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Factors to contemplate for elimination, administration of Soemmering ring

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A Soemmering ring is commonly encountered in people who bear cataract surgical procedure within the preliminary years of life.

The fusion of the anterior capsule with the posterior capsule and uninhibited proliferation of epithelial cells result in Soemmering ring formation (Determine 1).

a Soemmering ring with the haptic of a three-piece IOL trapped in the iris structure
Determine 1. The picture reveals a Soemmering ring with the haptic of a three-piece IOL trapped within the iris construction in a case with a posterior capsule defect.

Supply: Priya Narang, MS, and Amar Agarwal, MS, FRCS, FRCOphth

Removing and administration of a Soemmering ring want higher understanding because it can’t be aspirated with a routine irrigation and aspiration cannula. The Soemmering ring must be fastidiously nudged out of the capsular enclosure; utilizing a Sinskey or Lester hook is useful to hold out the process. As soon as it’s within the anterior chamber, the Soemmering ring may be maneuvered out of the anterior chamber by compressing the lip of the corneal incision together with viscoexpression. The Soemmering ring can’t be grasped with forceps because it disintegrates from wherever the surgeon holds it, making it inconceivable to drag it out of the anterior chamber. Chan and Chee described a way wherein an IOL cartridge can be utilized to take away the fragments from the anterior chamber and the Soemmering ring is guided into the lumen of the IOL cartridge and eliminated.

The haptic of the three-piece IOL is held with end-opening forceps
Determine 2. The haptic of the three-piece IOL is held with end-opening forceps, and an try is made to disentangle it from the iris tissue.
The haptic is successfully disentangled
Determine 3. The haptic is efficiently disentangled.
The haptic is externalized from the sclerotomy site made for the glued IOL procedure
Determine 4. The haptic is externalized from the sclerotomy website made for the glued IOL process.
Amar Agarwal
Amar Agarwal
Priya Narang
Priya Narang

Alternatively, a Soemmering ring may be emulsified with the assistance of a phacoemulsification probe (Figures 2 to eight); nonetheless, care ought to be taken to forestall slippage of the Soemmering ring because the fluid present in phaco can swirl and push Soemmering fragments round into the vitreous cavity in circumstances with a poor posterior capsule. Putting an IOL as a scaffold (Narang et al.) may also help seal the posterior capsule defect whereas the Soemmering ring will get emulsified. Prevention of slippage of the Soemmering ring into the vitreous cavity is among the key factors to be thought of in administration. The IOL scaffold process is particularly helpful in these circumstances because the optic of the IOL helps seal the posterior capsule defect and acts as a scaffold.

The second haptic is also externalized, with care being taken because the optic of the IOL forms the base of the Soemmering ring
Determine 5. The second haptic can also be externalized, with care being taken as a result of the optic of the IOL varieties the bottom of the Soemmering ring. The haptics are then tucked into scleral pockets.
The Soemmering ring is brought out of the capsular enclosure and maneuvered
Determine 6. The Soemmering ring is introduced out of the capsular enclosure and maneuvered slowly into the anterior chamber.
The Soemmering ring is emulsified with a phacoemulsification probe
Determine 7. The Soemmering ring is emulsified with a phacoemulsification probe.

A Soemmering ring is commonly visualized solely when the pupil is absolutely dilated. Due to this fact, placement of iris hooks ought to be thought of for higher intraoperative visualization and administration. As soon as the Soemmering ring is dislodged into the anterior chamber, the hooks may be eliminated because the presence of the iris across the fringe of the IOL optic is useful because it acts as a barrier and prevents the slippage of the Soemmering ring into the vitreous cavity.

The Soemmering ring is emulsified with a phacoemulsification probe
Determine 8. The Soemmering ring is emulsified with a phacoemulsification probe.
  • References:
  • Chan NS, et al. Am J Ophthalmol. 2024;doi:10.1016/j.ajo.2024.08.018.
  • Narang P, et al. J Cataract Refract Surg. 2015;doi:10.1016/j.jcrs.2015.02.020.
  • Narang P, et al. Ophthalmology. 2013;doi:10.1016/j.ophtha.2013.05.011.
  • For extra info:
  • Amar Agarwal, MS, FRCS, FRCOphth, director of Dr. Agarwal’s Eye Hospital and Eye Analysis Centre, is the creator of a number of books, together with Phaco Nightmares: Conquering Cataract Catastrophes, Bimanual Phaco: Mastering the Phakonit/MICS Approach, Dry Eye: A Sensible Information to Ocular Floor Issues and Stem Cell Surgical procedure and Presbyopia: A Surgical Textbook. He may be reached at aehl19c@gmail.com; web site: www.dragarwal.com.
  • Priya Narang, MS, of Narang Eye Care & Laser Centre, Ahmedabad, India, may be reached at narangpriya19@gmail.com.


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