| 본문 : Cataract surgery in combined vitrectomy can be challenging due to the poor fundus reflex caused by severe vitreous hemorrhage, lens opacity, or corneal opacity. To overcome the challenges in eyes with compromised red reflex, anterior capsule staining with dye, surgeon or assistant-held intravitreal illumination, or Chandelier retroillumination have been used for cataract surgery. With light pipe guard, we could perform cataract extraction with a hands-free view, with safety, without additional equipment. The purpose of this paper is to introduce the surgical technique of using light pipe guard for cataract surgery in combined vitrectomy in patients with poor red reflex.
From March to November in 2014, combined vitrectomy and cataract surgery was performed in 10 eyes 8 patients using light pipe guard who were scheduled for 23-gauge pars plana vitrectomy with coexisting cataract followed-up for more than 1 month. The causes of poor red reflex which need light pipe guard during combined phacovitrectomy were due to 8 vitreous hemorrhages (proliferative diabetic retinopathy in 7 eyes 5 patients and BRVO 1 eye) , 2 vitreous opacities ( Masquerade syndrome 1 eye. and RRD in 1 eye). Cataract extractions were successfully underwent in all patients without dye or other equipments. The intraoperative retroillumination was sufficient to perform all surgical steps during cataract extraction. All cases of cataract surgery were performed uneventfully except one case. Posterior capsular was ruptured in this case during phacoemulsification. Remnant lens materials were removed by vitrectomy and intraocular lens was placed in the ciliary sulcus without any other complications.
In this report, we introduce a new practical application of light pipe guard in combined cataract and vitrectomy improving visualizaion. With light pipe guard, we could perform cataract extraction with a hands-free view, with safety without additional equipment. Light pipe guard we introduced in this paper can offer safety of Chandelier illumination and did not need extra illumination system and is easily removable for access of light pipe to the delicate surgical field.
In conclusion, during phacovitrectomy clinicians operating on patients with poor red reflex may benefit from light pipe guard assisted cataract extraction, which is safe, cheap, and enhances visualization of lens structures.
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