William W. Culbertson, MD

The crystalline lens is bathed in aqueous humor and held in its resting position by zonules. Any compromise in zonular integrity threatens the crystalline lens position and makes cataract surgery more challenging and prone to potential complications. To avoid any intraoperative surgical surprises, it is essential to perform a comprehensive preoperative dilated ocular evaluation to assist in proper surgical planning. A new sign, called the anterior capsular snap, can result in intraoperative anterior zonular dehiscence in pseudoexfoliation with preoperative phacodonesis. In addition to phacodonesis, iridodonesis may be the initial telltale sign of compromised zonules. An important pearl is to examine the patient preoperatively in the supine position because a lens that appears easily accessible in the upright position may fall back well beyond the reach of the operating cataract surgeon.

The near-infrared femtosecond laser is a unique instrument, which can produce incisions and lamellar interface planes in the cornea by photodisruption. At the same time, complications can occur. My special guest for this column is William W. Culbertson, MD, professor of ophthalmology at Bascom Palmer Eye Institute, to explain these complications and solutions.

The near-infrared femtosecond laser is a unique instrument, which can produce incisions and lamellar interface planes in the cornea by photodisruption. Contiguous plasma gas bubbles are created in the cornea, which expand and cause microdelamination of the corneal collagen. At the same time, complications can occur. My special guest for this column is William W. Culbertson, MD, professor of ophthalmology at Bascom Palmer Eye Institute, to explain these complications and solutions.