EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/78708
18 EW NEWS & OPINION Taking continued from page 16 dromes occur in eyes under 22 mm in axial length or over 28 mm, and I now primarily insert a CTR at the time of cataract surgery in all these eyes (under 22 mm/over 28 mm). I believe that eyes with a history of previous angle closure are at particu- lar risk. In this case I simply lasered the posterior capsule, and the Z com- pletely resolved. The YAG was car- ried out up to and under the supe- rior hinge. As soon as the tension from the superior radiating striae was relieved, the Z resolved, as can be seen in Figure 7. This case illustrates that a Z syn- drome can often be resolved by YAG if the haptics are properly positioned in the equator of the bag and the posterior capsule is in contact with the optic with fibrosis pushing the lens forward asymmetrically. June 2012 Figure 4. Gonioscopy confirms that the inferior haptic is in the bag, but the hinge is flexed forward and is actually anterior to the iris plane 0.06% TRYPAN BLUE OPHTHALMIC SOLUTION VisionBlueTM is indicated for use as an aid in ophthalmic surgery by staining the anterior capsule of the lens.1 VisionBlueTM is intended to be applied directly on the anterior lens capsule, staining any portion of the capsule which comes in contact with the dye. It is recommended that after injection all excess VisionBlueTM be immediately removed from the eye by thorough irrigation of the anterior chamber. The dye does not penetrate the capsule, permitting visualization of the anterior capsule in contrast to the non stained lens cortex and inner lens material.1 VisionBlueTM is contraindicated Rx Only Please see adjacent page for brief prescribing information. when a non-hydrated (dry state), hydrophilic acrylic intraocular lens (IOL) is planned to be inserted into the eye because the dye may be absorbed by the IOL and stain the IOL. Adverse reactions reported following use of VisionBlueTM include D.O.R.C. International B.V. Scheijdelveweg 2 3214 VN Zuidland The Netherlands Phone: +31 181 45 80 80 Fax: +31 181 45 80 90 E-mail: sales@dorc.nl inadvertent staining of the posterior lens capsule or vitreous face. Staining of the posterior lens capsule or vitreous face is generally self limited, lasting up to one week. ORDER INFORMATION VisionBlueTM of 10 syringes of 0.5ml/box Dutch Ophthalmic USA 10 Continental Drive Bldg 1, Exeter, NH 03833, U.S.A. Phone: +1 800-75-DUTCH or +1 603-778-6929 Fax: +1 603-778-0911 E-mail: sales@dutchophthalmicusa.com Call: (800) 75-DUTCH or (603) 778-6929 E-mail: sales@dutchophthalmicusa.com 1 Melles GJR, de Waard PWT, Pameyer JH, Houdijn Beekhuis W, Trypan blue capsule staining to visualize the capsulorhexis in cataract surgery. J Cataract Refractive Surgery 1999; 25:7-9 is available in sterile packs Figure 6. Here we can see the opening created under the nasal hinge and a band of fibrosis along the anterior capsule inferiorly pulling the inferior haptic forward at 4:00 Case 2 discussion This case differs from case 1 in some fundamental ways. The first is that this is a highly myopic eye (30 mm). The second is that this patient is pre- senting to me over 1 year after initial cataract surgery. The third is in the malposition of the inferior haptic. Even though the haptic is under the anterior capsule, one can see by the way the anterior capsule is severely pointing down toward 7:00 in Figure 3 that the haptic is likely not cor- rectly positioned in the equator of the bag and is probably pinching the anterior capsule. It is also clear that there is a gap between the implant and the posterior capsule. In this case I was reluctant to offer YAG capsulo- tomy because I felt that the Z would likely not be completely relieved, and there was significant risk of vitreous Figure 5. See the central YAG opening and nasal haptic pushed forward inferiorly causing tilt