Preparing the right tools key to handling cataract cases with zonulopathy
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SAN FRANCISCO — Being prepared with the right tools is critical to handling cataract cases with zonulopathy, according to an expert at the American Academy of Ophthalmology meeting.
In a presentation on his top five pearls for zonulopathy, Beeran B. Meghpara, MD, said it all starts with having the right tools.
“Not only have the right tools, have them in the OR with you ahead of time,” he said. “That can be a lot. That can be capsular hooks, CTR, an injector, maybe a pre-loaded injector, capsular tension segments and something to dilate the pupil.”
This preparation is important for surgeons so that they are not rushing inside the operating room during a procedure, Meghpara said.
Once all of those tools are ready, Meghpara said surgeons need to be ready for the capsulorhexis to be the most challenging part of the procedure. Surgeons should also be careful not to put too much pressure on the capsule, because it could create a break or a tear.
When operating on patients with zonulopathy, Meghpara also urged surgeons to use capsular stability hooks rather than iris hooks.
“An iris hook has a sharper tip,” he said. “If you place that during phacoemulsification and inadvertently hit the hook, you can create an anterior capsular tear.”
Capsular stability hooks are longer and have a rounded end, allowing for gentler support of the capsular bag during phacoemulsification, he said.
Surgeons should also know when to use capsular tension rings and segments.
“CTR should be used as the sole support of a capsule when you have less than four focal clock hours of zonulopathy,” Meghpara said. “Don’t use these when you have an anterior or posterior capsular tear. If possible, I like to inject away from the area of zonular instability in order to not create a bigger problem.”
Finally, Meghpara said it is important for surgeons to be prepared to address the vitreous, which can prolapse anteriorly. He said it is key to be comfortable with cut-down block and bimanual anterior vitrectomy.
“If you are uncomfortable with vitrectomy, there is always the option of getting help from your vitreoretinal colleague to do these cases,” Meghpara said.
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Meghpara B. Pseudoexfoliation/zonulopathy. Presented at: American Academy of Ophthalmology meeting; Nov. 3-6, 2023; San Francisco.
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