Complex Cataract: multiple challenging issues

complex cataract 047 title

This patient had a large rhegmatogenous retinal detachment repaired a few years ago with a successful pars plana vitrectomy. The eye then developed a cataract which worsened quite rapidly and resulted in vision of counting fingers. This was left untreated for a while so the patient also developed sensory exotropia. The patient now presents for cataract surgery.

The list of challenging issues includes:

  • dense cataract with extensive posterior subcapsular opacities and a fibrotic scar of the posterior capsule
  • posterior synechiae of the iris to the lens capsule and the subsequent irregular pupil that dilates poorly
  • sensory exotropia of this eye
  • high degree of astigmatism with 3 diopters of cylinder in the cornea

We need to do multiple procedures at once:

  • break the synechiae, restore the iris/pupil anatomy and function
  • create a capsulorhexis that is large enough to avoid future posterior synechiae but will still overlap the optic edge of the IOL
  • remove the cataract, attempt to polish the posterior capsule fibrotic opacity
  • implant a toric IOL to address the astigmatism and place it at the correct axis
  • instill medication to quell inflammation and prevent more synechiae

For the sensory exotropia, there is a good chance that once vision is restored to this eye the ocular alignment will improve and binocular vision (fusion of images) will occur. If the patient is still left with diplopia after a few months, a future strabismus surgery may be required.

Here is a before / after comparison:

complex case before and after

complex case before and after
Before pic from the initial consultation. After pic is from the first post-operative day.

Click the pic below for the video showing the techniques:



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