Intraoperative cracking of the AMO Phacoflex-II Silicone (SI-40NB) intraocular lens while implanting with the Unfolder TM silver series system using hydroxypropylmethylcellulose
Identifieur interne : 000C16 ( Ncbi/Merge ); précédent : 000C15; suivant : 000C17Intraoperative cracking of the AMO Phacoflex-II Silicone (SI-40NB) intraocular lens while implanting with the Unfolder TM silver series system using hydroxypropylmethylcellulose
Auteurs : Rohit Saxena ; Ankur Sinha ; Sudarshan Khokhar ; Munish Dhawan ; Kiran TurukaSource :
- Indian Journal of Ophthalmology [ 0301-4738 ] ; 2007.
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PubMed: 17699959
PubMed Central: 2636010
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Intraoperative cracking of the AMO Phacoflex-II Silicone (SI-40NB) intraocular lens while implanting with the Unfolder<sup> TM</sup> silver series system using hydroxypropylmethylcellulose</title><author><name sortKey="Saxena, Rohit" sort="Saxena, Rohit" uniqKey="Saxena R" first="Rohit" last="Saxena">Rohit Saxena</name></author><author><name sortKey="Sinha, Ankur" sort="Sinha, Ankur" uniqKey="Sinha A" first="Ankur" last="Sinha">Ankur Sinha</name></author><author><name sortKey="Khokhar, Sudarshan" sort="Khokhar, Sudarshan" uniqKey="Khokhar S" first="Sudarshan" last="Khokhar">Sudarshan Khokhar</name></author><author><name sortKey="Dhawan, Munish" sort="Dhawan, Munish" uniqKey="Dhawan M" first="Munish" last="Dhawan">Munish Dhawan</name></author><author><name sortKey="Turuka, Kiran" sort="Turuka, Kiran" uniqKey="Turuka K" first="Kiran" last="Turuka">Kiran Turuka</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">17699959</idno><idno type="pmc">2636010</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2636010</idno><idno type="RBID">PMC:2636010</idno><date when="2007">2007</date><idno type="wicri:Area/Pmc/Corpus">000D60</idno><idno type="wicri:Area/Pmc/Curation">000D60</idno><idno type="wicri:Area/Pmc/Checkpoint">002447</idno><idno type="wicri:Area/Ncbi/Merge">000C16</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Intraoperative cracking of the AMO Phacoflex-II Silicone (SI-40NB) intraocular lens while implanting with the Unfolder<sup> TM</sup> silver series system using hydroxypropylmethylcellulose</title><author><name sortKey="Saxena, Rohit" sort="Saxena, Rohit" uniqKey="Saxena R" first="Rohit" last="Saxena">Rohit Saxena</name></author><author><name sortKey="Sinha, Ankur" sort="Sinha, Ankur" uniqKey="Sinha A" first="Ankur" last="Sinha">Ankur Sinha</name></author><author><name sortKey="Khokhar, Sudarshan" sort="Khokhar, Sudarshan" uniqKey="Khokhar S" first="Sudarshan" last="Khokhar">Sudarshan Khokhar</name></author><author><name sortKey="Dhawan, Munish" sort="Dhawan, Munish" uniqKey="Dhawan M" first="Munish" last="Dhawan">Munish Dhawan</name></author><author><name sortKey="Turuka, Kiran" sort="Turuka, Kiran" uniqKey="Turuka K" first="Kiran" last="Turuka">Kiran Turuka</name></author></analytic><series><title level="j">Indian Journal of Ophthalmology</title><idno type="ISSN">0301-4738</idno><idno type="eISSN">1998-3689</idno><imprint><date when="2007">2007</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Balasubramanya, R" uniqKey="Balasubramanya R">R Balasubramanya</name></author><author><name sortKey="Rani, A" uniqKey="Rani A">A Rani</name></author><author><name sortKey="Dada, T" uniqKey="Dada T">T Dada</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lee, Ga" uniqKey="Lee G">GA Lee</name></author><author><name sortKey="Dal Pra, Ml" uniqKey="Dal Pra M">ML Dal Pra</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chuah, Jl" uniqKey="Chuah J">JL Chuah</name></author><author><name sortKey="Rajesh, Cv" uniqKey="Rajesh C">CV Rajesh</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Olson, R" uniqKey="Olson R">R Olson</name></author><author><name sortKey="Cameron, R" uniqKey="Cameron R">R Cameron</name></author><author><name sortKey="Hovis, T" uniqKey="Hovis T">T Hovis</name></author><author><name sortKey="Hunkeler, J" uniqKey="Hunkeler J">J Hunkeler</name></author><author><name sortKey="Lindstrom, R" uniqKey="Lindstrom R">R Lindstrom</name></author><author><name sortKey="Steinert, R" uniqKey="Steinert R">R Steinert</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Singh, Ad" uniqKey="Singh A">AD Singh</name></author><author><name sortKey="Fang, T" uniqKey="Fang T">T Fang</name></author><author><name sortKey="Rath, R" uniqKey="Rath R">R Rath</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Liesegang, Tj" uniqKey="Liesegang T">TJ Liesegang</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="letter"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Indian J Ophthalmol</journal-id><journal-id journal-id-type="publisher-id">Indian Journal of Ophthalmology</journal-id><journal-title-group><journal-title>Indian Journal of Ophthalmology</journal-title></journal-title-group><issn pub-type="ppub">0301-4738</issn><issn pub-type="epub">1998-3689</issn><publisher><publisher-name>Medknow Publications</publisher-name><publisher-loc>India</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">17699959</article-id><article-id pub-id-type="pmc">2636010</article-id><article-id pub-id-type="publisher-id">IndianJOphthalmol_2007_55_5_396_33836</article-id><article-categories><subj-group subj-group-type="heading"><subject>Letter To Editor</subject></subj-group></article-categories><title-group><article-title>Intraoperative cracking of the AMO Phacoflex-II Silicone (SI-40NB) intraocular lens while implanting with the Unfolder<sup> TM</sup> silver series system using hydroxypropylmethylcellulose</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Saxena</surname><given-names>Rohit</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Sinha</surname><given-names>Ankur</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Khokhar</surname><given-names>Sudarshan</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Dhawan</surname><given-names>Munish</given-names></name><degrees>MBBS</degrees></contrib><contrib contrib-type="author"><name><surname>Turuka</surname><given-names>Kiran</given-names></name><degrees>MD</degrees></contrib><aff> Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. Email:<email>drankursinha@yahoo.co.uk</email></aff></contrib-group><pub-date pub-type="ppub"><season>Sep-Oct</season><year>2007</year></pub-date><volume>55</volume><issue>5</issue><fpage>396</fpage><lpage>397</lpage><permissions><copyright-statement>Copyright: © Indian Journal of Ophthalmology</copyright-statement><copyright-year>2007</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-sa/3.0"><license-p>This is an
open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.</license-p></license></permissions></article-meta></front><body><p>Dear Editor,</p><p>Silicone and acrylic intraocular lenses (IOLs) are commonly used after phacoemulsification. Damage to acrylic<xref ref-type="bibr" rid="ref1">1</xref>,<xref ref-type="bibr" rid="ref2">2</xref> and Clariflex<xref ref-type="bibr" rid="ref3">3</xref> IOLs during implantation has been reported; most of them do not affect visual outcome but may need explantation.<xref ref-type="bibr" rid="ref2">2</xref> We report cracking of Phacoflex-II during insertion, using hydroxylpropylemethyl cellulose (HPMC) with Unfolder<sup> TM</sup> system.<xref ref-type="bibr" rid="ref4">4</xref> </p><p>A 56-year-old male presented with bilateral immature senile cataract with best corrected visual acuity (BCVA) of 20/80 in right eye and 20/40 in left eye. Detailed evaluation was unremarkable. Phacoemulsification was performed in the right eye.</p><p>Phacoflex-II was loaded into Unfolder<sup> TM</sup> using HPMC according to the manufacturer′s instructions. Leading haptic was implanted successfully, while crack was noted at the trailing haptic-optic junction. The IOL optic had opened and it was impossible to withdraw. In spite of the crack, the IOL was well centered in the bag <xref ref-type="fig" rid="F1">[Fig. 1]</xref>. On the first post surgical day, the patient had BCVA of 20/20. Crack measured approx. 2.4 mm and was not in the visual axis.</p><p>After six weeks, the IOL remained stable and well centered, without compromising BCVA.</p><p>There are reports<xref ref-type="bibr" rid="ref1">1</xref>,<xref ref-type="bibr" rid="ref2">2</xref>,<xref ref-type="bibr" rid="ref3">3</xref> of IOL damage during implantation. Among silicone IOLs this complication has only been reported once with Clariflex but has never been reported with Phacoflex-II. </p><p> We have been using HPMC for insertion of Phacoflex-II using Unfolder<sup> TM</sup> for the past three years without any damage to the IOL. Though manufacturers instruct to avoid use of Healon<sup> TM</sup> with Unfolder<sup> TM</sup> , its use without any lens damage has been reported.<xref ref-type="bibr" rid="ref5">5</xref> </p><p>We used HPMC for cost constraint. This was the first complication of IOL damage.</p><p>In our case, proper technique for injection was followed, with use of HPMC. Hydroxylpropylemethyl cellulose has lower pseudo-plasticity<xref ref-type="bibr" rid="ref6">6</xref> than other viscoelastics, hence it is more difficult to begin and maintain injection through the cannula.<xref ref-type="bibr" rid="ref6">6</xref> With HPMC, the force required to dislodge optic and haptic from the cartridge at initiation of injection is higher. This may lead to movement of optic followed by movement of trailing haptic after a time lag, due to inherent design of the injector. These factors could induce stress at the optic-haptic-junction leading to the crack.</p><p>These small peripheral cracks have no ill-effects on the visual outcome and stability of the IOL in the short term. If HPMC is used, a standby IOL should be ready at the time of implantation.</p></body><back><ref-list><ref id="ref1"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Balasubramanya</surname><given-names>R</given-names></name><name><surname>Rani</surname><given-names>A</given-names></name><name><surname>Dada</surname><given-names>T</given-names></name></person-group><article-title>Forceps-induced cracking of a single-piece acrylic foldable intraocular lens</article-title><source>Ophthalmic Surg Lasers Imaging</source><year>2003</year><volume>34</volume><fpage>306</fpage><lpage>7</lpage><pub-id pub-id-type="pmid">12875459</pub-id></element-citation></ref><ref id="ref2"><label>2</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Lee</surname><given-names>GA</given-names></name><name><surname>Dal Pra</surname><given-names>ML</given-names></name></person-group><article-title>Cracked acrylic intraocular lens requiring explantation</article-title><source>Aust N Z J Ophthalmol</source><year>1997</year><volume>25</volume><fpage>71</fpage><lpage>3</lpage><pub-id pub-id-type="pmid">9107400</pub-id></element-citation></ref><ref id="ref3"><label>3</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Chuah</surname><given-names>JL</given-names></name><name><surname>Rajesh</surname><given-names>CV</given-names></name></person-group><article-title>Intraoperative fracture of AMO Clariflex siliconee posterior chamber IOL</article-title><source>J Cataract Refract Surg</source><year>2005</year><volume>31</volume><fpage>1260</fpage><lpage>1</lpage><pub-id pub-id-type="pmid">16039513</pub-id></element-citation></ref><ref id="ref4"><label>4</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Olson</surname><given-names>R</given-names></name><name><surname>Cameron</surname><given-names>R</given-names></name><name><surname>Hovis</surname><given-names>T</given-names></name><name><surname>Hunkeler</surname><given-names>J</given-names></name><name><surname>Lindstrom</surname><given-names>R</given-names></name><name><surname>Steinert</surname><given-names>R</given-names></name></person-group><article-title>Clinical evaluation of the Unfolder</article-title><source>J Cataract Refract Surg</source><year>1997</year><volume>23</volume><fpage>1384</fpage><lpage>9</lpage><pub-id pub-id-type="pmid">9423912</pub-id></element-citation></ref><ref id="ref5"><label>5</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Singh</surname><given-names>AD</given-names></name><name><surname>Fang</surname><given-names>T</given-names></name><name><surname>Rath</surname><given-names>R</given-names></name></person-group><article-title>Cartridge cracks during foldable intraocular lens insertion</article-title><source>J Cataract Refract Surg</source><year>1998</year><volume>24</volume><fpage>1220</fpage><lpage>2</lpage><pub-id pub-id-type="pmid">9768396</pub-id></element-citation></ref><ref id="ref6"><label>6</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Liesegang</surname><given-names>TJ</given-names></name></person-group><article-title>Viscoelastic substances in ophthalmology</article-title><source>Surv Ophthalmol</source><year>1990</year><volume>34</volume><fpage>268</fpage><lpage>93</lpage><pub-id pub-id-type="pmid">2111587</pub-id></element-citation></ref></ref-list></back><floats-group><fig id="F1" position="float"><label>Figure 1</label><caption><p>Intraoperative photograph showing cracked Phacoflex-II IOL in the capsular bag</p></caption><alt-text>Figure 1</alt-text><graphic xlink:href="IndianJOphthalmol-55-396-g001"></graphic></fig></floats-group></pmc><affiliations><list></list><tree><noCountry><name sortKey="Dhawan, Munish" sort="Dhawan, Munish" uniqKey="Dhawan M" first="Munish" last="Dhawan">Munish Dhawan</name><name sortKey="Khokhar, Sudarshan" sort="Khokhar, Sudarshan" uniqKey="Khokhar S" first="Sudarshan" last="Khokhar">Sudarshan Khokhar</name><name sortKey="Saxena, Rohit" sort="Saxena, Rohit" uniqKey="Saxena R" first="Rohit" last="Saxena">Rohit Saxena</name><name sortKey="Sinha, Ankur" sort="Sinha, Ankur" uniqKey="Sinha A" first="Ankur" last="Sinha">Ankur Sinha</name><name sortKey="Turuka, Kiran" sort="Turuka, Kiran" uniqKey="Turuka K" first="Kiran" last="Turuka">Kiran Turuka</name></noCountry></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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