3010: How will you fix this case of traumatic zonulopathy?
Severe ocular trauma with more than 180 degrees of zonular loss presents one of the most difficult challenges in anterior segment surgery. When capsular support is so extensively compromised, attempting standard phacoemulsification without specialized stabilization risks total dislocation of the crystalline lens into the vitreous cavity. A systematic strategy for managing massive zonular weakness involves utilizing early capsular hooks and then a capsular tension segment and CTR to re-establish centration and counter-traction before safely proceeding with nucleus removal. Watch the clip to analyze the step-by-step fluidic adjustments, gentle hydrodissection, and scleral-fixation techniques needed to achieve long-term lens stability in post-traumatic eyes. What is your go-to surgical strategy when facing greater than 180 degrees of zonular dialysis: scleral-fixated capsular devices, or complete intracapsular extraction with scleral IOL fixation? Please comment your thoughts and techniques below.
