Chanbour Wassef, Harb Fadi, Jarade Elias
Beirut Eye and ENT Specialist Hospital, Beirut, Lebanon.
Mediclinic, Dubai mall, Dubai, UAE.
Med Hypothesis Discov Innov Ophthalmol. 2020;9(1):1-6. Epub 2019 Nov 30.
Advanced Keratoconus and ectatic corneal diseases may lead to corneal thinning and irregular astigmatism. The optical distortion caused by these pathologies may result in poor visibility for the surgeon during phacoemulsification. Thus, the risk of complication would be increased intraoperatively (capsular rupture, vitreous loss). The aim of this case series was to use a modified customized Rigid Gas Permeable (RGP) contact lens to improve visualization during all the stages of phacoemulsification in irregular corneas and to avoid open sky technique for cataract removal during penetrating keratoplasty (PK). A customized, 12 mm, RGP contact lens was designed and manufactured. Two peripheral notches were customized to fit the hand position of the surgeon (at 11 O'clock and 2 Clock in this case series) to allow clear corneal incisions. Six eyes of 6 patients were included (3 eyes with advanced keratoconus and a severely optically distorted, yet clear corneas, planned for PK on the same day; 2 eyes were status post-intracorneal ring segment implantation for stage 4 keratoconus and 1 eye had combined phacoemulsification with superficial keratectomy to remove paracentral corneal Salzmann's nodule). Lens opacities ranged from +2 to +4 nuclear sclerosis in all eyes. Good visualization of the anterior lens and capsule attained with the RGP contact lens fitting. Improved visualization was reported during all the steps (Capsulorhexis, Irrigation/Aspiration, Phaco. Intraocular lens implantation). The phacoemulsification was smooth and non-complicated in a total of 6 eyes of 6 patients. In these cases, without RGP fitting, the operation was not technically possible. The customized notches allowed any insertion of surgical instruments, and with the help of viscoelastic maintained a good stability of the contact lens during the operation. We concluded that customized method RGP contact lens, may help reducing complications during phacoemulsification in advanced corneal ectasia and perhaps in irregular corneas as well.
晚期圆锥角膜和角膜扩张性疾病可能导致角膜变薄和不规则散光。这些病变引起的光学畸变可能导致白内障超声乳化手术过程中外科医生的视野不佳。因此，术中并发症的风险会增加（囊膜破裂、玻璃体丢失）。本病例系列的目的是使用改良的定制硬性透气性（RGP）隐形眼镜，以改善不规则角膜白内障超声乳化手术各阶段的视野，并避免在穿透性角膜移植术（PK）期间采用无晶状体眼技术进行白内障摘除。设计并制造了一种定制的12毫米RGP隐形眼镜。定制了两个周边切口，以适应外科医生的手部位置（在本病例系列中为11点和2点），以便进行清晰的角膜切口。纳入了6例患者的6只眼（3只患有晚期圆锥角膜且角膜严重光学畸变但仍透明的眼睛，计划同一天进行PK；2只眼为4期圆锥角膜行角膜内环植入术后，1只眼联合超声乳化和浅表角膜切除术以切除角膜旁中央的萨尔茨曼结节）。所有眼睛的晶状体混浊程度从+2到+4核硬化。通过佩戴RGP隐形眼镜可实现对晶状体前表面和囊膜的良好观察。据报告，在所有步骤（撕囊、灌注/抽吸、超声乳化、人工晶状体植入）中视野均得到改善。6例患者的6只眼中，超声乳化手术顺利且无并发症。在这些病例中，若不佩戴RGP隐形眼镜，手术在技术上是无法进行的。定制的切口允许任何手术器械的插入，并且在粘弹性物质的帮助下，手术过程中隐形眼镜保持了良好的稳定性。我们得出结论，定制的RGP隐形眼镜方法可能有助于减少晚期角膜扩张以及可能在不规则角膜的白内障超声乳化手术期间的并发症。
