PHACOEMULSIFICATIPHACOEMULSIFICATION IN INTUMESCENT ON IN INTUMESCENT MATURE CATARACT: MATURE CATARACT: Managing a run-out Managing a run-out

capsulorhexiscapsulorhexisDR.MANISH MAHENDRADR.MANISH MAHENDRA

KHAIRABAD EYE HOSPITAL & KHAIRABAD EYE HOSPITAL & P.N.MAHENDRA EYE INSTITUTEP.N.MAHENDRA EYE INSTITUTE

KANPURKANPURINDIAINDIA

The Author has no financial The Author has no financial interest in the subject matter interest in the subject matter

of this poster of this poster

INTRODUCTIONINTRODUCTION

White CataractsWhite Cataracts4 Types4 Types

Golden Nuclear Hue & Hard ConsistencyGolden Nuclear Hue & Hard Consistency Swollen Intumescent CataractSwollen Intumescent Cataract

Morgagnian Cataract Morgagnian Cataract

White Cortical Cataract – SpokingWhite Cortical Cataract – Spoking CleftingClefting Cortico-capsular AdhesionsCortico-capsular Adhesions

INTUMESCENT MATURE INTUMESCENT MATURE CATARACTCATARACT

EtiologyEtiology Characteristics Characteristics * Depth Of AC * Depth Of AC << 2.0 mm 2.0 mm * Angle Of AC * Angle Of AC << 40 40

DegreeDegree * Lens Thickness * Lens Thickness >> 5.50 5.50

mmmm * Shape Of Lens : Decrease * Shape Of Lens : Decrease

The Aspect Of Biconvex The Aspect Of Biconvex Lens And It Becomes Lens And It Becomes Spheroidal. Spheroidal.

Imbibe Aqueous Imbibe Aqueous Through Through Semipermeable Lens Semipermeable Lens CapsuleCapsule Lens Swells Lens Swells

1) UNANTICIPATED ELEVATED 1) UNANTICIPATED ELEVATED ENDOCAPSULAR PRESSUREENDOCAPSULAR PRESSURE2) COMPROMISED 2) COMPROMISED VISUALISATION OFVISUALISATION OF THE CAPSULORHEXIS THE CAPSULORHEXIS

TWO TWO DIFFICULTIESDIFFICULTIES

HydroStatic Or Intra Lenticular Pressure

PhacomorpPhacomorphic hic GlaucomaGlaucoma

MATURE CATARACT

MAKING MAKING OF OF “A”“A” FLAGFLAG

InitialInitial Entry Entry (Puncture) Of Ant.Cap(Puncture) Of Ant.Cap

Egress Of Liquified Egress Of Liquified

Cortex Cortex

High IntraLenticular High IntraLenticular

Pressure Pressure

Radial TearRadial Tear ( ARGENTINA FLAG ) ( ARGENTINA FLAG )

METHODMETHOD

If Rhexis is going radial,what to do?If Rhexis is going radial,what to do?

- Immediately Stop Performing The - Immediately Stop Performing The RhexisRhexis

- Fill The AC With High Molecular Weight - Fill The AC With High Molecular Weight

Viscoelastics Viscoelastics

- Make Sure Nothing Is Pressing On The- Make Sure Nothing Is Pressing On The

Globe (Finger,Lid Speculum,Pt Globe (Finger,Lid Speculum,Pt Squeezing Squeezing

Lids) Lids)

METHODMETHODManaging The Torn RhexisManaging The Torn Rhexis

Small cut by Vannas ScissorIn 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

METHODMETHODManagementManagement

Phaco Chopping – Most Phaco Chopping – Most AppropriateAppropriate

SupraCapsular SupraCapsular Phacoemulsification Phacoemulsification (Avoid Stressful (Avoid Stressful Cracking)Cracking)

Low Bottle Ht/Low Low Bottle Ht/Low Flow Rate/Low Vacuum Flow Rate/Low Vacuum Phaco Phaco

Fortunately These Fortunately These Cataracts Are Not Too Cataracts Are Not Too Hard To CrackHard To Crack

IOL Implantation In IOL Implantation In The Bag, Taking Care The Bag, Taking Care Not To Enlarge The Not To Enlarge The Existing Tear & Placing Existing Tear & Placing The Haptics The Haptics Perpendicular To It Perpendicular To It

METHODMETHODSteps To Avoid Argentina’s Steps To Avoid Argentina’s

FlagFlag Puncture And Aspirate The Liquified Cortex Puncture And Aspirate The Liquified Cortex

And Decrease The Intralenticular PressureAnd Decrease The Intralenticular Pressure Use Liberal HPMC Or High Mol.Wt. Use Liberal HPMC Or High Mol.Wt.

Viscoelastics (Ofcourse Better)Viscoelastics (Ofcourse Better) Aim For A Small RhexisAim For A Small Rhexis

RESULTRESULT

By applying modified techniques By applying modified techniques

- Modified Capsulorhexis- Modified Capsulorhexis

- Phaco Chop(Avoid Stressful - Phaco Chop(Avoid Stressful Cracking) Cracking)

SupraCapsular PhacoemulsificationSupraCapsular Phacoemulsification

- Lower Phaco Parameters- Lower Phaco Parameters

one can manage these Intumescent Mature one can manage these Intumescent Mature Cataracts with Run-out Capsulorhexis and do Cataracts with Run-out Capsulorhexis and do successful phacoemulsification successful phacoemulsification

CONCLUSIONCONCLUSION

Thorough Pre-Surgical Evaluation Is Thorough Pre-Surgical Evaluation Is A Must In These Types Of Cataracts A Must In These Types Of Cataracts

Careful Surgical Planning Careful Surgical Planning Skillful & Dilligent Surgical Skillful & Dilligent Surgical

Technique Technique

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GOOD FORTUNEGOOD FORTUNEPrevents Argentinean Flag Formation