Nothing is impossible if you have the right tools and techniques to support

Background: Zonular weakness is a known complication that a surgeon can encounter during cataract surgery. Purpose: The purpose of this video is to make surgeons aware about the different tools and techniques available to handle zonulopathy. Synopsis: This video describes the various causes of zonular weakness and different tools available to manage zonular weakness intraoperatively. The surgical technique of using the tools is also demonstrated in the video. Highlights: Causes of zonular weakness and surgical techniques to handle it intraoperatively.

Planned posterior assisted levitation in severe subluxated cataract: Surgical technique and clinical results.

We report the surgical technique and outcome of planned posterior assisted levitation (P-PAL) in four cases of subluxated cataract. P-PAL was planned as the preferred approach in all cases. A spatula was inserted via the pars plana, the whole lens was lifted to the anterior chamber and then removed through a scleral tunnel incision. Anterior chamber intraocular lenses were implanted in all cases. All four eyes had severe subluxation of the crystalline lenses with marked phacodonesis. Two eyes had history of blunt trauma, and the other two eyes had severe pseudoexfoliation with spontaneous lens subluxation. Follow-up ranged from 1 to 2 years in three cases. The postoperative visual acuity was 20/80 or better. No intraoperative complications were observed. In conclusion, the P-PAL technique was successfully performed during cataract surgery in four eyes with severe subluxated cataracts. There were no complications over the long-term follow-up.

A Case of Malignant Glaucoma-like Phenomenon During Cataract Surgery

PURPOSE: Malignant glaucoma is a rare complication of anterior segment surgery. The authors present a case of a malignant glaucoma-like phenomenon during cataract surgery in a primary open-angle glaucoma (POAG) patient. CASE SUMMARY: A 74-year-old man with POAG underwent a cataract surgery in his left eye. After phacoemulsificiation, sodium hyaluronate was used to form the capsular bag for intraocular lens implantation. Following this procedure, the capsular bag space and anterior chamber became shallow. Intraocular pressure (IOP) elevated, and the shallowing of the anterior chamber and capsular bag space continued to a dangerous level. The surgical procedure was stopped and postponed for two days. After two days, IOL was successfully implanted in the posterior bag. CONCLUSIONS: Although the preoperative ophthalmologic examination failed to reveal a zonular problem, there was a possibility for a small area of zonular defect. A malignant glaucoma-like phenomenon was suspected to have occurred due to leakage of sodium hyaluronate or balanced salt solution into the vitreous through a small area of zonular dialysis. If a similar condition, occurs delayed surgery for IOL implantation would be more effective than vitrectomy or laser treatment.

Long-Term Follow-up of the Insertion of Capsular Tension Ring in Cataract Surgery

PURPOSE: To evaluate the long-term results after the insertion of a capsular tension ring (CTR) in eyes with cataract surgery. METHODS: Twenty eyes of 20 patients with zonular dialysis determined preoperatively or intraoperatively had phacoemulsification with posterior chamber intraocular lens (PCIOL) and CTR implantation. Best-corrected visual acuity, refractive error, PCIOL decentration, posterior capsular opacity (PCO), and postoperative complications after long-term follow-up were reviewed retrospectively. RESULTS: The mean age of patients was 64 years and mean follow-up time was 34 months. Nineteen of 20 eyes gained 2 or more lines in BCVA. Intraoperatively, 3 eyes (15%) developed posterior capsular ruptures. During the immediate postoperative period, there was minimal corneal edema in 9 eyes (45%) and corneal erosion in 2 eyes (10%). Among the 6 eyes (30%) that developed raised intraocular pressure, 5 eyes responded well to medical therapy. After a long-term follow-up, 2 eyes (10%) developed PCO, but there were no refractive errors, IOL decentration, or high IOP that could affect visual outcome. CONCLUSIONS: CTR may enhance safety and efficacy during phacoemulsification and PCIOL implantation for patients with zonular dialysis, and reduce the incidence of IOL decentration and secondary cataract.

Long-Term Follow-up of the Insertion of Capsular Tension Ring in Cataract Surgery

PURPOSE: To evaluate the long-term results after the insertion of a capsular tension ring (CTR) in eyes with cataract surgery. METHODS: Twenty eyes of 20 patients with zonular dialysis determined preoperatively or intraoperatively had phacoemulsification with posterior chamber intraocular lens (PCIOL) and CTR implantation. Best-corrected visual acuity, refractive error, PCIOL decentration, posterior capsular opacity (PCO), and postoperative complications after long-term follow-up were reviewed retrospectively. RESULTS: The mean age of patients was 64 years and mean follow-up time was 34 months. Nineteen of 20 eyes gained 2 or more lines in BCVA. Intraoperatively, 3 eyes (15%) developed posterior capsular ruptures. During the immediate postoperative period, there was minimal corneal edema in 9 eyes (45%) and corneal erosion in 2 eyes (10%). Among the 6 eyes (30%) that developed raised intraocular pressure, 5 eyes responded well to medical therapy. After a long-term follow-up, 2 eyes (10%) developed PCO, but there were no refractive errors, IOL decentration, or high IOP that could affect visual outcome. CONCLUSIONS: CTR may enhance safety and efficacy during phacoemulsification and PCIOL implantation for patients with zonular dialysis, and reduce the incidence of IOL decentration and secondary cataract.