Crossed-swords, capsule-pinch technique for capsulotomy in pediatric and/or loose lens cataract extraction

Snyder, Michael E.; Lindsell, Luke B.

doi:10.1016/j.jcrs.2009.09.029

Cited by 9 publications

(5 citation statements)

References 12 publications

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“…3 With or without posterior support, as needed, the anterior capsule can be pierced with a cystotome, or if the lens is very wobbly, two 30-gauge needles in a crossed-sword approach, capsule-pinch technique (Figure 3). 4 A 4 mm to 5.5 mm capsulorhexis can be peeled, perhaps adding iris retractors to the capsule margin during the process or holding the capsule edge with a second microforceps for additional countertraction (Figure 4). 5 In cases of focal zonular damage only, phacoemulsification might be possible using a dispersive OVD to stent the bag equator.…”

Section: Michael E Snyder MDmentioning

confidence: 99%

Severely subluxated cataract

Chee,

McKee,

Snyder

et al. 2024

J Cataract Refract Surg

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A 56-year-old man with a history of myopic LASIK presented with left eye gradual blurring of vision over 3 months. There was no history of trauma. His uncorrected visual acuities were 20/25 in the right eye and 20/400 in the left eye. The right eye was normal except for an early cataract. The left eye had a moderate cataract that was phacodonetic. Vitreous was present in the shallow anterior chamber (AC) (Figure 1 JOURNAL/jcrs/04.03/02158034-202405000-00018/figure1/v/2024-04-22T135154Z/r/image-tiff ). The fundus was normal. The intraocular pressures (IOPs) were 14 mm Hg in the right eye and 20 mm Hg in the left eye. Ultrasound biomicroscopy of the anterior segment in the left eye revealed near total zonular loss with few intact zonular strands at the 6 and 10 o'clock regions (Figure 2 JOURNAL/jcrs/04.03/02158034-202405000-00018/figure2/v/2024-04-22T135154Z/r/image-tiff ). Vitreous was observed in the AC, herniating mostly from the 3 o'clock region. The endothelial cell density and optical coherence tomography (OCT) of the macular and disc in both eyes were normal. Central corneal thickness was 527 µm in the right eye and 520 µm in the left eye. Describe how you would manage this case surgically. Optical biometry had been obtained, and the axial length in both eyes was similar. Discuss how you would select the monofocal intraocular lens (IOL) diopter (D) targeted for −1.50 D if the AC depth in the left eye was 2.48 mm and in the right eye was 3.25 mm.

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Section: Michael E Snyder MDmentioning

confidence: 99%

Severely subluxated cataract

Chee,

McKee,

Snyder

et al. 2024

J Cataract Refract Surg

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“…As zonular deficiency reduces the countertraction forces, rhexis initiation may be difficult even with a sharp needle in severely lax zonules. A cross‐swords capsule pinch technique has been described whereby two 30G needles are introduced into the capsule simultaneously in counter directions 55 . In a tenaciously elastic paediatric anterior capsule, an MVR blade or straight 25G needle is required to puncture the anterior capsule in eyes without sufficient zonular counterforce; using a vitrector (vitrectorhexis) 56,57 has also been applied with success.…”

Section: Step‐by‐step Approach To Safe Surgerymentioning

confidence: 99%

Management of the subluxated crystalline lens: A review

Chan

2021

Clinical Exper Ophthalmology

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Cataract surgery for the subluxated crystalline lens is challenging. A thorough preoperative evaluation is important to determine the appropriate surgical approach for lens removal and the subsequent technique of intraocular lens placement. Important considerations include the extent and location of zonular weakness, and whether the zonular deficiency is caused by a static or progressive disease. The capsular bag should be preserved where possible. Creating a good‐sized and centred continuous curvilinear capsulorhexis is crucial to facilitate the use of capsular retractors and capsular tension devices, which provide capsular stability. Nucleus sculpting and rotation should be minimised to reduce zonular stress. Being cognisant of the possible intraoperative complications that may occur at each stage of the surgery and knowing how to reduce the risk of these complications occurring will enable surgeons to perform safe cataract surgery in these complex cases.

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“…Anterior capsule is pinched in between two 30-gauge needles until one of them penetrates to elevate a small flap which continues as CCC. [60] Pulsed-electron avalanche knife: Palanker et al [61] evaluated the pulsed-electron avalanche knife electrosurgical system as reported to create a histologically smooth cut. Surgical devices: Verus ophthalmic calliper has a disposable single-use silicone ring inserted into the AC, positioned on the anterior capsule to guide capsulorhexis creation. [62] Ring Calliper Designed by Tassignon et al is effectual in achieving a perfectly sized capsulorhexis along with a perfectly centred one with reference to pupil and limbus.…”

Section: Types and Modalities Of Anterior Capsulotomy In Cataract Surmentioning

confidence: 99%

“…Anterior capsule is pinched in between two 30-gauge needles until one of them penetrates to elevate a small flap which continues as CCC. [60]…”

Section: Types and Modalities Of Anterior Capsulotomy In Cataract Surmentioning

confidence: 99%

Techniques of anterior capsulotomy in cataract surgery

Sharma

Abell

Arora³

et al. 2019

Indian J Ophthalmol

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Optimal outcomes of a cataract surgery largely depend on the successful performance of an anterior capsulotomy. It is one of the most important steps of modern cataract surgery which reduces the risk of capsular tears and ensures postoperative stable intraocular lens (IOL). Anterior capsulotomy is considered ideal if it is round, continuous, well-centered, and overlaps the implanted IOL around its circumference. If any of these features is missing, it can be a cause of impedance for desired surgical and visual outcomes. Manual can opener and manual capsulorhexis are the routine standard techniques employed for manual extracapsular cataract extraction and phacoemulsification, respectively. Recent increasing use of femtosecond laser cataract surgery has allowed cataract surgeons to obviate inherent inaccuracies of manual anterior capsulotomy techniques. There is an ongoing quest to find an ideal, risk free, and surgeon-friendly technique of anterior capsulotomy that can be employed for surgery in all types of cataracts.

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Crossed-swords, capsule-pinch technique for capsulotomy in pediatric and/or loose lens cataract extraction

Cited by 9 publications

References 12 publications

Severely subluxated cataract

Severely subluxated cataract

Management of the subluxated crystalline lens: A review

Techniques of anterior capsulotomy in cataract surgery

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