1. Complications of SICS
Dr.Haripriya Aravind

2. Tunnel construction
Approach
Placement
Length
Depth

3. Placement Anterior incision Poor self sealing effect Wound leak
Astigmatism
Management: Suture

4. Posterior incision Wide tunnel Risk of bleeding
Risk of premature entry
Difficulty in nucleus delivery
and instrument manipulation
Management: Suture for premature entry

5. Incision length Short incision Difficulty in nucleus delivery
Endothelial damage
ris damage
Management: Enlarge incision with keratome

6. Long incision
Poor approximation
Wound leak
Induced ATR astigmatism
Management: Suture

7. Incision Depth
Premature entry
Button holing
Scleral disinsertion

8. Descemet’s Stripping Main wound Instruments Paracentesis VES/Fluids
Treatment
Air
Viscoelastics

9. Paracentesis
Site
Size
Too central
Too peripheral
Too small
Too big

10. Capsulotomy Peripheral extension/ Run away rhexis Post capsule tear
CAPSULORHEXIS
Peripheral extension/ Run away rhexis
Post capsule tear
Management
Reform AC with VES
Pull flap centrally
Cut capsule just ahead of peripherally
extending rhexis
Continue in reverse direction
Canopener

11. Inappropriate size Too small Too big Management: Enlarge the rhexis by
2 or 3 relaxing incisions
Too big

12. Large rhexis Decenteration

13. Hydrodissection Incomplete hydro Forceful hydro PPC Complications
Inadequate cortical-capsular bag separation
Fluid misdirection syndrome
Zonular damage
Posterior capsular tear
Nucleus drop
Capsular block syndrome
Complications
Inadequate cortical-capsular bag seperation
Fluid misdirection syndrome
Zonular damage
Posterior capsular tear
Nucleus drop
Capsular block syndrome

14. Nucleus prolapse Difficult situations Incomplete hydroprocedure
Small rhexis
Mid-iris synechiae
Very soft nucleus
Hard brown wodden nucleus
Small pupil
Endothelial Damage
Iridodialysis/Damage to Iris
Zonular Dialysis
PCR

15. Complications Endothelial Damage Iridodialysis/Damage to Iris
Zonular Dialysis
PCR

16. Nucleus Delivery
Endothelial damage
Zonular dialysis/PCR
Iris Sandwich

17. Iris injury Sphincter tear Iridodialysis Iris prolapse
<1 hr : no intervention
>1 hr : suture
Iris prolapse
Careful repositioning
Suture tunnel
Post op steroids & NSAIDs

18. Iridodialysis
Iridodialysis
McCannel Suture

19. Hyphema From tunnel From Iris Posterior tunnel Deep tunnel
Iris handling
Iridodialysis

20. Intraoperative Miosis
Avoid iris touch
VES
Pharmacological
Spincterotomy
Hook

21. Can be pre/intra operative
Zonular dialysis
Can be pre/intra operative
Approach
Bimanual prolapse of nucleus
Phacosandwich
IOL
1quad – sulcus (perpendicular to the dialysis)
2quad - CTR
>2quad - ACIOL/aphakia

22. Posterior capsular tear
Seal the tear using visco (don’t hydrate)
Automated ant vitrectomy
Residual cortex - dry aspiration
Post op inflammation
Obstruct visual axis
Secondary glaucoma

23. Bimanual automated vitrectomy
At the start of vitrectimy
Completed vitrectomy

24. Dropped nucleus If anterior : inject visco : deliver with vectis
Deep into the vitreous : Retinal surgeon intervention

25. Expulsive Haemorrhage
Tissue prolapse
Hard globe
Loss of red glow
Choroidal haemorrhage
CRAO
Rx : Suture
IV Mannitol
Post segment assessed

26. Immediate post op complications
Wound Dehiscence
Etilology
Excessive episcleral cautrey
Premature entry
Button holing
Nuclear or cortical fragment in tunnel
Postoperative IOP rise
Collagen vascular diseases
Leaking paracentesis wound

27. Treatment
Patch the eye
Cycloplegics
Exploration of wound and suturing

28. Corneal complications
Corneal edema
Striate keratopathy
Bullous keratopathy

29. Corneal complications
Management : Control inflammation
Antiglaucoma drugs
Treat epithelial defect
Cycloplegics

30. Post op Iritis Excess manipulation during nucleus prolapse & delivery
Residual cortex
Management
Topical steroids & antibiotics
Cycloplegics
Topical NSAIDs

31. Post op increase in IOP Retained viscoelastics
Over distention of AC while reforming
Rx: antiglaucoma medications

32. Late complications Corneal complications Uveitis
Capsular bag complications
PCO
IOL malformations
CME
Endophthalmitis

33. Post segment complicationsRD
Lost lens syndrome
Vitreous hemorrhage
Vitritis

34. Successful management
Recognition
Knowledge
Skill
Judgement

35. THANK YOU