After vitrectomy, treat cataract surgery steps with respect
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Zonulopathy and capsule breaches are issues that can occur after vitrectomy in eyes undergoing cataract surgery, according to a presentation at Real World Ophthalmology.
Joshua C. Teichman, MD, MPH, FRCSC, said most of the time, zonulopathy and capsule breaches can be addressed without much issue.
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“The most important thing is 99% of these go normal, so not to worry,” he said. “But that being said, you got to think about when they’re not normal.”
For capsule breaches, Teichman said it is important to treat them like a posterior polar cataract. That means using viscodissection to free the anterior lens as well as performing hydrodelineation and avoiding rotation.
When working on nuclear disassembly, Teichman said his preference is to use gentle chopping and to leave the central cortex for last. Surgeons should not allow the anterior segment to shallow or deepen excessively.
For zonulopathy, Teichman said good technique is usually all that is required. However, he shares a message with his fellows:
“Patients are allowed to have weak zonules, but you’re not allowed to weaken them further,” he said.
This means being gentle during hydrodissection. Teichman said the lens should rotate freely without stressing the zonules. He uses gentle chopping and tangential cortical removal, and capsular tension rings are key to the process.
“Treat every step with respect,” Teichman said.
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Teichman JC. Tackling cataracts after (not so routine) vitrectomy. Presented at: Real World Ophthalmology; April 27, 2024 (virtual meeting).
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