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Nicole Fram, MD, Samuel Masket MD
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This video demonstrates the use of a femtosecond laser in a patient with Weill- Marchesani syndrome and subluxated cataract. A 61-year-old female was referred for gradual diminution in her vision, which interfered with her ability to perform work-related reading. She had a history of Weill-Marchesani Syndrome, including brachymorphia and microspherophakia with zonulopathy, which induced inferior subluxation and tilting of bilateral cataracts. The patient demonstrated corneal astigmatism as well as mixed nuclear and posterior subcapsular cataracts which, in combination with zonular weakness, were consistent with her complaints of reduced visual function.
At surgery the anterior capsule OCT was noted to have large sine wave distortion, likely due to lens shape, decentration and tilt. As a result, the laser capsulotomy was incompletely perforated. Nevertheless, the curvilinear capsulotomy was accomplished by gently “tearing” the partially cut capsule with forceps in the direction of cut to uncut. Marked diffuse zonulysis was noted; this mandated use of capsule support hooks (Yaguchi-Kazawa, Handaya, Japan) to stabilize the capsule bag, allow phacoemulsification, placement of a capsular tension ring (CTR), scleral suture fixation of an CTR segment (Ahmed) and on-axis implantation of a toric IOL. The laser created capsulotomy had sufficient tensile strength to tolerate all the necessary maneuvers, and assured success of the procedure. Additional findings at surgery included marked loss of the superior zonule. As a result, when the CTR was implanted, the superior capsule bag was noted to be anterior to the iris. This finding required a limited pars plana vitrectomy in order to create adequate space in the posterior chamber for suturing of the CTR segment to the sclera.
This case demonstrates that femtosecond laser can be used for the creation and centration of anterior capsulotomy in the setting of subluxated cataracts. The patient had an uneventful recovery from surgery and achieved her optical goal of 20/20 uncorrected near visual acuity.
Posted: 5/08/2012
Nicole Fram, MD, Samuel Masket MD
This video demonstrates the use of a femtosecond laser in a patient with Weill- Marchesani syndrome and subluxated cataract. A 61-year-old female was referred for gradual diminution in her vision, which interfered with her ability to perform work-related reading. She had a history of Weill-Marchesani Syndrome, including brachymorphia and microspherophakia with zonulopathy, which induced inferior subluxation and tilting of bilateral cataracts. The patient demonstrated corneal astigmatism as well as mixed nuclear and posterior subcapsular cataracts which, in combination with zonular weakness, were consistent with her complaints of reduced visual function.
At surgery the anterior capsule OCT was noted to have large sine wave distortion, likely due to lens shape, decentration and tilt. As a result, the laser capsulotomy was incompletely perforated. Nevertheless, the curvilinear capsulotomy was accomplished by gently “tearing” the partially cut capsule with forceps in the direction of cut to uncut. Marked diffuse zonulysis was noted; this mandated use of capsule support hooks (Yaguchi-Kazawa, Handaya, Japan) to stabilize the capsule bag, allow phacoemulsification, placement of a capsular tension ring (CTR), scleral suture fixation of an CTR segment (Ahmed) and on-axis implantation of a toric IOL. The laser created capsulotomy had sufficient tensile strength to tolerate all the necessary maneuvers, and assured success of the procedure. Additional findings at surgery included marked loss of the superior zonule. As a result, when the CTR was implanted, the superior capsule bag was noted to be anterior to the iris. This finding required a limited pars plana vitrectomy in order to create adequate space in the posterior chamber for suturing of the CTR segment to the sclera.
This case demonstrates that femtosecond laser can be used for the creation and centration of anterior capsulotomy in the setting of subluxated cataracts. The patient had an uneventful recovery from surgery and achieved her optical goal of 20/20 uncorrected near visual acuity.
Posted: 5/08/2012
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Comments
Just Now
Richard Foulkes
13 years ago
I would like to see you do the other eye without the laser! There was clearly no advantage to your rhexis with large amounts of force and probable loss of zonuals. The outcome would likely have been the same..maybe even easier? Great technique and use of tools.
Mun Wai Lee
13 years ago
Very elegant surgery with the Hoffman pockets and capsular stabilization. My only comment would be the benefits of the Lensx capsulotomy?? Seems like more stress for the zonules(and the surgeon) when trying to complete the capsulotomy. Thanks for the video.
Nicholas Pefkaros
13 years ago
Way to go, Nicole!
Russ Van Norman
13 years ago
Nice surgery on a tough case. Do you feel that the laser made the creation of the rhexis easier in this case? Faster? In your opinion, did pulling on the incomplete cut cause more stress on the compromised zonules than a traditional CCC would? Thanks for the video.