Tunnel-floor entry continuous curvilinear capsulorhexis technique: Rhexis in a controlled and stable anterior chamber always

Continuous circular capsulorhexis (CCC) was demonstrated independently by Thomas Neuhann, Kimiya Shimizu, and Howard Gimbel in the 1980s and it finds mention in the landmark paper by Gimbel and Neuhann. The authors describe a technique of achieving the rhexis in a stable, viscoelastic-filled anterior chamber using the tunnel floor as the entry. This gets covered by the roof of the tunnel postoperatively and, therefore, does not leak. There is no oar-locking or striae even when cystitome goes beyond the edge of the tunnel. As there is no escape of the viscoelastic substance, there is no change in the pressure or shallowing of the anterior chamber. It is a useful technique for beginners. It is of great help in difficult cases like intumescent cataracts, shallow anterior chambers, hyperopes, nanophthalmos, pseudoexfoliation, small non-dilating pupils, intraoperative floppy iris syndrome (IFIS), and phacomorphic glaucoma.

Star CanVac-continuous curvilinear capsulorhexis - A novel, safe rhexis technique in intumescent total cataracts

Achieving a complete uniform capsulorhexis in an intumescent cataract is perhaps the most crucial and challenging step for surgeons. Star CanVac CCC is a new manual technique for creating a continuous curvilinear capsulorhexis (CCC) in intumescent total cataracts. Small centripetal tears in the shape of a star are created in the center of the anterior lens capsule by using a 26?G cystotome. This allows equal distribution of forces secondary to increased intralenticular pressure, thereby avoiding unidirectional or bidirectional tear extension. Subsequently, a 25?G flat?tipped fine cannula connected to a syringe is used to hold the free capsular flap. The piston of the syringe is withdrawn to create a stable suction pressure, and the rhexis is completed without withdrawing the instrument from the anterior chamber. Our technique is safe, affordable, and an alternative method to routine CCC or expensive techniques such as Femto or Zepto capsulotomy for white intumescent cataracts.

Vitrector-assisted anterior capsulorhexis in adult intumescent cataract

Performing capsulorhexis in white intumescent cataracts during phacoemulsification surgery is challenging for cataract surgeons because of high intralenticular pressure and reduced red reflex. Capsulorhexis extension to the periphery of the lens is a common occurrence due to lens intumescence. We used a vitrectomy cutter to create an initial tear in the anterior capsule and simultaneously remove a part of milky fluid coming out of the intumescent lens. Once the lens was decompressed, capsulorhexis was completed using capsulorhexis forceps. This technique helped in controlling capsulorhexis in eyes with intumescent cataracts by reducing the intralenticular pressure and thereby preventing unexpected radial capsular tear

A multipronged approach to prevent Argentinian flag sign in intumescent cataracts

In this communication, we describe a technique for creation of a single stage, adequately sized capsulorrhexis in intumescent cataracts by depressurizing the anterior and posterior intralenticular compartments in a nonleaky anterior chamber (AC) to prevent capsulorrhexis extension and Argentina flag sign. Initially, an incomplete main-port incision is made by the partial entry of a 2.2-mm keratome. A cohesive dispersive ophthalmic viscosurgical device (OVD) is injected into AC. Standard side-port incisions are made, followed by anterior capsular staining. The fluid cortex in anterior intralenticular compartment is aspirated by puncturing anterior capsule in the center using a 30-gauge needle entered through a separate limbal stab incision. The nucleus edge is gently tipped posteriorly with the needle tip to release the fluid from posterior intralenticular compartment also and as much fluid aspirated as possible. OVD is again injected and capsulorrhexis is performed in a single stage using micro-capsulorrhexis forceps.

A Study of Profile of Patients with Cataract.

Background: Cataract blindness is a public health problem of major proportions in developing countries. Intra capsular cataract extraction with aphakic spectacles has been the standard surgical technique for restoring sight. Cataracts, the world's leading cause of blindness, are an enormous public health problem in both developing and industrialized countries. Objective: To study clinical profile of patients with cataract. Methods: After applying inclusion and exclusion criteria as well as after ethical consideration only patients having cataract were included in the study. In this way, it was possible to include the 1000 patients over a period of two years. Present study was hospital based cross sectional study. A pre tested, semi structured questionnaire was used to collect the data. Complete detailed history was taken as per the questionnaire. Thorough clinical examination was carried out. The collected data was entered in Microsoft Excel Sheet and analyzed with the help of proportions. Results: The prevalence of cataract was highest in the age group of 51-60 years i.e. 45.1%. The most common prevalent type of cataract was found to be mature cataract in 50.5% of cases followed by hyper-mature cataract in 34.7% of cases. The overall incidence of capsular rupture was 4.7%. Highest incidence of capsular rupture was seen in complicated cataract followed by intumescent cataract. Incidence of vitreous loss was most commonly present in intumescent cataract followed by complicated cataract. 51% of patients recovered to normal vision of 6/6. 41.2% of patients had corrected vision from 6/60 to 6/18. Conclusion: The prevalence of cataract is common above 50 years of age. The patients reporting to the hospital for the complaint of loss vision commonly have mature or hyper-mature cataract. Complications are less in the mature and hyper-mature type of cataract.

Capsulorhexis in White Intumescent Cataracts: The Five Commandments to Follow.

We describe a surgical technique for achieving a successful capsulorhexis in white intumescent cataracts. Raised intralenticular pressure is responsible for the high incidence of peripheral extension of the capsulorhexis (Argentinian Flag Sign) in intumescent cataract surgery. Swollen anterior and posterior sub-capsular cortex is responsible for the high intralenticular pressure. We present surgical strategies in the form of five commandments, which would ensure better success rates in achieving capsulorhexis in intumescent cataracts. These five commandments are based on the surgical principles of maintaining positive pressure in the anterior chamber and performing a two staged sequential active decompression of the swollen capsular bag and a two staged capsulorhexis. These strategies aim at gradual decompression of the swollen capsular bag, which will ensure a less tense anterior capsule and better control over the tearing anterior capsule

Mini-rhexis for white intumescent cataracts

PURPOSE: To compare the intraoperative safety of two techniques of capsulorhexis for intumescent white cataracts: traditional one-stage continuous curvilinear capsulorhexis and two-stage continuous curvilinear capsulorhexis. METHODS: This prospective comparative randomized study included two groups: the 1-CCC group (11 patients) received traditional one-stage continuous curvilinear capsulorhexis with 5-6 mm diameter, and the 2-CCC (13 patients) group received a deliberately small continuous curvilinear capsulorhexis that was secondarily enlarged, or a two-stage continuous curvilinear capsulorhexis. Patients were stratified according to cataract subset, which was characterized echographically. Six patients were considered as type 1, fifteen as type 2 and three as type 3. Type 1 included intumescent white cataracts with cortex liquefaction and extensive internal acoustic reflections, type 2 included white cataracts with voluminous nuclei, a small amount of whitish solid cortex, and minimal internal acoustic reflections, and type 3 included white cataracts with fibrous anterior capsules and few internal echo spikes. RESULTS: With the one-stage technique, 46.15 percent of patients had leakage of the liquefied cortex; in addition, the surgeon perceived high intracapsular pressure in 61.53 percent of cases. Anterior capsule tears occurred in 23.07 percent of cases, discontinuity of capsulorhexis in 30.79 percent of cases and no posterior capsular rupture occurred. With the two-stage technique, leakage of the liquefied cortex occurred in 45.45 percent of cases; additionally, the surgeon perceived high intracapsular pressure in 36.36 percent of cases. No anterior capsule tears, discontinuity of capsulorhexis or posterior capsular rupture occurred. Considering each cataract subset, there was a higher incidence of leakage for type 2 as compared to types 1 and 3. CONCLUSIONS: Two-stage continuous curvilinear capsulorhexis helps prevent unexpected ...

Clinical Observation on Operation for Glaucoma Secondary to Senile Intumescent Cataract / 医学研究杂志

Objective To study the effects of cataract extraction (ECCE) and posterior chamber intraocular lens implantation( PC-IOL) or with antiglaucoma operation in secondary glaucoma caused by senile intumescent cataract.Methods To operation of ECCE and PC-IOL、or with antiglaucoma operation was performed in 26 cases(26eyes) with acute secondary glaucomacaused by senile intumescent cataract. Follow up 3~12 months after operation. Results The corrected visualacuity of 17eyes (65.4%) was up to 0.5, 22eyes had normal IOP postoperatively.Conclusions The clinical results showed that operation of ECCE and PC-IOL or with antiglaucoma operation is very good.

Diathermic Capsulotomy for Phacoemulsification in Hypermature Cataract

To evaluate the result of diathermic capsulotomy for phacoemulsification in hypermature intumescent cataracts, we retrospectively studied 34 patients(35 eyes) who were operated from January 1995 to February 1997. Central corneal endothelia cell counts were taken preoperatively and 2 months postoperatively by non-contact specular microscopy and endothelial cell loss(%) was calculated. The anterior capsular radial tear occurred in 24 eyes(68%), posterior capsular rupture occurred in 1 eye(2.9%) and the percentage of postoperative endothelial cell loss was 6.45(+/-7.27)%. The high rate of anterior capsular radialtear was due to altered mechanical integrity of the diathermic capsulotomy edge. But the thermal effect on the corneal endothelium was minute. Based on these findings, the diathermic capsulotomy for phacoemulsification in hypermature intumescent cataracts is very useful technique.