You are about to start doing phaco chop for this white cataract and you notice that the capsulorhexis is no longer round and there appears to be a fold in the capsule. What is going on?
Cataract surgery in a white cataract with 90 degrees of zonular loss presents significant challenges and requires careful intraoperative strategy. The white, intumescent lens increases the risk of capsulorhexis extension due to high intralenticular pressure. Staining the capsule with trypan blue and decompressing the lens by needle aspiration before initiating the capsulorhexis can help maintain control. With 90 degrees of zonular dialysis, capsular support is compromised, making the use of a capsular tension ring (CTR) essential to redistribute forces and stabilize the bag during phacoemulsification and IOL implantation. The CTR should be inserted after successful completion of the capsulorhexis and initial lens removal, ideally once enough space is created to avoid further zonular stress. Phaco should be performed with minimal turbulence, using low-flow parameters and a chopping technique to reduce zonular traction. Additional capsule hooks or iris retractors may be used to support the capsular bag intraoperatively. Following cortex removal, a posterior chamber IOL can typically be placed within the stabilized bag. However, careful centration and monitoring are required postoperatively, as the eye remains at risk for late decentration or phacodonesis. Long-term outcomes are generally good with proper surgical technique, though close follow-up is essential.
Can you be my Mentor Sir? I am a new Consultant from Nigeria with special interests in Phacoemulsification, and corneal surgeries