Abstract
Purpose :
To describe a technique for intraocular lens implantation that was performed after capsulorhexis and before phacoemulsification to protect the posterior capsule (PC) in a case of a Morgagnian cataract with a very thin, dense nucleus.
Methods :
After topical anesthesia was applied, a 1-mm side port clear corneal incision was made. Indocine green was used to dye the anterior capsule for 15 seconds before it was flushed out by balance salted solution. An ophthalmic viscosurgical device (OVD), 1.5% sodium hyaluronate was used to refill the anterior chamber. A 2.8-mm, 3-stepped, clear corneal incision was made 90 degrees to the right of the side port incision. Capsulorhexis was started by pinching the anterior capsule with forceps, and the liquid cortex was then aspirated from the capsular bag with a 5mL syringe. More viscoelastic materiel was injected into the anterior chamber to flatten the anterior capsule, and a 5.5-mm continuous curvilinear capsulorhexis (CCC) was then performed with forceps. Some of the OVD was injected into the capsular bag to tilt the lens nucleus and make more space between the nucleus and the rim of the CCC. A 3-piece IOL was implanted in the capsular bag beneath the nucleus. A venture system phaco machine was set to a perimeter lower than normal and used at a vacuum 280 mmHg, a bottle height 85 cm, and 40% power. The phaco-chop technique with phaco-tip bevel-down was used. After the entire nucleus was removed, the residual cortex and OVD were aspirated, the anterior chamber was reformed, and the 2.8-mm incision was sutured with 10-0 nylon.
Results :
The patient’s visual acuity at day 1 post-operation was 20/40, and there were some folds in Descemet’s membrane. Visual acuity was 20/20 on day 7, and the cornea was clear after the suture was removed.
Conclusions :
Pre-implanting an intraocular lens into the capsular bag following capsulorhexis but before starting phacoemulsification could protect the posterior capsule in a Morgagnian cataract with dense nucleus.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.