From the S. Fyodorov Eye Microsurgery Complex State Institution (Anisimova, Belodedova, Shilova, Malyugin), Moscow, A.I. Yevdokimov Moscow State University of Medicine and Dentistry (Anisimova, Malyugin), Russia; John A. Moran Eye Center (Arbisser), University of Utah , USA; and Ophthalmology Department, Soroka University Medical Center (Knyazer), Be'er-Sheva, Israel.
J Cataract Refract Surg. 2020 Jan;46(1):55-62. doi: 10.1016/j.jcrs.2019.08.005.
To confirm the presence of incomplete vitreolenticular adhesion via microscope-integrated intraoperative optical coherence tomography (iOCT) during cataract surgery and via diagnostic spectral-domain OCT (SD-OCT) postoperatively.
S. Fyodorov Eye Microsurgery Complex State Institution, Moscow, Russia.
Prospective noninterventional single-center study.
Clinical characteristics and surgical videos of 27 patients (28 eyes) who had cataract surgery were documented. Real-time iOCT integrated into the surgical microscope was directed to view the retrolenticular anatomy at the end of the surgery. Postoperatively, SD-OCT was also performed.
This study comprised 28 eyes of 27 patients. Berger space was identified in 21 cases (75%) intraoperatively via iOCT and in 23 cases (82%) postoperatively via stationary OCT. Depth dimensions varied from 33.5 ± 87.0 μm to 383.1 ± 226.3 μm. Hyperreflective dots and particles of different shapes and sizes were documented within Berger space in 16 cases (57%) intraoperatively and in 9 cases (32%) postoperatively. Capsular rupture occurred in 1 case due to excessive posterior capsular movement anteriorly. The posterior capsular rupture was converted into a posterior capsulorhexis, leaving the anterior hyaloid membrane intact.
iOCT confirmed the penetration of crystalline lens microfragments, cellular material, or medical suspension (triamcinolone) into the space between the posterior lens capsule and the anterior hyaloid membrane. This occurs due to discontinuity of both lenticular zonules and Wieger ligament attachment. A Wieger ligament rupture can also allow excessive Berger space hydration during phacoemulsification leading to anterior displacement of the posterior lens capsule increasing the risk of instrument touch and posterior capsule rupture.
通过白内障手术过程中的显微镜集成术中光相干断层扫描（iOCT）和术后诊断频域光相干断层扫描（SD-OCT），确认不完全玻璃体晶状体粘连的存在。
俄罗斯莫斯科 S. Fyodorov 眼科显微外科综合机构。
前瞻性非介入性单中心研究。
记录了 27 名（28 只眼）接受白内障手术患者的临床特征和手术视频。实时 iOCT 集成到手术显微镜中，用于在手术结束时观察后晶状体解剖结构。术后还进行了 SD-OCT 检查。
本研究包括 27 名患者的 28 只眼。通过 iOCT 在术中识别出 Berger 空间的有 21 例（75%），通过固定 OCT 在术后识别出 23 例（82%）。深度尺寸从 33.5 ± 87.0 μm 到 383.1 ± 226.3 μm 不等。在术中的 16 例（57%）和术后的 9 例（32%）中，记录到 Berger 空间内有不同形状和大小的高反射点和颗粒。由于后囊膜过度向前移动，1 例发生后囊膜破裂。后囊膜破裂转化为后囊膜环形切开术，使前玻璃膜完整。
iOCT 证实了晶状体微碎片、细胞物质或医用悬浮液（曲安奈德）穿透后囊膜和前玻璃膜之间的空间。这是由于晶状体悬韧带和 Wieger 韧带连接的连续性中断所致。Wieger 韧带断裂也可导致超声乳化过程中 Berger 空间过度水化，导致后囊膜向前移位，增加器械接触和后囊膜破裂的风险。
