IOL Implantation with Zonulopathy

Surgical decisions in the setting of zonulopathy

“…A slow-motion phacoemulsification technique is critical to success in these cases. 3 Specifically, as the last nuclear piece is being removed, the low-flow phacoemulsification settings should be confirmed, and OVD should be placed to push back the floppy posterior capsule to avoid inadvertent posterior capsule rupture. After the nucleus is removed successfully, dispersive OVD can be used to dissect the anterior cortical material off the capsule, which will facilitate a zonule-“friendly” cortical removal.…”

“…Lacking normal centrifugal zonular tension, the posterior capsule will be very lax; inflating the capsular bag with a dispersive OVD before removing the last several fragments will keep the posterior capsule taut and restrain it from trampolining toward the phacoemulsification tip. 3…”

“…Although a sutured CTR or segment is an excellent option, I have had consistent success with sulcus placement of a 3-piece monofocal IOL in the setting of diffuse zonulopathy. 3,4 However, unlike with his first eye, it is important to capture the optic with the capsulorhexis (Figures 1 and 2). This prevents capsulorhexis contracture and IOL subluxation or rotation.…”

“…1 I would otherwise proceed with phacoemulsification after inserting 4 capsule retractors (Microsurgical Technologies; Chang modification) between the iris hooks. 2,3…”