General

Third eyelid flap cat

Third eyelid flap cat

Third eyelid flap cataract surgery, also known as third eyelid scleral flap cataract surgery or third eyelid flap cataract extraction, is one of the surgical options for the treatment of cataract. The third eyelid flap technique was developed in the 1990s by Dr. Lodeiro-Guerrero, a Spanish cataract surgeon. It was not widely performed until the development of phacoemulsification and the avlability of foldable lenses.^[@ref1]^ Although third eyelid cataract surgery has been reported to be successful with all types of foldable lenses, including intraocular lenses (IOLs),^[@ref2]^ no case series of third eyelid cataract surgery with foldable toric IOLs has been published. Here, we report on an 84-year-old woman with senile cataract who underwent third eyelid cataract surgery with the AcrySof IQ Toric (Alcon Laboratories, Inc., Fort Worth, Texas, USA) toric IOL.

The patient was diagnosed with senile cataract with a best-corrected visual acuity (BCVA) of 1.0 and astigmatism of -2.0 diopters (D). She was referred to our clinic for third eyelid cataract surgery. Her preoperative uncorrected distance visual acuity (UDVA) was 0.1 and corrected distance visual acuity (CDVA) was 1.0. The preoperative refractive power of the manifest refraction sphere (MRSE) was -5.00 D and the refractive cylinder was -2.0 D.

Surgical Technique {#s1}

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Under topical anesthesia, a conjunctival peritomy was made 1 to 2 mm from the lateral aspect of the third eyelid at approximately 2 o'clock ([Fig. 1A](#f1){ref-type="fig"}). The superior border of the conjunctival peritomy was located just below the superior corneal limbus. After local anesthesia (0.4% benoxinate hydrochloride), a temporal 6-0 nylon suture was passed through the posterior aspect of the conjunctival peritomy and fixed at a point 6 to 7 mm behind the third eyelid ([Fig. 1B](#f1){ref-type="fig"}). The suture was then tied to close the peritomy. After the suture was tied, the anterior chamber was cannulated with a 30-gauge intravenous needle and an anterior chamber mntner was inserted.

A 2.75-mm clear corneal incision was made with a diamond knife, and a temporal relaxing incision was made from the superior aspect of the 3-mm clear corneal incision using an 8.0-mm angled blade ([Fig. 1C](#f1){ref-type="fig"}). The wound was hydrated with 0.9% saline solution, and the superior cornea was scraped with a diamond knife to remove the epithelial cells. The temporal incision was also hydrated with balanced salt solution. A bent tip-opening forceps was inserted through the superior corneal incision ([Fig. 1D](#f1){ref-type="fig"}). The tip of the forceps was directed towards the anterior pole of the iris, and a capsulorhexis of 6-mm length was made with the forceps. After the anterior capsule was created, the forceps was introduced through the temporal incision and the lens cortex was broken into 2 fragments. With the other hand, the third eyelid was grasped with the forceps, and the anterior surface of the third eyelid was moved cephalad ([Fig. 1E](#f1){ref-type="fig"}). After the anterior surface of the third eyelid was moved cephalad to the anterior chamber, the anterior capsule was extracted with a forceps, and the vitreous was removed with a 26-gauge needle ([Fig. 1F](#f1){ref-type="fig"}). Then, the capsular bag was inflated with viscoelastic material ([Fig. 1G](#f1){ref-type="fig"}). The viscoelastic material was then extracted with the 30-gauge intravenous needle. After removing the viscoelastic material, a toric IOL was implanted through the 2.75-mm clear corneal incision. The remning lens cortex was removed with a bent-tip hydrodissector. Then, the temporal relaxing incision was enlarged with a spatula. Finally, the suture was pulled to close the peritomy.

The third eyelid was sutured with two 10-0 nylon sutures that crossed in a Y fashion to fix the medial and lateral aspects of the third eyelid at the superior corneal limbus ([Fig. 2A](#f2){ref-type="fig"}). After the third eyelid was sutured, the conjunctiva was replaced and the anterior chamber was reformed. A subconjunctival injection of 5-fluorouracil was administered and a topical antibiotic ointment was applied to the eye. After surgery, 0.3% levofloxacin eye drops were administered 4 times a day for a week. Then, 0.3% levofloxacin eye drops were administered 3 times a day for 2 months. The eye was patched for 1 week. After 2 months, the eye patch was removed, and 0.3% levofloxacin eye drops were administered 3 times a day for another month. After 3 months, the eye patch was removed, and 0.1% levofloxacin eye drops were administered 3 times a day for another month.

The patient's BCVA and MRSE at 6 months after surgery was 0.6 and -0.75 D, respectively. The refractive cylinder was +0.5 D.

Discussion {#s2}

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Watch the video: Third eyelid flap and Subconjunctival injection in a dog. (December 2021).