Grewal Dilraj S, Singh Grewal Satinder Pal, Basti Surendra
From the Department of Ophthalmology (DS Grewal, SPS Grewal, Basti), Northwestern University Feinberg School of Medicine, Chicago, Illinois, and the Department of Ophthalmology (Grewal), Duke University, Durham, North Carolina, USA; the Grewal Eye Institute (SPS Grewal), Chandigarh, India.
From the Department of Ophthalmology (DS Grewal, SPS Grewal, Basti), Northwestern University Feinberg School of Medicine, Chicago, Illinois, and the Department of Ophthalmology (Grewal), Duke University, Durham, North Carolina, USA; the Grewal Eye Institute (SPS Grewal), Chandigarh, India.
J Cataract Refract Surg. 2014 Dec;40(12):2143-7. doi: 10.1016/j.jcrs.2014.09.022. Epub 2014 Oct 22.
We report 2 cases involving femtosecond laser-assisted cataract surgery following a retinal-detachment repair performed 1 and 2 years earlier using silicone oil endotamponade that was subsequently removed. Preoperative slitlamp examination did not show emulsified silicone oil in the anterior chamber. Intraoperatively, however, emulsified silicone oil was seen on anterior segment optical coherence tomography (AS-OCT) as a distinct hyperreflective retrocorneal line and there was no penetration of the OCT signal or delivery of the femtosecond laser treatment through this area, resulting in incomplete capsulotomy and lens fragmentation in both cases. Because silicone oil has a lower density than aqueous and migrates superiorly, careful preoperative gonioscopic examination to evaluate for emulsified silicone oil in the superior angle is warranted in eyes having femtosecond laser-assisted cataract surgery after a vitrectomy with silicone-oil endotamponade. Review of intraoperative OCT images can detect emulsified silicone oil, which would allow the procedure to be modified appropriately to prevent complications.
我们报告2例病例，这2例患者在1年和2年前接受了硅油眼内填充的视网膜脱离修复手术，随后硅油被取出，之后又进行了飞秒激光辅助白内障手术。术前裂隙灯检查未在前房发现乳化硅油。然而，术中在前节光学相干断层扫描（AS-OCT）上可见乳化硅油呈一条明显的角膜后高反射线，且OCT信号无法穿透该区域，飞秒激光治疗也无法通过该区域，导致两例患者均出现囊膜切开不完全和晶状体破碎。由于硅油的密度低于房水且会向上迁移，因此对于接受过硅油眼内填充玻璃体切割术后行飞秒激光辅助白内障手术的患者，术前应仔细进行前房角镜检查，以评估上方房角内是否存在乳化硅油。回顾术中OCT图像可检测到乳化硅油，从而能够适当调整手术方案以预防并发症。
