Our Summary

This research paper presents a new method for a type of eye surgery that could improve results for patients with a specific kind of cataract issue where the lens of the eye is out of place or subluxated. The procedure combines two types of surgeries: femto laser-assisted cataract surgery (FLACS) and a specific kind of eye surgery called a limited vitrectomy, performed from a particular angle known as the pars-plana.

FLACS involves using a laser to create a precise opening in the eye to remove the cataract. This laser method is gentle on the zonules, which are tiny fibres that suspend the lens within the eye. The laser also helps to break down the cataract, reducing the need for additional power or force in the procedure.

The paper also talks about a problem that can arise during surgery where the fluid used can over-hydrate a part of the eye leading to more problems. To solve this, they propose performing a vitrectomy - a procedure to remove some of the jelly-like substance that fills the eye - from the pars-plana angle. This way, it cuts the over-hydrated substance near its attachment, preventing further issues and putting less stress on the zonules.

By combining these procedures and using a device to support the capsule (the part of the eye that contains the lens and cataract), the researchers believe they can achieve better results for patients with moderate to severe lens subluxation.

FAQs

  1. What is the proposed technique for dealing with subluxated cataracts?
  2. How does FLACS assist in dealing with subluxated cataracts?
  3. What is the difference between trans-limbal vitrectomy and pars-plana vitrectomy?

Doctor’s Tip

A doctor might tell a patient undergoing vitrectomy to follow post-operative instructions carefully, including avoiding strenuous activities and lifting heavy objects to prevent any complications or damage to the eye. It is also important to attend all follow-up appointments to monitor healing and ensure the best possible outcome.

Suitable For

Patients who are typically recommended vitrectomy include those with:

  1. Severe retinal detachment or tears
  2. Macular holes
  3. Diabetic retinopathy with vitreous hemorrhage
  4. Vitreous opacities or floaters that significantly impair vision
  5. Epiretinal membranes
  6. Proliferative vitreoretinopathy
  7. Trauma to the eye causing vitreous hemorrhage or retinal detachment

Timeline

Before vitrectomy:

  1. Patient presents with subluxated cataract, which is causing visual impairment and possibly other symptoms such as glare or double vision.
  2. Patient undergoes pre-operative evaluation, including imaging tests to assess the extent of zonular weakness and vitreous involvement.
  3. Surgeon determines that a combined FLACS and limited vitrectomy procedure is necessary to optimize surgical results.
  4. Patient receives pre-operative instructions and consents to the procedure.

After vitrectomy:

  1. Patient undergoes FLACS, which creates a customised capsulotomy and prechops the nucleus, reducing the ultrasonic power required for cataract removal.
  2. Limited vitrectomy is performed from the pars-plana site, cutting the liquefied vitreous near its attachment to prevent further zonular weakness.
  3. A capsule support device is used to stabilize the capsular bag and ensure proper intraocular lens placement.
  4. Surgical outcomes are favorable, with improved visual acuity and reduced risk of complications such as retinal detachment or posterior capsule opacification.
  5. Patient undergoes post-operative care, including follow-up appointments to monitor healing and visual recovery.

What to Ask Your Doctor

  • What is the purpose of combining femto laser-assisted cataract surgery and limited vitrectomy for subluxated cataracts?
  • How does FLACS help in minimizing stress on compromised zonules?
  • What are the potential benefits of using a capsule support device in this combined procedure?
  • What are the risks or complications associated with this combined procedure?
  • How long is the recovery time expected to be for patients undergoing this combined procedure?
  • What are the success rates or outcomes typically seen with this combined procedure for subluxated cataracts?
  • Are there any specific criteria or factors that make a patient a good candidate for this combined procedure?
  • How does pars-plana vitrectomy differ from trans-limbal vitrectomy in terms of outcomes and risks?
  • What post-operative care or follow-up appointments should a patient expect after undergoing this combined procedure?
  • Are there any alternative treatment options available for subluxated cataracts that should be considered before opting for this combined procedure?

Reference

Authors: Sachdev MS, Gupta A, Gupta H, Sachdev GS, Malik R, Sachdev R. Journal: Indian J Ophthalmol. 2022 Feb;70(2):658-661. doi: 10.4103/ijo.IJO_1636_21. PMID: 35086258