Page 83 - The Book Pi in eye

Pi in eye

marked decrease in vision. In extreme cases the lens could fall behind
into the vitreous jelly. Stitching or exchanging the lens may be an
option.

Posterior Capsular Tear or Rupture
The lens sits in the bag. Integrity of this bag is important in
modern day cataract and Prelex procedure. If there is a tear or hole in
the bag, vitreous jelly may present itself in front. If it reaches the
wound, it could tug on the macula. In that event it would have to be
mechanically excised using an automated vitrector. The visualization
of this colorless jelly can be enhanced by injecting preservative free
steroid solution (kenalog).
Once the vitreous is cleared the lens and remaining support of the
bag will need to be reassessed. Crystalens insertion would not be
possible, and a three piece Restor or Tecnis may still be safely
implanted either over the posterior capsule or over the anterior
capsule.

Blood in the Anterior Chamber
The blood may originate from trauma of instruments to the vessels
near the wound or the iris. Tendency to bleed is increased in patients
on blood thinners like aspirin or anticoagulants like warfarin. The
opaque blood cells interfere with vision. Minor amounts of blood
clear with time. Moderate amounts can accumulate and form a clot
and may increase the intraocular pressure. This may require aspiration.

Iris Prolapse
The iris may come out of the wound if there is a wound leak or
high eye pressure. Besides causing inflammation this may provide a
channel for bugs to enter the eye. In cases detected approximately
within 48 hours the eye pressure can be lowered and the iris pushed
back. If detected later, the protruding iris has to be excised. It is
common in floppy iris or eyes with high pressure. Constricting the
pupil with Miochol/Miostat or Pilocapine can prevent it.

Wound Leak
Wound leak is a problem as it can cause shift of a well centered
lens. It can also give a pathway for the sinister bugs to enter and cause
infection. Wound leaks are more common due to poorly constructed

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