Dislocated Capsular Tension Ring

Self Cite

An 82-year-old man had uneventful phacoemulsification with bilateral implantation of a hydrophilic acrylic, single-piece intraocular lens (IOL) (ACR6D SE, Laboratoires Cornéal). Five years later, simultaneous and bilateral IOL subluxations occurred. In both eyes, the subluxation was situated on the side of one haptic that had moved forward (temporal area in the right eye and superior area in the left eye). In the right eye, the haptic-capsular bag was entrapped by the pupil and produced endothelial damage. A transscleral suture was placed over and under the subluxated haptic through the anterior and posterior capsules to capture the haptic. The haptic was then sutured to the sclera. No postoperative complications developed. We hypothesize that 10-degree angulated and broad haptic junctions can lead to zonular damage and IOL subluxation.

Section: J Cataract Refract Surg 2008; 34:700-702 Q 2008 Ascrs and Escrsmentioning

confidence: 99%

Bilateral intraocular lens subluxation secondary to haptic angulation

Moreno-Montañés¹,

Fernández-Hortelano²,

Caire³

2008

Self Cite

“…2 Another possibility is to insert a spatula through the opposite incision to provide counterpressure when the needle is passed through the peripheral capsule to loop and stabilize the IOLcapsular bag ( Figure 1). 3,4 With both methods, it is necessary to use a second instrument to stabilize the IOL-capsular bag. IOL-capsular bag may have to be sutured 2.0 mm posterior to the surgical limbus.…”

Section: Scleral Fixation Without Conjunctival Dissectionmentioning

confidence: 99%

“…4 During this procedure, the development of intraoperative recurrent iris prolapse led the surgical assistant, a first-year trainee registrar (D.G.C. ), to suggest the use of iris retractors, which he had seen used in a handful of patients with miosed pupils such as were required in a previous study.…”

Section: Iris Prolapse and The Floppy-iris Syndromementioning

confidence: 99%

Scleral fixation without conjunctival dissection

Moreno-Montañés¹,

Fernández-Hortelano²,

Olmo³

2007

Self Cite

With the advent of new phacoemulsification techniques and equipment, the need to teach residents the ECCE technique before phacoemulsification has been somewhat controversial. Many surgeons no longer perform ECCE, and many do not recommend ECCE before transition to phacoemulsification in residency. 3 Performing phacoemulsification surgery without ECCE experience has not been associated with more complications or decreased visual outcome in resident cataract cases. 4 Furthermore, complication rates among senior surgeons converting from ECCE to phacoemulsification have not been lower than those of residents performing phacoemulsification without ECCE experience. 5 This means ECCE experience does not guarentee a safe phacoemulsification procedure.Another concern is the patient factor. Many cataract patients are not willing to be operated on with techniques involving suturing and injectional anesthesia. They expect a state-of-the-art operation.In conclusion, we believe that ECCE experience is not a prerequisite for phacoemulsification cataract surgery. It is increasingly impractical for teaching units to impart experience in ECCE. Our study is one in a series establishing the safety of learning phacoemulsification de novo.dMustafa Ü nal, MD, _ Iclal Yü cel, MD 2. Coelho RP, Weissheimer J, Romao E, et al. Pain induced by phacoemulsification without sedation using topical or peribulbar anesthesia. J Cataract Refract Surg 2005; 31:385-388 3. Prasad S, Kamath GG. Phacoemulsification performed by residents. J Cataract Refract Surg 2000; 26:794-795 4. Quillen DA, Phipps SJ. Visual outcomes and incidence of vitreous loss for residents performing phacoemulsification without prior planned extracapsular cataract extraction experience. Am J Ophthalmol 2003; 135:732-733 5. Ah-Fat FG, Sharma MK, Majid MA, Yang YC. Vitreous loss during conversion from conventional extracapsular cataract extraction to phacoemulsification.

“…4 During this procedure, the development of intraoperative recurrent iris prolapse led the surgical assistant, a first-year trainee registrar (D.G.C. 4 During this procedure, the development of intraoperative recurrent iris prolapse led the surgical assistant, a first-year trainee registrar (D.G.C.…”

Section: Iris Prolapse and The Floppy-iris Syndromementioning

confidence: 99%

Reply : Scleral fixation without conjunctival dissection

Hoffman¹,

Fine²,

Packer³

2007

IOL-capsular bag may have to be sutured 2.0 mm posterior to the surgical limbus. In that case, retrieving the Prolene suture through the scleral pocket incision using a Sinskey hook and tying a knot could be more complicated. Performing a conjunctival dissection and creating a scleral flap might be a better technique.Despite disagreeing with certain aspects of the surgical technique of Hoffmann et al., we believe it is a step forward in refining scleral fixation of the IOLcapsular bag and increasing patient comfort.