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Cortex Aspiration Following Trypan Blue Staining of Anterior Capsule in White Cataracts

Cortex Aspiration Following Trypan Blue Staining of Anterior Capsule in White Cataracts. Rana Altan-Yaycioglu, Aysel Pelit, Yonca A. Akova Baskent University, Faculty of Medicine, Department of Ophthalmology.

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Cortex Aspiration Following Trypan Blue Staining of Anterior Capsule in White Cataracts

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  1. Cortex Aspiration Following Trypan Blue Staining of Anterior Capsule in White Cataracts Rana Altan-Yaycioglu, Aysel Pelit, Yonca A. Akova Baskent University, Faculty of Medicine, Department of Ophthalmology The authors have no financial interest in any company that makes/develops/provides ophthalmic products or services

  2. Introduction • White mature cataract – challenge to the surgeon • Reduced visibility • Raised intracapsular pressure • Liquefied lens contents are expelled through the opening • Uncontrolled rapid tearing toward the periphery Aim • To evaluate the results of phacoemulsification in white cataracts ASCRS 2008, Chicago, IL

  3. Materials & Methods • 46 consecutive patients with white cataracts • Jun 2005 - July 2007 • Same surgeon (RAY) ASCRS 2008, Chicago, IL

  4. Materials & Methods • Surgery • Air-bubble injection • Anterior capsule trypan blue 0.05% staining • Anterior chamber filled with dispersive viscoelastic • Controlled proceeding - 26 Gauge tuberculin syringe (unbent) • pierce the anterior capsule • aspirate liquefied cortex material • Continuous curvilinear capsulorhexis – 5.0 to 5.5 mm • Gentle hydrodissection • Phacoemulsification - in usual way ASCRS 2008, Chicago, IL

  5. Materials & Methods • Patients demographics • Staining patterns • Intraoperative complications • Postoperative complications were evaluated ASCRS 2008, Chicago, IL

  6. Results • Age 61.9 ± 7.8 years • 18 female, 28 male • DM – 16 patients • High blood pressure – 16 patients • Pseudoexfoliation - 18 patients • BCVA, mean ± SD • Preop HM [logMar 3.00] • Postop 0.7 ± 0.3 (Snellen) [logMar 0.14 ±0.24] ASCRS 2008, Chicago, IL

  7. Results • Dilated pupil diameter • Range between 3 and 9 mm • Mean 6.9 ± 1.3 mm • All patients stained well with trypan • Posterior synechia, 1 patient • iris hooks used • Capsular tear extending into the periphery – 1 patient • changed to ellipsoidal capsulorhexis ASCRS 2008, Chicago, IL

  8. Results • Fragile capsule, broke into pieces during rhexis • larger capsulorhexis encircling the previous one • uneventful surgery • Zonular dehiscence - 2 patient • 1 patient developed partial zonular dialysis • Posterior capsular rupture - 3 patient • unrelated to the capsulorhexis • intraocular lenses - into the sulcus • Postoperative complications - none ASCRS 2008, Chicago, IL

  9. Conclusion White cataracts with swollen cortex material may possess a challenge to cataract surgeon resulting inevitable capsular tear • Central piercing of anterior capsule with unbent 26-Gauge needle • Followed by immediate aspiration of liquefied cortex material lowers the intracapsular pressure • Subsequent safe capsulorhexis possible ASCRS 2008, Chicago, IL

  10. Conclusion According to our results we believe that • Aspiration of cortical material before capsulorhexis right after piercing the capsule • Enables safe capsulorhexis in white cataracts • Reduces the chance of Argentinean flag ASCRS 2008, Chicago, IL

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