This patient is young, about 30 years old, and he developed a very dense and large posterior sub-capsular opacity which has significantly dropped his vision. He just can’t function normally and now he desires cataract surgery. The challenge is the limitation of our IOLs: there is no man-made lens implant which functions as well as a young, normal human crystalline lens. The patient has absolutely no cataract in the other eye, which sees 20/20 for far and near due to the large degree of accommodation. We have chosen to implant a monofocal, aspheric IOL with a goal of plano in this eye.
The cataract itself is very soft because there is no nuclear sclerosis. So soft that we do not even need the phaco probe to remove the cataract — we can just use the irrigation / aspiration (I/A) probe with high suction. We also make a special consideration for the capsulorhexis size because we are anticipating more capsular contraction and fibrosis compared to a geriatric patient.
Click below to watch the technique in a very soft PSC cataract:
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How was iol power calculated? Can a symphony lens be a good choice?
Why did you not choose 0.5 mm ccc overlap over the optic as per conventional teaching?
best method for IOL power is http://www.IOLcalc.com (register for an account — it’s free)
The Symfony lens may cause issues with night glare / halos — see here
https://cataractcoach.com/2018/08/18/comparison-of-night-vision-with-different-iols/
choose whatever overlap that you desire — it does not make a difference. Young people will have larger pupils at night and I do not want the rhexis to block too much of the optic. Also remember that the capsule will contract in the post-op period (especially in young patients) and will become smaller.
How do you perform pupil dilation before surgery?
Topical tropicamide and phenylephrine.