ICCE in Anteriorly Dislocated Crystalline Lens

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.

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Comments (5)

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.

bplancha (11 months 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.

bplancha (11 months 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.

DR. SHALABH (29 months 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.

ranchump62 (30 months ago)

why u didn't perform anterior vitrectomy?

quickplay (31 months ago)