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Tanikawa A, Horiguchi M. Intravitreal Triamcinolone–Illuminated Cataract Surgery for Patients With Dense Vitreous Hemorrhage. JAMA Ophthalmol. 2015;133(1):93–94. doi:10.1001/jamaophthalmol.2014.3321
Almost all cataract surgical procedures rely on phacoemulsification, which requires favorable lens visibility. Visibility can be negatively affected by various ocular pathologies including dense vitreous hemorrhage. When the microscope light source reflects off the ocular fundus, the lens is transilluminated. In the presence of dense vitreous hemorrhage, light cannot adequately reach the fundus, and no red reflex is created. In these patients, vitrectomy and cataract surgery may be performed simultaneously (phacovitrectomy) but cataract surgery complications, such as nucleus drop or corneal damage, may lead to problems during vitrectomy.
Several surgical techniques have been used to alleviate the problem of poor lens visibility.1,2 Jang et al1 fixed a chandelier illuminator on the sclera, turned off the microscope light source, and visualized the lens by illuminating the vitreous cavity. Furino et al2 improved anterior lens capsule visibility by staining it with triamcinolone acetonide. Although both techniques were effective, both had limitations. Vitreous chamber illumination reduces the visibility of the cornea and iris because of the need to turn off the microscope light. Staining the anterior lens capsule with triamcinolone acetonide allows for better anterior chamber visualization but the lenticular nucleus and cortex remain difficult to see.
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