Capsulorhexis in shallow anterior chamber

Session Details

Session Title: Cataract Surgery Special Cases I

Session Date/Time: Sunday 14/09/2014 | 14:30-16:30

Paper Time: 15:44

Venue: Boulevard G

First Author: : C.Pedrosa PORTUGAL

Co Author(s): :    M. Ramalho   B. Feijóo   P. Pêgo   C. Vendrell   I. Prieto  

Abstract Details

Purpose:

Eyes with shallow anterior chamber are commonly associated with high vitreous pressure, high intralenticular pressure due to intumescent cataract, high hyperopia and/or early age. Cataract surgery in these cases is related to a higher technical complexity and complication rate, making this procedure more challenging. Anterior continuous curvilinear capsulorhexis (CCC) is a crucial step of phacoemulsification, which determines the surgical success and is hampered in these specific cases. The authors show in video a method of performing anterior CCC through a 1mm side port, before making the main incision, in various cases of shallow anterior chamber, evaluating its feasibility and benefits. This procedure aims to avoid anterior chamber instability and uncontrolled tear progression in coaxial phacoemulsification complex cases.

Setting:

Dept. of Ophthalmology, Fernando Fonseca Hospital

Methods:

We present a series of 28 eyes with higher risk of anterior capsule tear associated with shallow anterior chamber: 6 eyes with intumescent cataracts (2 of a 13-year-old child), 6 eyes with high hyperopia and 16 eyes with congenital cataract in infants. After performing two 1mm side ports, 120º apart, the anterior chamber was filled with high density viscosurgical device. Then the anterior CCC was performed with the needle and microforceps through the paracentesis, preceding the main incision. In 2 eyes, lens decompression was made before CCC, using a 26 Gauge needle, also through the side port.

Results:

In all cases described a complete CCC could be performed. Anterior chamber stability was ensured and, although technically difficult, we registered none of the major intraoperative complications related to CCC expected in these cases.

Conclusions:

In our experience, the procedure described permits a safer and controlled anterior CCC in coaxial phacoemulsification challenging cases. Therefore, this technique avoids the impairing of subsequent steps in complex cataract surgery and enhances its surgical success.

Financial Interest:

NONE