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Cataract Surgery | Posted 3/18/2014
In this case, the capsulorrhexis was smaller than the optic. The size was optimized after IOL insertion.
Capsulotomy/Capsulorrhexis • Cataract Surgery
Tushar Agarwal, MD
Cataract Surgery | Posted 3/18/2014
read: CATARACT & REFRACTIVE SURGERY TODAY EUROPE APRIL 2014
• Cataract Surgery
The surgeon is simply sharing a technique. It is possible you may want to do this. I have on occasion made a 4mm rhexis I contemplated enlarging, for various reasons, perhaps I was concerned about phimosis, perhaps retina surgery was to be done soon and the smaller rhexis may prevent good peripheral visualization. There is no need to beat up the surgeon for providing a technique.
an article came out a few months ago in one of the major journals addressing exactly this issue- does a well-centered rhexis really have any significant effect on centration of the iol. answer- none. so i agree this is an unnecessary maneuver and i would not bother. agree with above- why take slight risk of losing the rhexis, even in the best of hands??
Enlarging the capsulorrhexis provides no addition to vision and that is the point of the original comment. What benefit does it provide, and please do not say better centration of the lens.. The anterior capsule opening size has little to do with how a lens centers, just think about it. Do the zonules change position because of the size of the capsulorrhexis, very doubtful. The contraction of the bag posterior to the zonules after IOL implantation is what will move the lens and affect centration, not the size of the capsulorrhexis. Think about it. There is thus no "perfection' being performed here. Just because you can do something does not mean it should be done. Also, you weaken the torn capsulorrhexis edge when it is cut with scissors to start an enlargment, further increasing risk of an extending tear, especially during viscoelastic removal at the end of the case. There are moments in the enlargement where the patient could move, etc. and then a completely great result has just been compromised, and people watching this video in order to learn good techniques should know that this is not something to do, no matter what your skill is, because there is NO benefit to the patient, only increased risk of complications. If this were my eye being operated on, I certainly wouldn't want my surgeon doing this.
I do agree not to attempt surgical misadventure,but perfection is welcome. It is up to surgeon"s ability and long experience to perform such difficult procedure.Ultimate aim is to give good vision to the patient.
why would you risk thisat the end of an uncomplicated completed surgery-- in this case???? For No real benefit and a lot of risk. The capsule only has to overlap the iol in three places for it to be stable as shown in the most recent studies. think how stable a pyramid is. The enemy of good is perfect. Please, nobody else do this.
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