Case Reports

Applying a novel micro-interventional lens fragmentation technique in a case demonstrating functional execution under the difficult circumstances of a small anterior segment relative to the volume of the crystalline lens to be removed

Case Report Details

First Author: G.Roper USA

Co Author(s):                        

Abstract Details

Purpose:

Difficult surgical cases are particularly daunting when attempting to apply novel techniques. The development of a novel cataractous lens fragmentation technique to improve safety by applying controlled, tolerable forces to fragment dense and challenging cataractous lenses is of benefit to patients and surgeons. As a challenging case is considered by the surgeon, variability in tissue behavior and the potential courses of the case balance against the techniques and experiences in the surgeons repertoire. I have selected an example case of a patient with a significantly dense lens, whose large lens volume must be reconciled within a shallow, low-volume anterior chamber.

Setting:

The surgery takes place in a typical outpatient operating room, as one of a series of cases, in which the patient desired refractive intraocular lens assistances, including presbyopia and astigmatic assistance.

Report of Case:

A 69 year old caucasian female presented with bilateral visual decline with vision 20/40 OD and 20/30 OS, and additional decide of up to two lines on Brightness Acuity Testing. On presurgical evaluation bilateral combined forms on cataract including posterior subcapsular cortical, and nuclear forms. She was also found to have glaucoma with occludable iridocorneal angles and suspected intermittent chronic angle closure glaucoma, with very shallow anterior chambers of 2.09 mm OD and 2.12 mm OS and short axial lengths of 21.10 mm OD and 21.25 mm OS, as well as bilateral mild epiretinal membranes OS>OD and vitreomacula adhesion without traction visible OD>OS. She was referred to a Glaucoma Service for further evaluation and discussion of treatment options, after which she elected bilateral Laser Peripheral Iridotomies. Mannitol administration immediately prior to cataract extraction was recommended to assist with anterior chamber crowding by reducing vitreous volume and posterior to anterior pressure. The case proceeded uneventfully, including the novel technique of prechopping with a novel micro-interventional lens fragmentation device and technique. Extended Depth of Focus Toric IOL was placed and rotated into the appropriate meridian under intraoperative computer guidance. At one-month postoperatively, the demonstrated eye ad uncorrected vision 20/15-1 and Jaeger !+ was read at 18”.

Conclusion/Take Home Message:

A well-designed micro-interventional lens fragmentation instrument can be applied successfully under the challenging conditions of unfavorable surgical anatomy and narrow workspace relative to the dense and large crystalline lens to be removed, applying a technique well within the skill repertoire of the cataract surgeon, instilling intraoperative confidence, and resulting in favorable patient outcomes.

Financial Disclosure:

... receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented