If the zonular structures are intact and normal, the anterior lens capsule should be taut, especially after instillation of viscoelastic. When piercing the anterior capsule with the forceps or cystotome for creation of the capsulorhexis, it should be easy. But if the anterior capsule is not tightly stretched and the zonules are weak, the instrument will cause radial wrinkles in the anterior lens capsule. This is an important warning sign that zonular weakness may pose challenges and induce complications during cataract surgery.
During surgery, make a generous capsulorhexis, at least 5 mm in diameter. Avoid placing stress on the capsular bag during maneuvers such as nucleus division. Be careful during cortex removal to avoid further zonular compromise. And choose the IOL type and placement wisely to offer the best long-term results.
These eyes are also more likely to develop late post-operative complications such as anterior capsular phimosis or dislocation of the IOL-bag complex decades later.
Click below to learn about this important sign during cataract surgery:
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