In rare cataract cases, particularly those from prior trauma, we can get fibrosis of the anterior capsule. This makes the capsulorhexis difficult since the tearing motion is impeded by the fibrotic bands which are tough and resistant. In this case, submitted by Neto Rosatelli MD from Brazil, small gauge micro-scissors are used to assist in cutting the capsular edge.
Here is more information from Dr Rosatelli:
This is a 71yo woman with a history of cataract OD after blunt trauma when she was 10yo. A 61yo cataract! The usual features of a traumatic cataract are well illustrated in this case, such as fibrotic anterior and posterior capsule, zonular laxity, dense cataract, and even a kind of “dark spot sign” indicating a likely capsule puncture. There was a distinct feature on the lens superonasal quadrant, with partial absorption of lens material and also a very hard and adherent peripheral nucleus remnant, which I wasn’t able to remove without risking rupturing the capsule. Since it probably had already been exposed to the aqueous at the time of trauma and would elicit almost no reaction, I decided not to remove it and place the IOL in the sulcus.
The case proceeds very well and the patient achieves an excellent outcome. There may be some diplopia in the post-op period, particularly if the patient had significant sensory exotropia from visual deprivation for so many decades.
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Click below to learn from the cataract case with fibrotic anterior capsule:
Again a great video, with a nice video comment.
Beautiful job done by dr Rosatelli!
I wonder if this case was suitable for fliping the lens in the anterior chamber.
What kind of approach would you choose when dealing with such a case?
I like Dr Rosatelli’s approach using phaco chop. I worry that prolapsing the nucleus out of the bag may damage the irregular capsulorhexis since the anterior capsule is fibrotic and less elastic