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For eyes with challenging zonules, capsules, ‘be prepared,’ surgeon says
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NEW YORK — When facing cataract surgery in an eye that may present a zonular or capsular challenge, the surgeon must be vigilant, suspicious and prepared in advance, according to Priscilla E. Perry Arnold, MD.
Dr. Arnold said eyes with challenging capsules should be treated and coded as complicated cataracts.
“You need to prepare for them as such. Document the findings for surgical planning, equipment needs and complex coding,” Dr. Arnold said here at the Ocular Surgery News Symposium.
In preparation for these cases, Dr. Arnold said, the surgeon should be sure to have the correct anesthesia, viscoelastic and phacoemulsifier on hand. In addition, in case they are needed, iris hooks, sutures, capsular tension rings, alternative IOLs and a vitrector should be available.
She recommended that surgeons should consider using low-flow parameters rather than their usual settings, which are most likely high-flow, for such cases.
Dr. Arnold said that during these complicated cases, the surgeon should bear in mind that subsequent surgery may be needed.
“If all else fails and zonular support is nonexistent, you may need a posterior segment specialist,” she said.
Postoperatively, the surgeon should monitor patients for signs of infection and cystoid macular edema, she said.