Eyeworld

EW FEATURE 70 Complex cataract cases October 2015 AT A GLANCE • Creating a safe and stable rhexis is crucial in cases of zonular deficiencies. • Examine the patient in an undilated state; dilation can dampen the zonular state. • Always be prepared to suture, and have CTRs or CTSs present. Use retractors liberally. by Michelle Dalton EyeWorld Contributing Writer Zonular issues can complicate cataract surgery The key here, experts say, is being vigilant about recognizing issues preoperatively and always having the right tools on hand in the OR Z onular issues—caused by any number of conditions from pseudoexfoliation syndrome to trauma, con- genital disorders (Marfan syndrome or ectopia lentis), in- creased age, or vitrectomy, among others—can turn a straightforward cataract surgery into a much more complicated procedure. Sometimes, however, "there is no obvious etiology and zonular deficiencies aren't noticed until the patient undergoes surgery," said Bonnie An Henderson, MD, clinical professor of ophthalmology, Tufts University School of Medicine, Boston. Agreed Robert J. Cionni, MD, medical director, The Eye Institute of Utah, Salt Lake City: In post-vit- rectomized eyes there may have been "some underlying pathology that was already present; because the vitreous is no longer supporting the capsular zonular IOL anatomy, it may allow for an increase in the dialysis or lens dislocation, be it the phakic or pseudophakic lens." The key to easing the potential- ly difficult surgery is "to get the lens into position to do a safe rhexis, to stabilize the lens during rhexis and phaco, and to place the intraocular lens in the capsular bag safely while maintaining or providing support to the extent that is needed to provide centration and stability for the life An example of familial ectopia lentis where the lens is not centered on the pupil and iris retractors are used to assist in the rhexis Source: Steven Safran, MD

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