Posterior Capsule Rupture Research Articles

Changes in Lens Structure in Pathological Myopia, Cataract Surgery and Special Situations

Pathological myopia is a major cause of low vision and blindness worldwide. In patients with pathological myopia, there are changes such as thinning of the lens and increase in equatorial diameter. In various population and clinic-based cohort, case-control and cross-sectional studies, it has been reported that myopic patients have a higher risk of posterior subcapsular cataract, cortical and nuclear cataract. It is known that the modern technique of phacoemulsification and intraocular lens implantation is effective in highly myopic eyes and provides significant improvement in visual acuity. However, complications related to phacoemulsification such as posterior capsule rupture, retinal detachment, progression of existing maculopathy, capsular phimosis, late lens dislocation and transient intraocular pressure elevation occur more frequently in highly myopic patients. As a result, it is extremely important that cataract surgeries of these patients are performed by experienced surgeons and that attention is paid to perioperative and postoperative complications.

Risk of Posterior Capsule Ruptures in Fellow-Eye Cataract Surgeries: A Multicenter Comparative Study

ABSTRACT Purpose To quantify the risk of posterior capsule rupture (PCR) in fellow-eye phacoemulsification surgery and to determine risk factors. Methods We pooled data from 8 United Kingdom sites for patients undergoing bilateral non-simultaneous phacoemulsification. Main outcome measures were the incidence and risk factors of the development of PCR during the fellow-eye phacoemulsification. Results We included 66,288 patients with a mean age of 75.3 ± 10.2 years. PCR during phacoemulsification occurred in the first eye in 932 patients (1.4%) and the fellow eye in 1039 patients (1.5%). The risk of fellow eye developing PCR in patients with PCR in the first eye was significantly higher than in patients without first eye PCR: 30 patients (3.2%) vs. 1009 (1.5%), respectively (odds ratio (OR) = 1.7, 95% confidence interval (CI) = 1.1-2.7). Other risk factors for fellow-eye PCR included zonular dialysis (OR = 5.4, CI = 3.3-7.8) and advanced cataract (OR = 2.8, CI = 2.1-3.7). Conclusions History of PCR in the first-operated eye is an independent risk factor for PCR in the fellow eye.

Ten-year trends of delayed sequential bilateral cataract surgery (DSBCS) in Sweden: a register-based study.

To study the trend of delayed sequential bilateral cataract surgery (DSBCS) in Sweden in the past decade. This register-based cohort study utilized data from the Swedish National Cataract Register (NCR) from 2010 through 2019. Register files from patients who underwent cataract surgery in both eyes during the study period were linked using their social security numbers. Bilateral surgeries on different days were classified as DSBCS. The study investigated the association between DSBCS within 3months and several variables with stratification and multivariate logistic regression. The following variables were used: operation year, region, private or public unit, age, sex, indication for surgery, type of intraocular lens (IOL), preoperative visual acuity, ocular comorbidity, posterior capsule rupture and perioperative difficulties. During the study period, 368,106 patients underwent DSBCS, of which 62.6% (n = 230,331) had bilateral surgery within 3months. The median time between the surgeries was 61days (interquartile range 26-161days), showing regional variations. Better visual acuity in the fellow eye, presence of ocular comorbidity, various perioperative events and complications were associated with longer time to surgery of the second eye. Conversely, cataract surgery in more recent years, private clinic, increasing age, anisometropia and multifocal IOL were associated with shorter timespan between surgeries. The majority of DSBCS were conducted within a 3-month timeframe, with the interval between surgeries decreasing throughout the study period. Several rational factors were associated with the time difference, in addition to regional variations. Many patients would probably benefit from less time between the surgeries, and we encourage a clinical practice taking the whole patient's visual function into account.

The Royal College of Ophthalmologists' National Ophthalmology Database study of cataract surgery: Report 17, a risk factor model for posterior capsule rupture.

To create a risk factor model for posterior capsule rupture (PCR) during cataract surgery. Eligible operations between 01/04/2016 and 31/03/2022 from centres supplying data to the UK national cataract audit with complete data including patients' gender and age at surgery, anterior chamber depth (ACD) measurement and preoperative visual acuity (VA) were included. A logistic regression model was fitted to identify risk factors and calculate their odds ratios (OR) and 95% confidence intervals (CI) for PCR. This analysis included 961,208 cataract operations performed on 682,381 patients from 136 participating centres by 3198 surgeons. 9730 (1.01%) of surgeries were complicated by PCR. The median age was 75.7 and 76.7 years for first and second eye surgery respectively, and 5154 (53.0%) were female. The highest risk factors for PCR were less experienced trainee surgeon (OR 3.75, 95% CI 3.33-4.24, p < 0.001), pseudoexfoliation/phacodonesis (OR 3.47, 95% CI 3.05-3.94, p < 0.001), younger males (OR 3.05, 95% CI 2.23-4.16, p < 0.001) and brunescent/white/mature cataract (OR 2.41, 95% CI 2.24-2.60, p < 0.001). Other risk factors identified were glaucoma, worse preoperative VA, previous intravitreal therapy, high myopia, previous vitrectomy, systemic diabetes, diabetic retinopathy, amblyopia, older age, shallower ACD and inability to lie flat and cooperate. Various surgical, patient and ocular factors increase the risk of PCR during cataract surgery. This risk factor model permits estimation of individualised risks for patients and allows risk-adjustment for surgeons to evaluate their PCR rates based on case complexity.

Incidence of Posterior Capsule Rupture During Phacoemulsification Cataract Surgery Among Patients Treated With Intravitreal Bevacizumab Injections.

To assess whether intravitreal bevacizumab injections increase the risk of posterior capsular rupture during phacoemulsification cataract surgery in diabetic patients. A retrospective study that included diabetic patients who underwent phacoemulsification cataract surgery at King Hussein Medical Center of the Jordanian Royal Medical Services during a one-year period from January 2023 until January 2024. Patients were categorized into four groups. The first group did not receive an intravitreal bevacizumab injection; the second group received only one injection; the third group received two injections; and the fourth group received three or more injections. Results from the four groups were compared with a control group for patients who underwent phacoemulsification surgery and were not known to have diabetes mellitus and did not receive previous intravitreal injections. All injections were received within a period of one year before the time of phacoemulsification surgery. Inclusion criteria for the study groups included diabetic patients with a history of diabetes of more than 10 years with the presence of diabetic retinopathy. Exclusion criteria included patients who received intravitreal injections other than bevacizumab, previous intraocular surgery or trauma, and the presence of ocular pathology that led to an increased risk of posterior capsular rupture. The incidence of posterior capsular rupture was compared among these groups. A p-value was used to assess statistical significance and was considered to be statistically significant if ≤0.05. The number of patients in the control group (group 0) was 1440 patients with a mean age of 64.9, and in the study groups were 1306 patients. Group 1 included 244 patients (18.7%) with a mean age of 62.4 years, compared to 306 patients (23.4%) in group 2 with a mean age of 66.1 years, 352 patients (27%) in group 3 with a mean age of 64.2 years, and 404 patients (30.9%) in group 4 with a mean age of 63.1 years. Posterior capsular rupture occurred more significantly in patients with group 4. It occurred in 21 patients, representing 5.2% of them, compared to four patients (1.6%) of group 1, six patients (2%) of group 2, and eight patients (2.3%) of group 3, while in the control group, the number of patients with posterior capsular rupture was 20 (1.4%). Intravitreal bevacizumab in diabetic patients is considered a risk factor for posterior capsular rupture in phacoemulsification cataract surgery in patients receiving more than three injections.

Isolated posterior capsule rupture secondary to blunt ocular trauma: Case presentation and literature review

IntroductionAn isolated posterior capsule rupture (PCR) is a rare complication associated with traumatic cataracts. We report our findings in three cases of traumatic cataracts with isolated PCR caused by blunt ocular trauma. Presentation of casesCase 1: A 1.5-year-old boy was examined after his parents noticed that the center of the pupil of the left eye was white. The mother reported that the boy had fallen and bruised his left forehead 4 months earlier. Case 2: An 18-year-old boy had a traumatic cataract that developed one month after a blow to his eye. Case 3: A 13-year-old boy was treated for hyphema and high intraocular pressure after blunt trauma to his eye. Ten days later, a total cataract developed. Anterior segment optical coherence tomography revealed an isolated PCR with a protruding lens cortex, and ultrasonography showed vitreous opacities. DiscussionAn isolated PCR was observed intraoperatively in the center of the posterior lens capsule. The lens cortex was prolapsed into the PCR or into the vitreous cavity in Case 3. An intraocular lens (IOL) was implanted in the lens capsule or to the ciliary sulcus after vitrectomy in Case 3. Vision improved in all eyes. ConclusionsOur findings indicated that the external force by a trauma to the eye can lead to an isolated PCR with a protruded lens cortex in young patients. These PCRs can be successfully treated with the IOL implanted in or out of the capsular bag.

Association Between Intraoperative Cataract Surgical Complications and Mortality

ABSTRACT Purpose To evaluate the association between intraoperative complications of cataract surgery and postoperative mortality. Methods A retrospective review of patients who underwent cataract surgery at our institution from 2014 to 2020 was conducted. Intraoperative complications included choroidal hemorrhage, posterior capsule rupture, vitreous loss, retained lens, and/or severe zonular dialysis in either eye. All-cause mortality statistics were obtained through a collaborative agreement with the Colorado Department of Public Health and Environment. Hazard ratios (HRs) from Cox proportional hazard models were used to estimate survival following cataract surgery. Results Among 8,054 patients, the mean follow-up time was 4.4 (SD = 2.3) years and the mortality rate was 15% (n = 1,175). The overall complication rate was 2.2% (n = 181), and the rate of retained lens was 0.7% (n = 58). In univariate analysis, retained lens (HR: 1.86, 95% CI: 1.08–3.21, p = 0.026), severe zonular dialysis (HR: 2.00, 95% CI: 1.29–3.12, p = 0.002), and any intraoperative complication (HR: 1.51, 95% CI: 1.09–2.11, p = 0.015) were associated with higher hazard of mortality. When adjusted for demographic factors, comorbid medical conditions, and pre-operative visual acuity, intraoperative complications were not associated with mortality. Conclusion Intraoperative cataract surgery complications were associated with mortality in univariate analysis. However, this association was not significant in the multivariable analysis as it is confounded by other factors such as pre-operative visual acuity.

270° Glenoid Labral Tear and Posterior Capsule Rupture in a Collegiate Athlete

270° Glenoid Labral Tear and Posterior Capsule Rupture in a Collegiate Athlete

Intraocular Lens (IOL) Exchange Procedure in Refractive Surprise After Ten Years of Cataract Surgery

Introduction: Postoperative refractive surprises may manifest following cataract surgery. A residual refraction difference of &gt; 2.0 D after cataract surgery was considered a refractive surprise. Treating refractive error after cataract surgery includes non-surgical and surgical options. The objective is to report clinical outcomes of intraocular lens (IOL) exchange with ciliary sulcus placement technique to manage refractive surprise. Case Presentation: A female patient aged 70 years reported experiencing blurred vision in her right eye (RE) for the past two years. History of RE cataract surgery ten years ago, however, she only had control 1-2 times after surgery. After that, the patient underwent cataract surgery on the left eye (LE), and then she complained that her RE was getting blurry. Her RE's visual acuity (VA) was 1/60 with best corrected visual acuity (BCVA) S-8.00 C-1.00 X100° to 6/10, and her LE was 7/10 with BCVA C-0.75 X60° to 10/10. The anterior segment examination of the RE was a 3-piece sulcus intraocular lens with complete continuous curvilinear capsulorhexis (CCC) intact anterior capsule, posterior capsule rupture, and the LE was in the bag IOL. Ultrasound examination of the RE revealed posterior staphyloma. She was diagnosed with OD refractive surprise, pseudophakia, posterior staphyloma, and OS pseudophakia. She underwent IOL exchange surgery on her RE. Post-operatively, the visual acuity of the RE was 7/45 using the Snellen chart. Three months post-op, the BCVA of RE was 10/10. Conclusions: In well-prepared cataract surgery, unexpected refractive outcomes such as a refractive surprise can be prevented. IOL exchange with ciliary sulcus placement technique is a treatment option for refractive surprise associated with posterior capsule rupture, and it has a good outcome.

Safety of Phacoemulsification with Gradual Hydro Dissection on Posterior Polar Cataract

Introduction: Phacoemulsification has been a procedure of choice for treating cataractous lenses and restoring visual function. Posterior polar cataract have been one of many cases in which phaco surgeons should be careful and aware for more to perform phacoemulsification. One hydrodissection procedure is safe to perform as an alternative to hydrodileniation during phacoemulsification for posterior cataract. It is called gradual hydrodissection. Methods: This study performed a quasi-experimental pre-post study that tested the safety of gradual hydrodissection in phacoemulsification in 50 eyes of 50 patients. The safety parameter used in this study includes the incidence of posterior capsule rupture and nucleus drop during phacoemulsification until surgery is finished. Descriptive statistics were used to summarize the characteristics of the study participants, such as age, sex, race, eye laterality, and previous intraocular surgery. A paired student’s t-test was conducted to compare preoperative and postoperative values for visual acuity and intraocular pressure. The P &lt;0.05 was considered the level of statistical significance. Results: There was no complication of the posterior capsule during the hydrodissection procedure. There was a statistically significant difference in visual acuity and intraocular pressure before and after surgery by P value &lt;0.001. All of the phacoemulsification studies were considered uneventful and successful. Conclusions: Gradual hydrodissection may be safe to be performed in phacoemulsification for posterior polar cataract.

The output of cataract surgery performed by trained non-ophthalmologist physicians in rural areas: study of cataract outcomes and up-take of services report 7.

Cataract is the leading cause of blindness worldwide and surgery can restore vision in most patients. Some patients have little access to surgical services due to lack of cataract surgeons and the unaffordable costs. In 2005 we built a service model that trained rural non-ophthalmologist physicians to perform cataract surgeries in rural China. This study evaluates the long-term impacts of this model. We conducted a retrospective cohort study to analyze patients' hand-written medical records and electronic outpatient record between January 2005 and December 2019 at two rural health clinics in Southern China. In total, 34,601 patients (49,942 eyes) underwent cataract surgery by non-ophthalmologist physicians from 2005 to 2019.Visual acuity was clearly documented in 38,251 eyes. Before surgery, the unaided distance visual acuity (UDVA) of 60.7% (23,205/38,251) eyes was less than 0.05 decimal. On the first day after surgery, the percentage of UDVA < 0.05 eyes was reduced to 6.0%, and 96.7% (36,980/38,251) of the eyes achieved a better UDVA compared to pre-operation. Surgical-related complications occurred in 218 eyes. The most common complication was posterior capsule rupture (114, 0.23%). 44.3% (15,341/34,601) of the patients chose to have a second eye cataract surgery (SECS) in the same clinic. At one of the outpatient clinics, 21,595 patients received basic eye care apart from cataract surgery between 2018 and 2020. Non-ophthalmologist physicians trained for cataract surgeries in rural clinics can improve cataract related visual acuity and basic eye care to the local population.

The uveitis–glaucoma–hyphema syndrome. Part 1. Pathogenesis, clinical features, diagnosis

BACKGROUND: The uveitis–glaucoma–hyphema (UGH) syndrome was first described in 1978 as a complication of anterior chamber polymethyl methacrylate intraocular lenses implantation. Introduction into practice of foldable intraocular lenses with intracapsular fixation has reduced the incidence of UGH. However, this complication still occurs today, especially with extracapsular intraocular lens fixation. AIM: The aim of this study is to describe “uveitis–glaucoma–hyphema” syndrome pathogenesis, clinical features, and diagnosis. MATERIAL AND METHODS: A retrospective analysis of medical data for 2017–2021 identified 100 patients (101 eyes) diagnosed with UGH syndrome, they made up the study group. Complaints, medical history, biomicroscopy, visual acuity and intraocular pressure were assessed. 37 patients underwent anterior segment ultrasound biomicroscopy using the Accutome UBM Plus (USA). RESULTS: The occurrence of UGH syndrome is at least 0.19%. The leading UGH syndrome risk factor was intraocular lens material. In 49% of cases these were AcrySof hydrophobic intraocular lenses. The second UGH risk factor was extracapsular (mixed and sulcus) intraocular lens fixation, occurring, according to ultrasound biomicroscopy, in 54 and 19% of cases, respectively. The most significant diagnostic UGH sign was hyphema (93%). Ocular hypertension was detected in 66%, and uveitis in 57% of cases. CONCLUSIONS: The main UGH syndrome manifestations are hyphema and iris transillumination after phacoemulsification complicated by posterior capsule rupture with extracapsular hydrophobic intraocular lens fixation. The most informative instrumental method to assess intraocular lens position is ultrasound biomicroscopy.

Comparison of complications and visual outcomes of combined phacovitrectomy vs stand-alone phacoemulsification: multicenter database study.

To compare the rates of intraoperative complications, cystoid macular edema (CME), and visual outcomes in eyes that underwent combined phacovitrectomy (Phaco-PPV) with those with stand-alone phacoemulsification. A multicenter database study across 8 ophthalmology departments in the United Kingdom. Retrospective, nonrandomized, multicenter comparative study. We extracted data for patients who underwent Phaco-PPV and stand-alone phacoemulsification from January 2000 through May 2015. The primary study outcomes were the rates of intraoperative complications and CME postoperatively. The study included 2222 eyes in the combined Phaco-PPV group and 112 689 in the stand-alone phacoemulsification group. The combined Phaco-PPV group had a higher incidence of posterior capsule rupture (2.7% vs 1.7%), dropped lens fragments (0.5% vs 0.2%), suprachoroidal hemorrhage (0.4% vs 0.1%), and CME (3.6 vs 1.1%) ( P < .001). The mean preoperative visual acuity (VA) was lower in the combined Phaco-PPV group, with a mean VA of 0.98 vs 0.68 logMAR (Snellen ∼20/200 vs 20/100) in the stand-alone phacoemulsification group ( P < .001). VA at 24 weeks was lower in the combined Phaco-PPV group (mean VA 0.67 vs 0.22 logMAR (Snellen ∼20/100 vs 20/32), P < .001). Combined Phaco-PPV had higher rates of intraoperative complications and CME, along with a lower postoperative VA, when compared with stand-alone phacoemulsification surgery.

VISUAL OUTCOME OF AGE-RELATED CATARACT SURGERY IN PATIENTS 50 YEARS AND ABOVE WHO UNDERGO CATARACT SURGERY. A CROSS-SECTIONAL STUDY AT JINJA REGIONAL REFERRAL HOSPITAL

Purpose of the study The study was to evaluate the visual outcome of age-related cataract surgery among patients 50 years and above who underwent cataract surgery at Jinja Regional Referral Hospital. It was carried out from December 2022 to April 2023. Study methods A hospital-based descriptive retrospective study methodology was used. Data was extracted from patients’ records and 80 files of patients aged 50 years and above who had undergone age-related cataract surgery in JRRH were analyzed. The data was captured using an interview guide and was presented in tables, figures, and narratives. Principle finding Out of 80 eyes analyzed, at 3-4 weeks good outcome was in 31.25% of eyes, borderline outcome in 17%, and poor outcome in 6.25%. Good and borderline outcome was due to biometry performed before surgery and turned up for review. Poor outcome was due to complications, pre-existing co-morbidity, and failure to turn up for review as required. 20% did not turn up at 1-2 weeks for review and 45% did not turn up for review at 3-4 weeks. Complications included; corneal edema, shallow anterior chamber, uveitis, elevated IOP, posterior capsule rupture, iridodialysis, and lens dislocation. Visual outcomes had a positive impact on quality of life after cataract surgery in all patients. Conclusion Visual outcome at the fourth week of follow-up was below the WHO recommendations and this was due to pre-existing co-morbidity, complications, and failure to turn up for review. Recommendations Devise a better information capture technique and find means to reach out to patients to come for follow-up visits, use modern technology and equipment, practice refraction for all post-operative patients, and encourage early uptake of cataract surgery services.

Simulation-based training for intraoperative posterior capsule rupture management: an analysis of nontechnical skills development and the relationship between technical and nontechnical skills.

To analyse development of individual nontechnical skills (NTS) domains after undertaking a previously developed simulation-based training model and analyse the relationship between technical skills (TS) and NTS in ophthalmic surgery. The simulation-based training model involved a cataract surgery case complicated by intraoperative posterior capsule rupture. Cataract surgeons underwent the simulation twice, separated by a training intervention. Two blinded independent experts assessed participants' NTS using HUFOES, NOn-Technical Skills for Surgeons (NOTSS), and the OSATS global rating scale for TS. Paired t-tests assessed differences in individual NTS domains, with p < 0.05 indicating significance. The Pearson Product Moment Correlation Coefficient was used to assess the correlation between scores from each scoring system. All NTS domains within HUFOES and NOTSS demonstrated statistically significant improvements secondary to the training intervention. Positive correlations were demonstrated between HUFOES and OSATS scores in the pre- and post-training simulations, r = 0.870 (p < 0.001) and r = 0.861 (p < 0.001), respectively. Positive correlations were also demonstrated between NOTSS and OSATS scores in pre- and post-training simulations, r = 0.849 (p < 0.001) and r = 0.757 (p = 0.001), respectively. Positive correlations were demonstrated between HUFOES and NOTSS scores; r = 0.979 (p < 0.001) (n = 17) and r = 0.959 (p < 0.001) for pre- and post-training simulations, respectively. All NTS domains contained within HUFOES and NOTSS demonstrated significant increases following the completion of the simulation-based training model. Positive correlations exist between an ophthalmic surgeon's TS and NTS. This is the first study to report these findings within ophthalmic surgery.

The Royal College of Ophthalmologists' National ophthalmology database study of cataract surgery: Report 14, cohort analysis - the impact of CapsuleGuard® utilisation on cataract surgery posterior capsule rupture rates.

The aim of this study was to investigate whether the use of the silicone tipped irrigation/aspiration (I/A) handpiece CapsuleGuard® (Bausch + Lomb, Laval, Canada) reduced rates of posterior capsule rupture (PCR) during cataract surgery. Royal College of Ophthalmologists' National Ophthalmology Database (NOD) Cataract Audit data from 01/04/2010 and 31/03/2021 and Bausch + Lomb sales figures were combined to identify centres participating in national cataract audit who have routinely adopted the silicone tipped I/A handpiece, CapsuleGuard®. Data were included only from centres with eligible cataract operations recorded on the NOD both before and after adopting CapsuleGuard®. Review of the literature was undertaken to estimate the proportion of PCR that occurs during I/A, to evaluate the impact of adoption of CapsuleGuard® on PCR occurring in this phase of surgery. Within the study period, 267 371 eligible cataract operations were performed in 14 centres with >50 eligible operations both before and after adopting CapsuleGuard®. Within centres adopting CapsuleGuard®, the rate of PCR occurrence reduction was 16.4%. Before and after the adoption of CapsuleGuard® the median change of PCR was 21.7% reduction (IQR: 4.8% to 37.7% reduction). A reduction in the rate of PCR was seen after regular adoption of CapsuleGuard® during cataract operations. Review of published studies attributing PCR to various components of the cataract operation suggest around 25% of PCR may occur during I/A; adoption of CapsuleGuard may, therefore, be associated with avoidance of a substantial proportion of the PCR during that phase of surgery.

Ethnic Differences in the Rates of Posterior Capsule Rupture and Long-Term Sequelae in Phacoemulsification Cataract Surgery.

Purpose The purpose of this study is to investigate the rates of posterior capsular rupture (PCR) and its sequelae during phacoemulsification across different ethnicities. Methods This is a retrospective cohort study of all consecutive phacoemulsification cases complicated by PCR that met the inclusion criteria over a four-year period at a single tertiary eye centre in the United Kingdom (UK). Results PCR occurred in 0.85% of cases overall (157/18,481). PCR rates were 1.8% (26/1485), 1.2% (51/4350), and 0.7% (75/10,927) in African-Caribbean, Indian subcontinent, and Caucasian patients, respectively (p < 0.001). Mean final corrected distance visual acuity improved (p < 0.05) in all ethnic groups(0.40 ± 0.57 logMAR) compared to pre-op (0.78 ± 0.61 logMAR). Post-operative cystoid macular oedema and unstable intraocular pressure rates following PCR did not statistically differ amongst ethnicities (p = 0.37 and p = 0.75, respectively). However, post-operative uveitis rates significantly differed at 11.5%, 15.7%, and 1.3% amongst the three ethnic groups, respectively (p = 0.01). Conclusion This is the first study to highlight a possible link between patient ethnicity and the risk of PCR during phacoemulsification cataract surgery. We observed significantly greater numbers of PCR cases amongst certain ethnic groups (highest in African-Caribbean eyes, then Indian subcontinental eyes, and lowest in Caucasian eyes) within the same multi-cultural urban population. Ethnicity may therefore be a contributing factor for PCR and should potentially be taken into consideration during preoperative risk stratification.

Intraoperative Complications in Cataract Surgery

Cataract surgery is frequently and successfully performed in the developed world. The indications for the operation have shifted on one hand towards healthier patients seeking freedom from glasses and on the other hand towards more complex cases. How should the patient be informed? What complications can occur intraoperatively, and what treatment options are available for these complications?This article offers a focus on conditions such as zonulopathy and pseudoexfoliation that can pose challenges to cataract surgery. It discusses the use of specialized tools such as capsular tension rings and capsular hooks and precise maneuvers to minimize stress on weakened zonules in order to ensure in-the-bag fixation of the IOL.Furthermore, the article addresses appropriate actions towards intraoperative complications such as anterior or posterior capsule ruptures and loss of nuclear fragments into the vitreous cavity.Exploring innovative advancements, this article presents the latest alternatives for intracapsular lens fixation, such as sutureless scleral fixation and emerging lens designs in cases where there is insufficient capsular support.Ultimately, the primary objective remains delivering optimal outcomes even for complex cases, and minimizing post-surgical issues. Numerous tools and techniques are available.

CHALLENGES IN THE SURGICAL MANAGEMENT OF BILATERAL POSTERIOR LENTIGLOBUS

Introduction : Lentiglobus is a lens deformation characterized by spherical bulging of the lens surface. The weakness of the posterior capsule in the lentiglobus makes the surgery challenging. We present a case of bilateral posterior lentiglobus and its management.&#x0D; Case Illustration : A 5-year-old boy was presented with the chief complaint of gradually blurred vision since 1 year ago. Visual acuity were 0.1 and closed face finger counting in the right and left eyes, respectively. An ophthalmology examination revealed lens opacities with partially reabsorbed lens material and protrusion of the lens surface posteriorly in both eyes (figure 1). The patient was diagnosed with developmental cataracts of the membranous type and posterior lentiglobus in both eyes. The patient underwent a surgical intervention for cataract extraction with aspiration technique. A spontaneous posterior capsule rupture was found with a shape like a lentiglobus. An anterior vitrectomy was performed. An intraocular lens was implanted. At one month after surgery, the best corrected visual acuities were 0.5 in both eyes (figure 2).&#x0D; Discussion : Several difficulties can be encountered during pediatric cataract surgery with the posterior lentiglobus morphology because of the thin or ruptured capsule. Previous studies have found preoperative and intraoperative posterior capsule rupture in 25% and 3.13% of lentiglobus cases, respectively. Hydrodissection should be avoided due to the weakness of the posterior capsule.&#x0D; ConclusionAppropriate surgical techniques to anticipate posterior capsule defects in the lentiglobus are required to produce a favorable outcome.

ND:YAG Laser Vitreolysis as The Management of Occluded Tube After Glaucoma Drainage Device Implantation (GDD)

Introduction : Glaucoma Drainage Devices (GDD) implantation surgery can be an alternative therapy for patients with uncontrolled IOP after trabeculectomy. However, tube occlusion is a common complication of GDD implantation. Management of tube occlusion can be done using laser or with surgery. This case presents the management of vitreous occlusion of tube implant using ND:YAG laser-vitreolysis.&#x0D; Case Illustration : A 63 year-old male patient came with chief complaint of pain in his right eye. The patient had a history of cataract surgery on the right eye and was diagnosed with glaucoma. An examination showed IOP in the right eye was increased, vitreous in COA and lens was aphakic with posterior capsule rupture. The patient had undergone trabeculectomy, but IOP remained high, so an Aurolab Aqueous Drainage Implant (AADI) GDD implantation was performed. However, six weeks after the procedure, the IOP still increased, and an examination revealed vitreous occlusion of the GDD tube (Figure 1) . The patient underwent Zeiss ND-YAG laser-vitreolysis on his right eye (Figure 2) with laser spot size of 50?m and power of 2.1 MJ. Post laser IOP was decreased.&#x0D; Discussion : GDD implantation is a surgical option for primary or secondary therapy, but tube occlusion can cause implantation failure. Laser-vitreolysis is a non- invasive modality to treat tube occlusion caused by vitreous.&#x0D; Conclusion : GDD occlusion can occur due to various etiologies, but laser-vitreolysis is a non-invasive treatment option aimed at restoring tube patency and aqueous outflow.