Difficult Cases - Hypermature Cataract
A 16-year-old girl presents with a hypermature cataract. After staining the capsule with Trypan Blue, Alan Aker, MD, uses I/A to remove soft, milky lens material. The surgeon notes a horizontal tear in the posterior capsule caused by extension from the anterior capsule and converted to continuous curvilinear posterior capsular opening.
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Comments (5)
Again, a very appropriate comment. Your approach is exactly what was planned for this case to reduce the intracapsular pressure. As soon as the capsule was entered, there was a dramatic horizontal split precluding the possibility to aspirate cortex. Of note, when the second eye was done this was again impossible because of the immediate horizontal splitting of the capsule. All this despite the knowledge we had from the first eye and the use of a dispersive viscoelastic.
in such cases what i do is first perform a very small rhexis then aspirate little cortex so that intralenticular pressure is reduced , then extend the rhexis to bigger size and perform phaco
understood--from the video, i couldnt tell that the rhexis had split so early in the case. it looked like the rhexis was salvageable early on. thanks for the clarification.
Your comment is very appropriate and would have been my approach had the capsule tear not extended so dramatically. Unfortunately, the split in the rhexis was virtually side to side which caused me to opt to simply remove the cortex and then address the reshaping of the anterior capsule opening. Alan Aker
i was anticipating that you would have resumed the rhexis soon after aspirating some cortex, instead of removing all of it. in hindsight, that would have saved the rhexis.