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Phaco with Weak Zonules, 4+ NS

Dr. David Chang illustrates multiple strategies for these challenging cases including capsular dye, capsule retractors, vertical phaco chop, bimanual I/A, dispersive OVD to prevent capsular incarceration, delaying CTR insertion, and sulcus fixation of a PC IOL.

Comments (7)

I saw this last night. This morning I had a pseudoexfolation case with loose zonules. I tried your technique after a quarter of the capsule came loose. I used two hooks, worked like a charm, cleaned up the capsule, put in the CTR and placed the lens in the sulcus, optic captured by the bag. Thanks for a great day.

WALTER FRIED (98 months ago)

I have used this technique on a number of occasions. The Trypan Blue stained anterior capsule seems more brittle and on 2 cases "cheese wired" through the anterior capsular rim. Has anyone seen this? Also a cruise control (Staar Surgical) is very helpful in diminishing posterior capsular movement (in addition to lowering vacuum- flow levels). Do you consider using a Cionni Ring is these cases of severe PXE?

ed (108 months ago)

thank you for an excellent video

sceye (109 months ago)


Dr. Amer (109 months ago)

wich lense did you used?

riramco (110 months ago)

too hard on the cornea. chang's approach much better

ranchump (111 months ago)

As an alternative, after the nucleus is loose, why not move it into the anterior chamber and do the phaco to avoid pressure on the zonules with the in-the-bag removal?

(111 months ago)