1. Occlusion Controlled Phaco and Shallow Anterior Chamber Dr. Bekir Sıtkı Aslan TOBB ETU Hospital Ankara Turkey Financial Interest-Alcon Speakers Bureau

2. Purpose  Cataracts with shallow anterior chamber is a challenge for surgeons, due to lacking space.  Anterior chamber fluctuation may contribute to increase the fragility of the tissues in the anterior chamber.  We looked the added benefits of “Occlusion Controlled Phaco” in cataracts with a shallow chamber.

3. Methods  Prospective analysis of 12 cases with cataracts of varying density and shallow anterior chambers  Patients anterior chambers 2.0 mms ≤ were assigned.  Anterior chambers were measured with immersion A-scan.  All cases were operated with torsional energy with vacuum sensitive longitudinal energy delivery.

4. Methods  Videoanalysis ;  Configuration of incision,  The nucleus removal times,  Amount of energy dispersed,  Amount of fluid used,  Number of surges during nucleus removal were recorded.  Pre and post operative visual acuities and eye pressures, corneal edema and iris defects were noted.

5. Shallow Anterior Chambers Hyperopic Eyes5 After Filtration Surgery 2 Crystalline Lens Swelling 3 Acute Angle Closure Glaucoma 2

6. Clinical ConditionAC DepthAxial LengthVitreous Tap Hyperopic1,9321,53 Hyperopic1,8621,61 After Filtration Surgery1,3822,11 Crystalline Lens Swelling1,4522,12Yes Acute Angle Closure1,2123,89Yes Crystalline Lens Swelling1,7923,89 Hyperopic1,4321,95Yes Hyperopic1,6321,83 Acute Angle Closure1,3822,45Yes After Filtration Surgery1,3422,41 Hyperopic1,9121,03 Crystalline Lens Swelling1,5021,85

7. Cataract Surgery Challenge  Wound construction,  Capsulorhexis,  Endothelial Trauma Cataract Surgery Challenge-Control  Smaller wound construction,  Viscoadaptive use for capsulorhexis,  Occlusion Controlled Phaco for Endothelial Trauma ( A small percent of vacuum sensitive Longitudinal energy is added to push back the nuclear material when the shearing activity stops with torsional because of occlusion.)

9. Clinical ConditionCDE Nucl Removal Time Amount of Fluid Used n of clogging Hyperopic16,534,51867 Hyperopic32,686,039021 After Filtration Surgery19,525,418510 Crystalline Lens Swelling12,614,395912 Acute Angle Closure23,986,5611512 Crystalline Lens Swelling11,954,21697 Hyperopic18,454,17211 Hyperopic21,743,39649 Acute Angle Closure17,282,39446 After Filtration Surgery15,023,26598 Hyperopic19,525,418510 Crystalline Lens Swelling14,554,578910

10. Clinical Condition Incision Problems With 2.2 mm Slit LogMar Pre-op VA LogMar 1 month Post-Op VA Pre-op IOP Post-op IOP Cornea Clarity Post-op Day 1 Iris TraumaRemarks Hyperopic 0,70,12118 Hyperopic 0,50,12217 After Filtration SurgeryYes10,31420Edema cosopt Crystalline Lens Swelling 1,50,11412 Yes Acute Angle ClosureYes10,42720EdemaYescosopt Crystalline Lens Swelling 1,40,72517 Hyperopic 0,40,715 Yes Hyperopic 101517 Ambliopic Acute Angle Closure 1,61,42818EdemaYes After Filtration Surgery 0,50,412 EdemaYes Hyperopic 112320 Crystalline Lens Swelling 0,5021

11. Conclusions  Immature entry into the Anterior Chamber may lead to shorter tunnels,  Previous surgery and acute angle closure may jeopordize endothelial resistance,  Iris trauma is inevitable in cases with shallower anterior chambers,  Vitreous tap may be needed if anterior chamber cannot be deepened with viscoadaptive viscoelastics,  Low flow, low infusion bottle yields succesful lens removal with very acceptable energy and fluid use,  Good visual outcomes can be achieved,  Eye pressures have the tendancy to drop whereas some slight pressure rise should be controlled with topical antiglaucomatous drops.