Abstract
Purpose :
To report a simple, effective technique for novice surgeons creating a capsulorhexis in patients with pupillary miosis and a white, mature cataract.
Methods :
A single center, two-year retrospective chart review examined 1408 phacoemulsification cataract surgeries. The criteria for inclusion involved a white, mature cataract that was unresponsive to pharmacologic pupillary dilation preoperatively. A standardized technique was used for all cases. A 1mm corneal paracentesis was performed and a cohesive viscoelastic was used to expand the anterior chamber. Next, a 2.4mm temporal clear corneal incision was made and a collar button was introduced to break any posterior synechiae that were present. A malyugin ring was placed to expand the pupil. The cohesive viscoelastic was removed via the irrigation-aspiration tip. The wound was sealed with a small amount of viscoelastic and an air bubble was placed in the anterior chamber. The anterior capsule was then painted with trypan blue. The air bubble and trypan blue were then replaced by a dispersive viscoelastic used in the anterior chamber. Next curvilinear capsulorhexis was performed followed by standard phacoemulsion.
Results :
Eight patients ranging from 77 +/- 12 years (mean +/- standard deviation) met the criteria with a mature cataract and 3mm pupil preoperatively. Pupillary miosis was caused by posterior synechia in 50% of the cases followed by pharmacologic interactions from tamsulosin and donepezil in 25% of cases respectively. Cataract surgery was uneventful in all eight patients with no capsular tear or vitreous loss; however, one case had cortex retention requiring removal.
Conclusions :
Dense, mature cataracts and small pupils both compromise the view for the surgeon and may be significant risk factors for training ophthalmologists. Thus, good visualization of the anterior capsule with our simple technique facilitates a reliable capsulorhexis, potentially limiting the risk of complications in novice surgeons.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.