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Surgeon offers tips on managing mature cataract cases
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NEW YORK — Generous use of dispersive viscoelastic, the initial crack and chop of the nucleus, and optimal use of technology are critical to maximizing outcomes in challenging cases of mature cataract, a surgeon said here.
Rosa Braga-Mele, MD, FRCSC, presented pearls on mastering mature cataracts at OSN New York 2012.
“The initial crack/chop is really important,” Braga-Mele, OSN Cataract Surgery Board Member, said. “I always tell my residents to watch for the red reflex to know they have completed the chop and penetrated the posterior plate of the nucleus.”
Patients should be told that they may have a long recovery and that they may need to undergo extracapsular cataract extraction as opposed to phacoemulsification.
Hard mature cataracts are age-related and may stem from previous trauma, previous intravitreal injection or previous pars plana vitrectomy. They are commonly associated with pseudoexfoliation and glaucoma with phacomorphic or phacolytic pathogenesis.
The cataract procedure itself relies on proper incision design and abundant use of a dispersive viscoelastic. VisionBlue (trypan blue ophthalmic solution, DORC) staining should be used to maximize visualization of the capsulorrhexis, which should be made larger to make room for manipulation of a large, dense lens.
Gentle fluidics settings should be used to ensure complete mobility of the lens; the nucleus should float freely in the bag.
A capsular tension ring or capsular tension hooks should be considered in cases of phacodonesis.
Longitudinal ultrasound should be used for the initial chop, and torsional ultrasound should be used for segment removal. The cleavage plane should be propagated laterally and through the posterior plate, Braga-Mele said.
Disclosure: Braga-Mele is a consultant for Abbott Medical Optics and Alcon.