In this case presented here, the patient is quadriplegic and will have great difficulty sitting for a future YAG laser capsulotomy. Our guest surgeon decides to create a posterior capsulorhexis but then it runs out — all the way out to the capsular bag equator. Now what? How will he implant the single-piece acrylic IOL? He does a reverse optic capture. Click to learn more.
What IOL power offset would you use for reverse optic capture? Rule of 9s?
yes, rule of 9s due to the more anterior optic position
Kudos to this surgeon for presenting a challenging technique. I would have done the EXACT same thing. And it’s only as a third party am I realizing an obvious mistake. It seems to me that over inflation with viscoelastic was the problem here. It is helpful to prevent runout of the anterior capsule when we are inflating outside the bag. But when injecting into the bag, you are basically creating a setup for an Argentinian flag. When pressure in the bag exceeds pressure in the vitreous cavity. If I attempt this in the future I will try and inflate to close to physiologic iop. Will send a video if I do!