PHACOEMULSIFICATION IN INTUMESCENT MATURE CATARACT: Managing a run-out capsulorhexis

DR.MANISH MAHENDRA KHAIRABAD EYE HOSPITAL & P.N.MAHENDRA EYE INSTITUTE KANPUR INDIA The Author has no financial interest in the subject matter of this poster

INTRODUCTION White Cataracts 4 Types

  Golden Nuclear Hue & Hard Consistency Swollen Intumescent Cataract  Morgagnian Cataract  White Cortical Cataract – Spoking Clefting Cortico-capsular Adhesions

INTUMESCENT MATURE CATARACT

 Etiology Imbibe Aqueous Through Semipermeable Lens Capsule Lens Swells  Characteristics * Depth Of AC < 2.0 mm * Angle Of AC < 40 Degree * Lens Thickness > 5.50 mm * Shape Of Lens : Decrease The Aspect Of Biconvex Lens And It Becomes Spheroidal.

MATURE CATARACT

HydroStatic Or Intra Lenticular Pressure

TWO DIFFICULTIES

Phacomorphic Glaucoma

1) UNANTICIPATED ELEVATED ENDOCAPSULAR PRESSURE 2) COMPROMISED VISUALISATION OF THE CAPSULORHEXIS

MAKING OF

“A”

FLAG

Initial Entry (Puncture) Of Ant.Cap

Egress Of Liquified Cortex High IntraLenticular Pressure Radial Tear ( ARGENTINA FLAG )

METHOD



If Rhexis is going radial,what to do?

- Immediately Stop Performing The Rhexis - Fill The AC With High Molecular Weight Viscoelastics - Make Sure Nothing Is Pressing On The Globe (Finger,Lid Speculum,Pt Squeezing Lids)

METHOD Managing The Torn Rhexis

Small cut by Vannas Scissor In the Periphreal Upper Part of the Torn Rhexis Use of Utrata Forcep to complete a Superior semi circle of the Modified Rhexis Nick in the Peripheral Lower Part of the Torn Rhexis Use of Utrata Forcep to complete the Inferior semi circle Rhexis Forcep completing the Inferior Modified Rhexis “Modified Rhexis” Superior and Inferior Semi Circles

METHOD Management

 Phaco Chopping – Most Appropriate SupraCapsular Phacoemulsification (Avoid Stressful Cracking)   Low Bottle Ht/Low Flow Rate/Low Vacuum Phaco Fortunately These Cataracts Are Not Too Hard To Crack  IOL Implantation In The Bag, Taking Care Not To Enlarge The Existing Tear & Placing The Haptics Perpendicular To It

METHOD Steps To Avoid Argentina’s Flag

   Puncture And Aspirate The Liquified Cortex And Decrease The Intralenticular Pressure Use Liberal HPMC Or High Mol.Wt. Viscoelastics (Ofcourse Better) Aim For A Small Rhexis

RESULT

 By applying modified techniques - Modified Capsulorhexis - Phaco Chop(Avoid Stressful Cracking) SupraCapsular Phacoemulsification - Lower Phaco Parameters one can manage these Intumescent Mature Cataracts with Run-out Capsulorhexis and do successful phacoemulsification

CONCLUSION

 Thorough Pre-Surgical Evaluation Is A Must In These Types Of Cataracts  Careful Surgical Planning  Skillful & Dilligent Surgical Technique + GOOD FORTUNE

Prevents Argentinean Flag Formation