Eyeworld

EW CATARACT 29 December 2018 aspiration in the hole and reducing the aggressiveness of your irrigation/ aspiration settings. Once the cortex is all removed, prevent anterior chamber collapse by instilling more viscoelastic to tamponade the hole, and to fill the anterior chamber and capsular bag. "The defect didn't open up more and the posterior capsule stayed in place," Dr. Devgan said. "Normally, if there's a large posterior capsule break, you can't put the lens in a bag so you have to fixate it in some other way. But here, the break ended up being so small that it did not extend so we could still put our lens right in the capsular bag, and that even helped cover the hole more." Dr. Devgan also oriented the lens haptics 90 degrees away from the posterior capsular hole to ensure that they would not intersect it. Another change in such cases is that the hydration of the corneal incision should be done before re- moval of the viscoelastic to prevent collapse of the anterior chamber. Then, use low pressure and lower bottle height during irrigation/as- piration to remove the viscoelastic. Small shallowing can be quickly addressed by increased hydration. When a hole is manageable Dr. Devgan's delineation between when a hole is manageable and when it's unmanageable is if the defect is one-third the size of the optic diameter. Any hole that size or smaller still allows lens placement in the capsular bag. "If I have a huge hole, I can't put the lens in," Dr. Devgan said. "But when the lens is 6 mm in diameter and the hole is 2 or 3 mm in diameter, I can certainly put that lens in the capsular bag." At the end of the case it's important not to let the anterior hyaloid face collapse and allow vitreous to come through. In the postop period, the sur- geon needs to look to ensure there's no vitreous prolapse, as he or she would as part of any routine postop care. "I fumbled the ball, but I recov- ered and everything was fine," Dr. Devgan said. "The capsular defect had no effect on the patient's visual outcome because it was caught quickly. When you catch a compli- cation like this early, you can still have problems but you can recover the ball. " The case illustrates that every surgeon will face a complication sooner or later, and the key is knowing how to minimize and recover from it. The full case in- cluding video can be seen at www. CataractCoach.com. EW Editors' note: Dr. Devgan has no finan- cial interests related to his comments. Contact information Devgan: devgan@gmail.com Our Charity Delivers High-Volume, Well-Equipped Phacoemulsification Projects to the Impoverished of Mexico. We are Now Recruiting Volunteer Phaco Surgeons for Our Upcoming Surgical Projects in 2019. Learn More About Us and Contact Us at: www.choseneyemission.com Are You a Phaco Surgeon Interested in Compassionate Surgery in the Developing World?

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