3022: angle closure and white cataract case
Performing cataract extraction in an eye with primary angle closure and a white cataract represents a high-stakes challenge that requires deliberate control at every step. In this impressive video, a resident surgeon performing case 359 demonstrates good technique while creating a continuous curvilinear capsulorhexis under difficult conditions. Operating in a shallow anterior chamber with increased intralenticular pressure increases the risk of an Argentinian flag sign or peripheral vector run-out; however, the surgeon effectively neutralizes these forces by staining the capsule with trypan blue, decompressing liquefied cortex, and pressurizing the anterior chamber with heavy viscoelastic. Maintaining precise micro-forceps control allows for a flawless, centered rhexis that sets the stage for safe phacoemulsification and opens up the drainage angle postoperatively. Watch the video to see this resident’s fantastic execution and surgical poise in a complex case. How do you approach chamber depth management and capsulorhexis creation in eyes with acute or chronic angle closure and intumescent lenses? Please comment your pearls below.
