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Speaker offers tips for dealing with weak zonules in cataract surgery
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NEW YORK — Surgeons should take extra time to look for risk factors related to weakened or compromised zonules at the cataract surgery consult, according to a speaker here.
“If we all do enough cataract surgery, we are going to come across patients who have zonular issues. It could be zonular laxity or actual zonular dehiscence,” Cynthia Matossian, MD, said at OSN New York 2014.
Cynthia Matossian
Patients who are at risk for weakened zonules have ocular trauma, pseudoexfoliation syndrome, congenital conditions, mature cataract, high myopia, previous ocular surgery or retinopathy of prematurity, Matossian said.
“If these risk factors exist, take a little extra time at the time of your cataract consult. Check their angle. Is there angle recession? If there is, then most probably there is going to be zonular issues right around those clock hours,” she said.
When choosing an IOL to implant, keep in mind that a one-piece acrylic lens cannot have haptics placed in the sulcus; a three-piece lens is more amenable to suture fixation and can have haptics placed in the sulcus; and multifocal and toric lenses may not be ideal for zonular instability, according to Matossian.
The degree of zonulopathy is usually worse by the end of the case than at the beginning, she said.
“[Possibly] some of it is the surgical trauma itself in the eye and some of it is that the lens itself is pushing against the capsule keeping it nice and taut. Once that cataract is out, the lens now has nothing pushing against it, so you are going to notice the level of zonular pathology is much more apparent,” Matossian said.
There are many capsular rings (CTR) available on the market, so it is important to learn how to use each one in certain circumstances, she said.
“The rule of thumb is [to use] standard CTR if you have 3 to 4 clock hours of zonulysis. If it is larger than that, you may consider a sutured device,” Matossian said.
Disclosure: Matossian has relevant financial interests with Abbott Medical Optics, Alcon, Allergan, Alphaeon, Bausch + Lomb, Checked-Up, Imprimis Pharmaceuticals, Lenstec, Marco, Ocular Therapeutix, Physician Recommended Nutriceuticals and TearLab.