3020: early surgery for anterior lenticonus
Anterior lenticonus, a classic manifestation often associated with Alport syndrome, presents distinct surgical challenges due to progressive forward bulging of the central lens capsule and marked thinning of the anterior capsule matrix. Creating a safe capsulorhexis in these eyes requires executing the soft-shell viscoelastic technique, layering a dispersive OVD over the anterior capsule to protect the endothelium while using a dense cohesive OVD to press down centrally, flattening the conical protrusion and equalizing vector forces to prevent a radial run-out. Controlled micro-forceps manipulation combined with gentle hydrodissection allows for safe nuclear clearance while keeping the capsular bag safe. Watch the video to see this step-by-step approach for navigating complex anterior segment pathology. What is your preferred OVD strategy when creating a capsulorhexis in an eye with severe anterior lenticonus? Please comment your thoughts and surgical pearls below.
