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• W4310588856 abstract "This has given us an opportunity to discuss the nuances in capsulorhexis which is a crucial step in hypermature cataract surgery. The progression of a hypermature Morgagnian cataract (HMC) can happen in 2 ways. It can either progress to an absorbing cataract with capsular and zonular calcification or, on the other hand, result in phacolytic glaucoma/lens-induced uveitis due to leakage of lens matter through an intact capsule.1 For performing a successful CCC, capsulorhexis in HMC is begun after staining with trypan blue. An initial nick is made in the anterior capsule using a cystitome, and the liquefied cortical fluid is washed off with a balanced salt solution. The capsular bag is inflated with ophthalmic viscosurgical devices. Being a mobile nucleus, it is moved to the side wherever the rhexis is performed to create an underlying hard surface for support, and rhexis is fashioned with a microrhexis forceps or cystitome. In cases where fibrosis of the anterior capsule is noted, it is an indication of underlying weak zonular fibers and advanced hypermaturity. Two microforceps can be used, one to fashion the rhexis and the other to provide countertraction to prevent further zonular damage. In cases of diffuse anterior capsular fibrosis where rhexis is impossible, microscissors or an anterior vitrectomy probe can be used to create a capsular opening. Multiple radial cuts are given on the margins of the capsular opening, which will help to release the stress on the zonular fibers and prevent capsular phimosis. The use of capsular tension rings should be performed with caution especially in advanced hypermaturity with fibrosed capsule because they can cause undue stress on the already weak bag and can compromise the posterior capsule.2 Nucleus prolapse is usually difficult with the conventional sinskey prolapse technique because the nucleus in HMC is hard and slippery like a marble. The sclerocorneal tunnel is depressed, and this results in collapsing of the anterior chamber and flattening of the bag causing the nucleus to pop into the anterior chamber. In the case of a harder and larger nucleus, it is essential to make sure of good capsular opening and pupillary dilation before nucleus delivery. In manual small incision cataract surgery, iris hooks are a good option to ensure good pupillary dilation. In cases with successful CCC, a single-piece IOL can be implanted in the capsular bag. In cases with a weak bag with zonulopathy, a 3-piece IOL is placed in the sulcus with optic capture.3 Although iris-claw IOLs are known for their advantages such as an easier learning curve for anterior segment surgeons and a quicker procedure, they are contraindicated in patients with pseudoexfoliation and eyes with active inflammation.4 In such cases, secondary scleral fixation of IOL is a safer option and should be planned after 2 to 3 months." @default.
• W4310588856 created "2022-12-12" @default.
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• W4310588856 date "2022-12-01" @default.
• W4310588856 modified "2023-10-14" @default.
• W4310588856 title "Reply: Outcomes of manual small incision cataract surgery in hypermature morgagnian cataract" @default.
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• W4310588856 doi "https://doi.org/10.1097/j.jcrs.0000000000001078" @default.
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