Intraoperative Zonular Disaster - Surgical Management of a Complicated Case
by Alin Stefanescu-Dima, MD, PhD
Alin Stefanescu-Dima, MD, PhD, presents a case of hypermature, Morgagnian cataract, with fibrous anterior capsule, extreme zonular weakness and hard, brown nucleus moving freely within the lens bag. During the nucleus fracture, a large zonular dehiscence occurs, expanding over 6-clock hours. Therefore iris hooks and CTR are placed to support the bag. At the end of phacoemulsification a small posterior capsule tear is noticed which is converted into PCCC. No vitreous presented in the anterior chamber. A lens is implanted in the sulcus, judging this position to offer a better long-term stability.
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Comments (4)
Very educational, thank you.
i prefer debulking the nucleus with wide grooves using very high power- i have found that very high power done in the bag poses no risk to endothelium. good save with the hooks and ctr!
Very good observation, thank you very much. Staying out of trouble is very important in any kind of surgery... But, equally important is getting out of trouble once you have stepped into it. Zonular weakness remains a challenge for every surgeon. Retrospectively, I think inserting the CTR prior to phacoemulsification would have saved me a lot of effort.
Zonular weakness was obvious from the beginning of the case. The most important management would be not doing the things you have done till 180 degrees zonulolizis occured. But thank you for your nice video.