The Use of the Anterior Chamber Maintainer in Special Cataract Cases 129
phaco. Cole et al. [22] studied these complications. More
specifically, in 12.5% rupture of the posterior capsule
occurred, in 5.6% retinal detachment and in a few cases
loss of vitreous and zonule rupture were recorded. Anato-
mical changes that take place after pars plana vitrectomy
prejudice the onset of complications. Yung et al. [23] in-
vestigated the pathophysiological changes that occurred
in eyes that underwent vitrectomy and admission of silicon
oil. A hypertrophic response of the anterior capsule of
about 20 - 25 μm was observed. Also, the epithelium of
the lens was hypertrophic and fibrosis of the posterior
surface of the anterior capsule occurred. These changes
make the work of the cataract surgeon really difficult in
relation to the posterior capsule fluctuations as a result of
the lack of support due to the previous vitrectomy. The
role of the ACM in previously vitrectomized eyes, with
silicon oil is really of significant importance. It is well-
known that during phaco, when the phaco tip is removed,
silicon oil pervade through zonule to the anterior cham-
ber. More specifically, the intraocular pressure drops sig-
nificantly when the phaco tip is removed from the eye.
Due to the collapses of the anterior chamber, the iris dia-
phragm is protruded and the zonular spaces become wider.
Through these spaces silicon oil drops, pass into the ante-
rior chamber. The ACM in our cases, stabilized the intra-
ocular pressure and thus prevented the passage of the si-
licon oil to the anterior chamber.
Furthermore, the ACM, due to the stability of the depth
of the anterior chamber, diminishes the vitreo-retinal trac-
tions in pathological cases such as proliferative diabetic
retinopathy. Some researchers [24] tried to eliminate these
vitreo-retinal tractions, in patients with diabetic retino-
pathy, with the use of intravitreal injections of bevani-
zumab. They aimed at reducing the proliferative neovas-
cularisation, the edema and the tractions between the vi-
treous and the retina. ACM is obviously useful in these
cataract cases.
Another application of the ACM is in cases of rupture
of the anterior capsule (capsulorhexis tear). In our opinion
(experience in a great number of phaco cases), the appli-
cation of the ACM stabilizes the pressure in the anterior
chamber and it may prevent the extension of the rupture
to the posterior capsule.
Other researchers [25] investigated the vitreous loss
that is observed in cases of rupture of the posterior cap-
sule during phaco. They compared cataract cases that were
performed by experienced surgeons with or without the
ACM. They concluded that both groups had the same per-
centage of post-operative complications and also a greater
vitreous loss was observed when the rupture of the poste-
rior capsule occurred with the presence of an ACM. In
our material no capsule rupture occurred.
It also has to be mentioned that complicated cataract
surgery is related with higher incidence of CME. It has to
be outpointed that none of our patients developed clinical
CME.
Conclusively, according to our experience, the use of
an ACM facilitates the operation and makes surgeon feel
safer. It increases the safety of the phaco procedure by
increasing the stability of the depth of the anterior cham-
ber and by reducing the posterior capsule fluctuations
during the insertion and withdrawal of the phaco tip and
the irrigation aspiration cannulas. Thus many intra-opera-
tive and postoperative complications may be prevented.
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