Complications of SICS
Dr.Haripriya Aravind
Tunnel construction
Approach
Placement
Length
Depth
Placement
Anterior incision
Poor self sealing effect
• Wound leak
• Astigmatism
Management: Suture
Posterior incision
Wide tunnel
Risk of bleeding
Risk of premature entry
Difficulty in nucleus delivery
and instrument manipulation
Management: Suture for premature entry
Incision length
Short incision
Difficulty in nucleus delivery
Endothelial damage
ris damage
Management: Enlarge incision with
keratome
Long incision
Poor approximation
Wound leak
Induced ATR astigmatism
Management: Suture
Incision Depth
Premature entry
Button holing
Scleral disinsertion
Descemet’s Stripping
Main wound
Instruments
Paracentesis
VES/Fluids
Treatment
Air
Viscoelastics
Paracentesis
Site
Too central
Too peripheral
Size
Too small
Too big
Capsulotomy
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
Inappropriate size
Too small
Management: Enlarge the rhexis by
2 or 3 relaxing incisions
Too big
Large rhexis Decenteration
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
Nucleus prolapse
Difficult situations
Incomplete hydroprocedure
Small rhexis
Mid-iris synechiae
Very soft nucleus
Hard brown wodden nucleus
Small pupil
Complications
Endothelial Damage
Iridodialysis/Damage to Iris
Zonular Dialysis
PCR
Nucleus Delivery
Endothelial damage
Zonular dialysis/PCR
Iris Sandwich
Iris injury
Sphincter tear
Iridodialysis
<1 hr : no intervention
>1 hr : suture
Iris prolapse
Careful repositioning
Suture tunnel
Post op steroids & NSAIDs
Iridodialysis
McCannel Suture
Hyphema
From tunnel
Posterior tunnel
Deep tunnel
From Iris
Iris handling
Iridodialysis
Intraoperative Miosis
Avoid iris touch
VES
Pharmacological
Spincterotomy
Hook
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
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
Bimanual automated vitrectomy
At the start of vitrectimy
Completed vitrectomy
Dropped nucleus
If anterior : inject visco
: deliver with vectis
Deep into the vitreous : Retinal surgeon intervention
Expulsive Haemorrhage
Tissue prolapse
Hard globe
Loss of red glow
Choroidal haemorrhage
CRAO
Rx : Suture
IV Mannitol
Post segment assessed
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
Treatment
Patch the eye
Cycloplegics
Exploration of wound and suturing
Corneal complications
Corneal edema
Striate keratopathy
Bullous keratopathy
Corneal complications
Management : Control inflammation
Antiglaucoma drugs
Treat epithelial defect
Cycloplegics
Post op Iritis
Excess manipulation during nucleus
prolapse & delivery
Residual cortex
Management
Topical steroids & antibiotics
 Cycloplegics
 Topical NSAIDs
Post op increase in IOP
Retained viscoelastics
Over distention of AC while reforming
Rx: antiglaucoma medications
Late complications
Corneal complications
Uveitis
Capsular bag complications
PCO
IOL malformations
CME
Endophthalmitis
Post segment complications
RD
Lost lens syndrome
Vitreous hemorrhage
Vitritis
Successful management
Recognition
Knowledge
Skill
Judgement