux of fluid forced the outflow of viscoelastic from the main corneal incision. (d) The ciliary processes, lens capsule, and pars plana (white arrow) were observed to be stained green. The staining provides evidence of irrigation through the zonular fibers to the posterior chamber.

(a)

(b)

(c)

(d)