Channels: Cataract Surgery | Posted 12/13/2012
Ivan Cima, MD, PhD, presents a cataract surgery in a 36-year-old male patient with Fuchs' heterochromic iridocyclitis. Preoperative visual acuity was count fingers at one meter. Slit lamp examination revealed deep anterior chamber, iridodonesis, and phacodonesis. The cataract was graded NO2 NC1 C3.5 P5 according to LOCS III. At the beginning of the surgical procedure, difficulties were encountered with capsulorrhexis because of the deep anterior chamber, poor red reflex, extreme zonular laxity and sticky cortex. During the hydrodissection, limited intraocular bleeding from anterior chamber angle (Amsler's sign) occured. During the phacoemulsification low bottle height and low vacuum settings were used. The cataract was soft and it was easily pulled out of the capsular bag into the anterior chamber where most of the surgery was performed, thus sparing the zonules. The cortical material was gently removed with bimanual irrigation and aspiration. Polishing of posterior capsule was only partly successful due to the presence of primary capsular fibrosis. A single-piece acrylic intraocular lens (IOL) was implanted in the bag. At the end of the surgery, triamcinolone acetonide 1 mg/ 0.1 mL was injected intracamerally. On the first postoperative day, uncorrected visual acuity was 1.0 on Snellen chart.
Cataract • Cataract Surgery • Zonules