Congenital Iris Coloboma and White Cataract
In this video, James Lewis, MD, performs cataract surgery in a 22-yr old female with a congenital coloboma and congenital cataract. Trypan blue is instilled to aid capsulorhexis formation and the cataract is phacoemulsified through a 2.2 mm incision. For extra support, Dr. Lewis inserts an endocapsular ring prior to placing a single-Piece Aspheric nanoFLEX IOL (STAAR Surgical, Monrovia, California) in the bag.
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Comments (6)
The successful capsulorhexis was aided by the closed chamber and the paracentesis based tear. In my experience the collamer material is extremely well tolerated, visual superb, atraumatically inserted, and capsule friendly. Once the endocapsular ring is in place lens material rather than capsule support is my main goal.
Very brave surgery, did you think about iris painted capsular ring or iris painted IOL?
is a good case, in my opinion one of the biggest problems is the Behavior of the capsule, are very elastic and,I think it's a good idea to place endocapsular ring, but I'dont think that IOL is the best option for this case.
agreed. many of my patients also get impressive opacification of the anterior capsule and are not bothered by large pupils when i have to stretch them. by the way, i am in awe of surgeons like you who operate on potentially difficult cataracts in 22 year old monocular patients. if i tried that, i would have to wear a diaper! i have operated many times on elderly monocular patients, and thankfully they have gone well, but it makes me so anxious- i cant imagine doing it on a 22 year old. strength to you!
Coloboma repair using a Siepser Knot or something similar might have been successful and is a good idea. Similarly, a Morcher Segment creating an artificial iris would have worked also. Given her monocular status I didn't want to add any additional risk and I wanted to use a small incision. Finally, I have been pleasantly surprised by the tendency of the anterior capsule to create a pseudo-iris in my post-op aniridia patients.
you are a great surgeon.