Demographics and demand spur innovation in ophthalmology

Despite recent advances, lens surgeries such as cataract extraction or secondary IOL implantation in vitrectomized eyes remain challenging. Eyes with deficient capsules with a primary vitreoretinal procedure requiring silicone oil injection often require silicone oil removal and visual rehabilitation by secondary IOL implantation. Combining silicone oil removal with glued IOL implantation in a single sitting has advantages compared with a two-step procedure. It negates a second surgical procedure for IOL implantation, which minimizes the overall treatment time, reduces the risk of anesthetic complications and achieves a faster visual rehabilitation while cutting down the total costs involved.Under peribulbar anesthesia, localized conjunctival peritomies were made at 3 and 9 o’clock hours. Two partial-thickness limbal-based scleral flaps about 2.5 mm × 2.5 mm were created exactly 180° diagonally apart (Figure 1). Infusion was maintained by a 23-gauge pars plana transconjunctival trocar cannula. After making the scleral flaps, a superior corneolimbal 2.8-mm incision was made for transpupillary silicone oil removal (Figure 1). Here a continuous controlled pressure was given on the posterior lip of the wound using the flat end of the iris repositor or vitrector, while the infusion flow was maintained (Figure 2). This flushed the silicone oil from the intraocular space in a controlled fashion through the dilated pupil. Silicone oil removal can also be performed using a 23-gauge transconjunctival three-port pars plana sclerotomy using motorized active suction with continuous infusion through the pars plana trocar. In cases of emulsified silicone oil, multiple air-fluid exchanges were performed, if possible, to ensure complete removal. In cases with silicone oil in the anterior chamber or an inverse hypopyon, a thorough wash of the anterior chamber was done with balanced salt solution after making a side-port incision.