Intracameral illuminator-assisted advanced cataract surgery combined with 23-gauge vitrectomy in eyes with poor red reflex

PURPOSE: To evaluate the efficacy and outcomes of intracameral illuminator-assisted advanced cataract surgery combined with 23-gauge vitrectomy in eyes with a poor red reflex. SETTING: Department of Ophthalmology, Gachon University Gil Hospital, Incheon, Korea. DESIGN: Interventional case series. METHODS: Surgeon-controlled intracameral illumination was used for visualization during combined cataract surgery and 23-gauge vitrectomy. The main outcome measures were causes of the poor red reflex, value of the intracameral illuminator in specific cataract steps, and intraoperative and postoperative complications. RESULTS: The study comprised 17 patients (17 eyes). The main causes of a poor red reflex were vitreous hemorrhage in 8 eyes, vitreous opacity in 6 eyes, and corneal opacity, bullous retinal detachment, and globe deviation in 1 eye each. Horizontal or oblique intracameral illumination minimized the amount of corneal scatter and reflection of the illuminating light and provided high-quality intraoperative lens images in most surgical steps. In addition, excellent visibility of the lens capsules facilitated the removal of almost all lens epithelial cells from the capsular bag. In all eyes, completion of the capsulorhexis and in-the-bag implantation of an intraocular lens were accomplished. In 1 eye, a radial anterior capsule tear occurred during irrigation/aspiration. Postoperatively, the rate of anterior capsule opacification was 11.8% (2/17 eyes) and of posterior capsule opacification, 23.5% (4/17 eyes). CONCLUSIONS: Surgeon-controlled intracameral illumination provided excellent imaging and almost 360-degree visualization of the lens capsule structures. This capability can be used for challenging cataract surgery combined with vitrectomy in eyes with a poor red reflex. (C) 2013 ASCRS and ESCRS