Untoward events associated with aberrant fluid infusion during cataract surgery: Laboratory study with corroborative clinical observations

Richard S Koplin; David C Ritterband; Jack M Dodick; Eric D Donnenfeld; Mark Evan Schafer

doi:10.1016/j.jcrs.2016.07.014

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Untoward events associated with aberrant fluid infusion during cataract surgery: Laboratory study with corroborative clinical observations

Journal article

Peer reviewed

Untoward events associated with aberrant fluid infusion during cataract surgery: Laboratory study with corroborative clinical observations

Richard S Koplin, David C Ritterband, Jack M Dodick, Eric D Donnenfeld and Mark Evan Schafer

Journal of cataract and refractive surgery, v 42(8), pp 1135-1140

Aug 2016

DOI: https://doi.org/10.1016/j.jcrs.2016.07.014

PMID: 27531288

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Abstract

Cataract

Cataract Extraction

Humans

Intraoperative Complications

Lens, Crystalline

Phacoemulsification - adverse effects

Retrospective Studies

Purpose : To determine the relationship between untoward events noted during phacoemulsification surgery associated with aberrant infusion misdirection and their causal relationship to current infusion sleeve design. Setting : The New York Eye & Ear Infirmary of Mt. Sinai, New York, New York, USA. Design : Retrospective case reports and experimental study. Methods : Observations of live cataract surgery were documented with high-definition videography using 3 commercial phacoemulsification platforms. Laboratory studies using a Photron MC2 high-speed camera and the Kitaro cataract surgical system were used to simulate surgical maneuvers and assess flow patterns and visualize the dynamics of fluid movement in the anterior chamber. Color-flow Doppler ultrasound studies were used to demonstrate the effect of infusion fluid on the iris during surgery. Results : Misdirected infusion and floppy-iris leaflets were determined to be secondary to a fulcrum effect at the corneal wound that constrained movement of the standard silicone sleeves. The phacoemulsification needles could therefore decenter independently of the infusion sleeve, attenuating infusion volume down 1 side of the sleeve and, as a result, obstructing fluid exiting the ipsilateral port. Conclusions : Untoward events associated with aberrant fluid infusion during phacoemulsification surgery were secondary to a fulcrum effect at the corneal wound. Complications included misdirected infusion that facilitated the transport of retained nuclear fragments to the vitreous, inconsistent lens followability during phacoemulsification, and exaggerated movements of the iris particularly consistent with intraoperative floppy-iris syndrome and pseudoexfoliation.

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3 citations in Scopus

Details

Title: Untoward events associated with aberrant fluid infusion during cataract surgery: Laboratory study with corroborative clinical observations
Creators: Richard S Koplin - New York University
David C Ritterband (Corresponding Author) - New York University
Jack M Dodick - From the Department of Ophthalmology (Koplin, Ritterband), the New York Eye and Ear Infirmary of Mt. Sinai, Icahn School of Medicine, and the Department of Ophthalmology (Dodick, Donnenfeld), the New York University School of Medicine, New York, New York, USA
Eric D Donnenfeld - New York University
Mark Evan Schafer - New York University
Publication Details: Journal of cataract and refractive surgery, v 42(8), pp 1135-1140
Publisher: Elsevier
Number of pages: 6
Resource Type: Journal article
Language: English
Academic Unit: School of Biomedical Engineering, Science, and Health Systems
Web of Science ID: WOS:000382424000006
Scopus ID: 2-s2.0-84999016928
Other Identifier: 991019562015604721

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Collaboration types: Domestic collaboration
Web of Science research areas: Ophthalmology; Surgery