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Due to the lack of zonular support and presence of vitreous in the anterior chamber, Richard Schulze, Jr., MD, opts to perform an intracapsular cataract extraction for a crystalline lens that was dislocated anteriorly by blunt trauma. After the wound is enlarged with corneoscleral scissors, the lens is engaged with a lens loop and scooped out of the eye. Due to questionable visual function, the eye was left aphakic and the surgeon uses a running suture with 10-0 nylon to close the wound.
Posted: 7/13/2011
Due to the lack of zonular support and presence of vitreous in the anterior chamber, Richard Schulze, Jr., MD, opts to perform an intracapsular cataract extraction for a crystalline lens that was dislocated anteriorly by blunt trauma. After the wound is enlarged with corneoscleral scissors, the lens is engaged with a lens loop and scooped out of the eye. Due to questionable visual function, the eye was left aphakic and the surgeon uses a running suture with 10-0 nylon to close the wound.
Posted: 7/13/2011
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Just Now
12 years ago
I have done a case very similar to this, but I think in a much better way. I first placed my 3 25 gauge vitrectomy ports, did an inferior and superior peritomy (small inferior peritomy). I then made a 9 mm incision and expressed the lens. I then resutured the wound with temporary 10.0 nylon sutures, did a PPV, staining with triessence to make sure I removed all the vitreous, then sutured in a CR70BU lens to the sclera with 9.0 prolene suture under 250 micron thick scleral flaps, then closed the main incision with 10.0 nylon suture. Not doing a PPV or even an anterior vitrectomy in this case and not placing a lens is awful. Very 1960s.
12 years ago
I have done a case very similar to this, but I think in a much better way. I first placed my 3 25 gauge vitrectomy ports, did an inferior and superior peritomy (small inferior peritomy). I then made a 9 mm incision and expressed the lens. I then resutured the wound with temporary 10.0 nylon sutures, did a PPV, staining with triessence to make sure I removed all the vitreous, then sutured in a CR70BU lens to the sclera with 9.0 prolene suture under 250 micron thick scleral flaps, then closed the main incision with 10.0 nylon suture. Not doing a PPV or even an anterior vitrectomy in this case and not placing a lens is awful. Very 1960s.
SHALABH SINHA
14 years ago
I would ask the same question......why no anterior vitrectomy???? And sponge vitrectomy in an era of 23/25/27 high speed vitrectomy????? The incision could have been a frown incision, less astigmatism induced, viscoat should have been put both infront and behind the lens, an AC maintainer with a sheet's glide would have better, rather than a lens loop to deliver the cataract. A pre-op ERG / VEP would have told you if to go further and place a scleral fixated IOL. Use of triamcinolone in the AC would have shown the vitreous which must be removed by a bimanual approach using two stab corneal incisions.
ari weitzner
14 years ago
if i could sweep the wound and make sure no vitreous strands, and see a nice small, round pupil after miochol, then avit may not be necessary- the viscoelastic would be enough to keep the vit out of ac.
ahmed fekry
14 years ago
why u didn't perform anterior vitrectomy?