This patient sustained trauma to his eye years ago and that resulted in a cataract which, over time, became liquefied and then resorbed. This allowed the capsular bag to collapse and this caused extensive zonular loss. The remaining lens material became very dense and the rest of the capsular bag fibrosed. This is a challenging case and it is successfully operated by a resident surgeon who does a great job. Before watching the video, ask yourself, “How should I approach this case?” What will you do for IOL placement?
Uday
I apologize for interjecting on this case.
I have great respect for you as a teacher and I know that many young surgeons follow you and listen to what you teach and that is why I feel compelled to comment on this case. In my opinion this surgeon breaks many rules for handling this kind of a case. Leaving a shriveled mess of a capsular bag with lens material in it is one bad idea because that will end up being pro inflammatory and have a risk of dislocating into the visual axis and causing problems …..but balancing an IOL on that unstable mess is really IMO a huge no no. That IOL is sure to dislocate over time (if not the next day) and I think it’s important that young surgeons know that just because an IOL looks OK with the patient lying flat when you give it a nudge to center it….. that doesn’t mean that it will stay there without adequate support. I think young surgeons should be taught how to plan, evaluate and execute these kinds of cases to make sure that when they leave the O.R. the lens is stable and properly fixated and just because it looks OK on the table doesn’t mean a thing. The hardest way to learn this is to have to see the patient that you operated on with the lens dislocated a day or a week later and to explain to the patient why you now have to either bring them back or refer it for proper management.
In my opinion this case would have been based managed by complete removal of the lens bag complex and scleral fixation of a new lens and this should be accompanied by proper pars plana vitrectomy.
Ultimately that is what this patient is going to need in a second surgery IMO.
Again I apologize for sticking my nose in here but I only do this because of my great respect for you. I know how many young surgeons follow you and I think that most of what you teach is fantastic but this case I feel very strongly about and I know many of my colleagues who handle these kinds of cases would (and do) absolutely agree on these principles. Please feel free to reach out to some and get their thoughts on this too.
Steve
Great input and I value your expertise. We present a wide variety of cases showing many different techniques, and ultimately the surgeons choose what is best in their hands and experience.