Surgeons should prepare for longer procedures when dealing with dense cataracts
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WASHINGTON — Dense lenses can cause problems during cataract surgery but do not have to be a cause for panic, according to a presenter at Glaucoma Day at the American Society of Cataract and Refractive Surgery meeting.
“These are not your 2-, 4- or 6-minute procedures,” Manjool Shah, MD, said. “These are going to be a little bit longer. You want to be prepared for a longer, slower procedure.”
Shah said every surgery involving hard cataracts should begin with getting comfortable. These procedures tend to take a little longer, so surgeons should maintain good positioning and pay attention to ergonomics.
While hard cataracts could be just a dense lens, Shah said they are often associated with comorbid conditions such as blunt or penetrating trauma, pseudoexfoliation, angle closure or uveitis.
Getting a good view into the eye is a critical part of the surgery. Shah said he uses pupil expansion techniques such as iris hooks to optimize the view. He also stains the anterior capsule if the red reflex is poor. When he suspects zonulopathy, he paints under viscoelastic cover to prevent posterior migration.
When removing the lens, Shah said he pays close attention to ensure he makes a large enough capsulotomy because making it too small could lead to complications. His preferred technique for nuclear disassembly is to create a deep trench in the lens. Then he imbeds the phaco tip in the nasal wall of the trench and starts a vertical chop.
Finally, Shah said it is crucial to protect the cornea during the process. He does this with liberal reapplication of a dispersive ophthalmic viscosurgical device.
“Treat a dense lens as if the zonules are lousy and be happy when they turn out to be fine,” Shah said. “Because of how dense the lens is, it’s going to transmit those forces out to the zonules. It’s going to behave like a zonulopathy case, so treat it like one until you realize that everything is OK.”
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Shah M. Rock hard cataracts don’t have to be hard on your coronaries. Presented at: American Society of Cataract and Refractive Surgery meeting; April 22-26, 2022; Washington.
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