If you’re wondering how to manage unilateral circular opacity with a toric presbyopic intraocular lens (IOL), it’s time to attend the latest review of online launched on the Masters Video Library by HOYA Surgical Optics.
In this webinar Dr Robert Osher, Medical Director Emeritus of the Cincinnati Eye Institute and Professor of Ophthalmology at the University of Cincinnati, Ohio, demonstrates the importance of meticulous surgical technique and adaptability in the management of young patients with complex cataract presentations.
The video explores the case of a 22-year-old woman presenting with unilateral circular opacity, posterior polar cataract (PPC), and an open posterior capsule. The cataract was found to be soft, which necessitated a limited multimeridial hydrodissection. Following this, careful removal of subincisional cortex was performed using gentle hydrodissection techniques.
manipulation after the IOL implantation inadvertently damaged the posterior capsule, leading to a tear that required conversion to a posterior capsulorrhexis
Given the patient’s young age and axial myopia, a toric presbyopic IOL was planned to address her visual needs effectively. To stabilise the capsular bag during the procedure, an ophthalmic viscosurgical device (OVD) was injected for tamponade, allowing for the dissection of fibrotic tissue surrounding the open posterior capsule. The use of cohesive and dispersive OVDs was critical during this phase, as it helped facilitate the removal of fibrosis while maintaining the integrity of the surgical field.
Inadvertent Damage
However, manipulation after the IOL implantation inadvertently damaged the posterior capsule, leading to a tear that required conversion to a posterior capsulorrhexis.
The next challenge was to manage the toric IOL in the context of an open posterior capsule, especially for this young axial myope. To maintain a deep anterior chamber and stabilise the IOL, OVD was injected before the removal of the irrigation/aspiration (IA) tip.
Despite the initial setback, the tip of the IOL was repositioned carefully, but it did not sit correctly against the rupture. To correct this, the team opted for a reverse optic capture technique after deepening the chamber once more, ensuring the IOL was appropriately aligned within the capsular bag.
The day following the surgery, Dr Osher and his team were pleased to find that the patient’s uncorrected distance vision was 20/20, demonstrating a successful outcome despite the complexities encountered during the procedure.
About the Masters Video Library
The Masters Video Library for ophthalmologists is designed to support surgeons by providing an extensive collection of videos to enhance learning and skill development.
With a focus on the anterior segment, the library enables surgeons to easily search for and find videos that are most relevant and interesting to them. This platform promotes continuous education and helps refine learning skills by offering the latest techniques, procedures, and innovations in ophthalmology.
Visit the Masters Video Library and register to access the resources.
