3019: traumatic zonulopathy and mydriasis
Managing traumatic zonulopathy and fixed mydriasis requires a multi-step game plan to maintain control at every stage of the procedure. In this challenging case featuring 180 degrees of zonular loss, the surgeon initial placement of flexible capsule hooks provides critical counter-traction and stabilization, allowing for a safe phacoemulsification and nucleus removal. Recognizing that the remaining capsular support is non-viable for long-term IOL stability, the surgeon then completes a controlled removal of the entire capsular bag, followed by a thorough anterior vitrectomy to clear all vitreous traction from the anterior segment. The case culminates in a precise Yamane double-needle scleral fixation of a three-piece IOL, achieving excellent centration and secure long-term lens placement. Finally a pupilloplasty is performed with 10-0 polypropylene. Watch the video to study this comprehensive step-by-step strategy for handling complex post-traumatic reconstructive cases. What is your threshold for sacrificing an unstable capsular bag in favor of secondary scleral fixation? Please comment your thoughts below.
