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Ahmed Assaf, PhD, FRCS
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Ahmed Assaf, PhD, FRCS, demonstrates the management of a routine white intumescent cataract. During phacoemulsification, a large piece of the nucleus was noted in the anterior vitreous. Surprisingly the posterior capsule was intact, and most likely the fragment reached the anterior vitreous through an area of large zonular dialysis inferiorly. Dr. Assaf made an iatrogenic opening to move the fragment back into the anterior chamber. He then performed a scaffold technique with implantation of a three-piece IOL in the anterior chamber, followed by injection of an ample amount of dispersive OVD to protect the corneal endothelium. Phacoemulsificaiton continued followed by limbal and pars plana anterior vitrectomy for the remaining cortex and prolapsed vitreous. Finally, the IOL was placed into the sulcus with optic capture. However, the lens showed a considerable tilt due to the massive zonular dialysis. At this point, a decision was made to prolapse the IOL optic into the anterior chamber and suture the haptics to the iris with Prolene 10/0. At the conclusion of the surgery, the IOL was well centered in the sulcus and the pupil was rounded.
Posted: 9/07/2021
Ahmed Assaf, PhD, FRCS
Ahmed Assaf, PhD, FRCS, demonstrates the management of a routine white intumescent cataract. During phacoemulsification, a large piece of the nucleus was noted in the anterior vitreous. Surprisingly the posterior capsule was intact, and most likely the fragment reached the anterior vitreous through an area of large zonular dialysis inferiorly. Dr. Assaf made an iatrogenic opening to move the fragment back into the anterior chamber. He then performed a scaffold technique with implantation of a three-piece IOL in the anterior chamber, followed by injection of an ample amount of dispersive OVD to protect the corneal endothelium. Phacoemulsificaiton continued followed by limbal and pars plana anterior vitrectomy for the remaining cortex and prolapsed vitreous. Finally, the IOL was placed into the sulcus with optic capture. However, the lens showed a considerable tilt due to the massive zonular dialysis. At this point, a decision was made to prolapse the IOL optic into the anterior chamber and suture the haptics to the iris with Prolene 10/0. At the conclusion of the surgery, the IOL was well centered in the sulcus and the pupil was rounded.
Posted: 9/07/2021
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