| 본문 : Vitrectomy with intraocular gas tamponade is an established treatment for idiopathic macular hole and retinal detachment. Because nucleosclerosis is a common complication of vitrectomy with gas tamponade, phacovitrectomy, combined pars plana vitrectomy with phacoemulsification and intraocular lens (IOL) implantation, has become a common procedure for treating various disease.
Posterior optic buttonholing (POBH) though a primary posterior continuous curvilinear capsulorrhexis (PPCCC) is a surgical technique primarily designed to prevent PCO. Previous report demonstrated significantly reduced postoperative anterior movement of IOL and few complications in 1000 consecutive cases that had primary posterior CCC with posterior optic buttonholing. However, this procedure, the forcep-created posterior CCC with POBH, is technically difficult with a steep learning curve and it is uncommon to use this technique for a phacovitrectomy. Recent study reported that using 25-gauge vitreous cutter in phacovitrectomy can be easily performed and avoid the complications caused by inexperience.
In our study, we considered this primary posterior capsulotomy and posterior optic buttonholing technique in eyes with phacovitrectomy with gas tamponade.
Phacoemulsification is performed in the usual fashion through a 3 mm superior clear corneal incision. A well-centered 5.0 mm-sized continuous curvilinear capsulorhexis of the anterior lens capsule is made, followed by a hydrodissection, phacoemulsification and irrigation/aspiration. The foldable 3-piece acrylic IOL with a 6.0 mm round optic is inserted into the ciliary sulcus. The posterior capsule is then removed from the center toward the periphery using a 25-gauge vitreous cutter with pars plana approach. The size of posterior capsulotomy is approximately 4.5 to 5.0 mm in diameter. Using a Sinskey hook via corneal incision, the one side of the optic was gently pushed back into the vitreous cavity and enclavated beneath the posterior capsulotomy. The other side of the optic is enclavated in the same manner.
This technique helps maintain stable compartmentalization between the anterior and posterior segments during fluid-air exchange and gas tamponade. It also makes stability of IOL, prevents posterior synechiae and posterior capsular opacity after phacovitrectomy with gas tamponade. |