Capsulophimosis Small diameter CCC 1. 2. Weak zonules x 360 3. - - PowerPoint PPT Presentation

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David F. Chang, MD Clinical Professor UCSF

AMO Consultant Fees donated (Project Vision, Himalayan Cataract Project) 1.

Use CTR if any zonulopathy

2.

If no CTR, use 3-pc acrylic

3.

Larger CCC diameter or radial cuts

4.

3-pc IOL in sulcus + CCC capture

5.

Cionni or Malyugin ring/Ahmed CTS

Capsulophimosis

1.

Small diameter CCC

• 2. Weak zonules x 360
• 3. Capsulotomy - sphincter

CTR after IOL

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NO CTR: 3-pc haptic – more compressive force Less capsular fibrosis with hydrophobic acrylic 1.

Secondary enlargement

2.

Partial slits to CCC edge

Gills Uthoff scissors Better red reflex; no ant caps convexity Increased capsular tension (haptics) Optic = diameter template Radial tear ok

84yo PXF (hx trabeculectomy) Perfect surgery … until I make a BIG mistake

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What is the FIRST thing you should do?

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1.

Leave it alone?

• 2. Suture CTR to sclera

3.

Suture haptic to iris

• 4. Move it to sulcus
• 5. Sulcus + iris suture
• 6. AC IOL

Would you jiggle the eye?

Yes – jiggle it and see No – quit right now!

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Pseudoexfoliation – Diffuse Zonulopathy

Same eye – Same 3-piece IOL 1) In bag 2) In sulcus Additional 2 point fixation during eye movement (Haptic – Ciliary body)

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+ Optic capture

Prevents CCC contraction Good centration Prevents rotation (e.g. through dialysis) No IOL power adjustment

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Malyugin CTR

(FCI Ophthalmic/Morcher) Ahmed Capsule Tension Segment

(FCI Ophthalmic/Morcher)

1.

Use CTR if any zonulopathy

2.

If no CTR, use 3-pc acrylic

3.

Larger CCC diameter or radial cuts

4.

3-pc IOL in sulcus + CCC capture

5.

Cionni or Malyugin ring/Ahmed CTS