A patient with a traumatic cataract stemming from an event 40 years ago presents for surgery to improve cosmesis. Eric Rosenberg, DO, opts for removal of the “iceberg” cataract with an extracapsular technique. After the lens is expressed, a 3-piece IOL is inserted and the eye is closed. The patient achieved a 2 to 3 line improvement in vision.
Cataract • Cataract Surgery • Extracapsular Cataract Extraction (ECCE) • Ocular trauma • Post Traumatic Cataract • Zonular Dehiscence • Zonules
Hi, I'm Eric Rosenberg, and I'm one of the third year residents at New York Medical College. A case presented here today is iceberg cataract, an extracapsular approach to doing a cataract extraction. We have a male with a history of traumatic cataract that had a guarded visual prognosis. After a thorough consent, we discussed the possibility of doing cataract extraction for him. We started off by doing the normal peritomy. Here, using a crescent blade, we'll go ahead and do the limbal groove associated with the extracapsular technique.
We like to start by first putting in a one millimeter paracentesis blade, get control of the anterior chamber, and inject viscoelastic. Now we're getting ready to do the can-opener capsulorhexis and loosen the nucleus. While we're doing this can opener, you can see that there is significant movement of the nucleus. That's secondary to zonular dialysis and zonular instability. As we discussed before that this cataract has been there for quite some time, roughly about 40 years and it was a result of trauma originally. So it was important to take it methodically and slow and not to compromise the zonules further.
Next step, we used the corneal scissors, left and right, to open up the incision. Ready to deliver the nucleus and with everything we do in surgery, it's about safety first so we placed two 7-0 vicryl sutures on either side of the main wound to gain control of the eye should that be necessary in the future part of the case.
Here we apply pressure, about 2 mm below the limbal grove and try to express the nucleus from the interior chamber. Sometimes it's not as easy as it looks and this particular case took about two attempts in order to get that nucleus delivered out of the eye. We quickly tied down the 7-0 safety sutures to get control of the eye and then proceed to continue closing the case. We do a little I/A, insert the lens. Usually when we do the safety sutures, we like to make sure that there's about 6 or 7 mm on either side so that way we can insert the intraocular lens.
And lastly here, we're just closing up the conjuctiva. You can see a nice round pupil. There's no vitreous and we had a successful surgical case. You can see here in the Pentacam (Oculus) images of the preoperative cataract and the postoperative outcomes which looked very good. The patient got about a 2 to 3 line improvement in vision, likely secondary to childhood amblyopia but everybody was very happy with the outcome of the case.