Intraoperative trypan blue central landmark and its use in capsulotomy and capsulorhexis centration.

PURPOSE: To compare 3 capsulotomy centration methods. SETTING: Private clinic, Zlin, Czech Republic. DESIGN: Prospective, consecutive case series. METHODS: 180 eyes undergoing cataract surgery had anterior capsule staining with microfiltered 0.4% trypan blue solution before selective laser capsulotomy. The first 60 eyes (Group 1) had mydriatic dilated pupil centered capsulotomies. The next 60 eyes (Group 2) were centered on the trypan blue central landmark (TCL). The final 60 capsulotomies (Group 3) were centered on the patient fixated coaxial Purkinje reflex (CPR). Measurements between key anatomical landmarks and the TCL, CPR capsulotomies, and implanted intraocular lens (IOL) center were made. RESULTS: The TCL, observed in >94% of eyes in the study, coincided with the CPR with a displacement of <0.1 ± 0.1 mm. Group 1 capsulotomies were noticeably decentered on the IOLs by 0.3 ± 0.2 mm. The Group 2 symmetrical IOL relationship was maintained with a decentration of 0.15 ± 0.1 mm. Group 3 had a similar decentration with the IOLs with 0.15 ± 0.1 mm. Verification with IOLMaster 700 data and CALLISTO Eye System showed that the CPR and the TCL were coincident with the measured visual axis. CONCLUSIONS: The clearly visible TCL served as an alternate landmark to the patient fixated CPR, and being on the anterior capsule was not sensitive to tilt. Further patient compliance was not required. Both were superior to dilated pupil centration, to achieve symmetric IOL coverage. This has application for both capsulotomies and capsulorhexes.

Preventing the Argentinian flag sign and managing anterior capsular tears: A review.

The Argentinian flag sign (AFS) is a feared complication during cataract extraction. Intralenticular pressures, especially excessive posterior pressure, have been identified as potential mechanisms for capsular stress and tearing associated with AFS. Capsular tension is created by positive intralenticular pressures, which cause the irido-lens diaphragm to move anteriorly once the manual capsulorhexis has been initiated. This tension can cause inadvertent tears that self-propagate to the lens equator, causing an AFS, among other intraoperative complications. Thus, this review highlights the importance of identifying intumescent cataracts as well as a combination of techniques to relieve intracapsular pressures needed to prevent AFS. However, some instances of anterior capsular tears are unavoidable. Therefore, focus will also be placed on techniques during cataract extraction used to manage anterior capsular tears, mitigating extension to the posterior capsule.

Impact of anterior capsule polishing on capsule opacification and capsule bend after age-related cataract surgery.

PURPOSE: To investigate the effect of anterior capsule polishing on postoperative capsule opacification and capsular bend in patients with age-related cataract displaying normal axial length. SETTING: Eye Hospital of Wenzhou Medical University at Hangzhou. DESIGN: Prospective self-controlled trial. METHODS: Patients with age-related cataracts aged 56 to 84 years displaying normal axial length were enrolled. Before surgery, a coin-toss method was used to randomly select 1 eye for intraoperative 360 degrees anterior capsule polishing (polishing group); the contralateral eye received no treatment (control group). Capsular bend index (CBI), anterior capsule opacification (ACO), posterior capsule opacification (PCO), and anterior capsule opening area (ACOA) were recorded at 1 week, 1 month, 3 months, 6 months, and 12 months postoperatively using swept-source optical coherence tomography and slitlamp examination. RESULTS: 21 patients (42 eyes) were enrolled. Within-group comparisons showed that both groups had significant differences in CBI between 1 week and 1 month postoperatively, and between 6 months and 12 months postoperatively ( P < .05). Between-group comparisons revealed a significant difference in CBI at 1 week postoperatively ( P < .05); at 12 months postoperatively, there was a significant difference in ACOA ( P < .05). There were no significant between-group differences regarding ACO or PCO at any timepoint ( P > .05). CONCLUSIONS: For patients with age-related cataracts and normal axial length, 360 degrees anterior capsule polishing can delay early capsular bag deformation without increasing the risks of ACO and PCO. This approach can also limit contraction of the anterior capsule opening.

ZEPTO-assisted pseudophakic capsulotomy: Precision pulse technology for management of capsular contraction syndrome.

We describe a novel technique that uses precision pulse capsulotomy (PPC) to perform a secondary capsulotomy for the management of anterior capsule contraction syndrome (ACCS), a condition that comprises a late complication after cataract surgery and intraocular lens (IOL) implantation. Micropulse secondary capsulotomy offers a controlled and safe approach for patients with severe anterior capsule contraction syndrome and may be considered as an alternative surgical technique.

A Modification of the Intraocular Lens Blocking Technique Without Posterior Capsulorhexis for Intraocular Foreign Body Removal.

PURPOSE: The intraocular lens blocking technique described for the removal of intraocular foreign bodies emerged as a result of an effort to prevent the foreign body from being retracted into the posterior segment because of the resistance encountered while removing it from the corneal incision. However, in the technique described, in addition to the difficulty of the surgical procedure, the new concern is to create a posterior capsulorhexis according to the size of the foreign body and to pass the foreign body through the capsulorhexis. METHODS: Here, the authors describe a new approach to the intraocular lens blocking technique. In this approach, the intraocular foreign body, which is held with intraocular forceps without any opening in the posterior capsule, is held in a perpendicular position to the long axis, lifted directly into the anterior chamber, and safely removed from the front of the monoblock foldable intraocular lens. RESULTS: In all patients treated with this approach, IOFBs were successfully removed without intraoperative or postoperative complications, and postoperative intraocular lens centralization was achieved in all patients. CONCLUSION: This approach may provide practicality to the intraocular lens blocking technique.

Influence of posterior capsule abnormalities in pediatric cataract surgery.

PURPOSE: To report how to manage posterior capsule abnormalities (PCAs) in pediatric cataracts and evaluate the influence of PCAs during intraocular lens (IOL) optic implantation in Berger space surgeries. SETTING: Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China. DESIGN: Retrospective case series study. METHODS: Pediatric patients with PCAs who underwent cataract surgery were evaluated. A video-based analysis of the surgical interventions included the type of crystalline lens opacification, types and management of PCAs, complications during primary posterior continuous curvilinear capsulorhexis (PCCC), need for anterior vitrectomy (AV), and feasibility of IOL optic capture. RESULTS: There were 227 pediatric cataract surgeries performed during the study period, and 76 eyes of 66 children with PCAs were evaluated (33.5%, 76/227). Unilateral cataract with PCAs were found in 50 eyes (22.0%, 50/227) and bilateral were found in 26 eyes (11.5%, 26/227). The PCAs were posterior capsule plaque (19.8%, 45/227), posterior capsule defect (6.2%, 14/227), posterior lenticonus (3.1%, 7/227), and persistent fetal vasculature (4.4%, 10/227). In the PCA cases, primary PCCC was successful in 44.7% of the cases (34/76). An unplanned AV during the surgeries was performed in 47.4% (36) of the 76 eyes. IOL optic implantation in Berger space was achieved in 63.2% of the eyes (48/76). CONCLUSIONS: PCAs are often encountered during pediatric cataract surgeries, especially in unilateral cases. The presence of PCAs may complicate a primary PCCC procedure, resulting in an unplanned AV in some cases. IOL optic implantation in Berger space can also be performed fortunately with well-designed and skilled operation.

Surgical challenges of posterior optic capture in pediatric cataract surgery.

PURPOSE: The efficacy of posterior optic capture (POC) in reducing posterior capsule opacification (PCO) in pediatric cataract is well recognized. The purpose of this paper was to identify the surgical challenges when attempting this technique and highlight the etiquettes to follow when performing this maneuver. METHODS: Prospective observational noncomparative case series. Children diagnosed with congenital or developmental cataracts undergoing cataract surgery and primary IOL implantation with posterior optic capture (and no anterior vitrectomy) from June 2017 to April 2022 at a tertiary care referral institute were included. Records of all intraoperative findings and postoperative complications until the last follow-up were noted. RESULTS: Posterior optic capture was attempted in 53 eyes of 49 children aged 2.4 ± 1.98 years. The mean follow-up of the patients was 16.5 ± 14.2 months (range 6 months-5 years). Successful POC could be performed in 46 eyes (86.8%). Two eyes developed posterior capsular opacification at the last follow-up. In eyes where POC could not be performed, five of these (83%) were children below 12 months of age with half of them having a preexisting posterior capsular defect. CONCLUSION: Posterior optic capture is technically challenging with a steep learning curve that can be mastered over time. Adequate relative sizing of the anterior and posterior capsulorhexis is important. Caution is advised when using this technique in infants and in cases with posterior capsular defects.

Flow capsulorhexis: A novel technique in white and hypermature cataracts.

We described a novel "flow capsulorhexis" technique in white and hypermature cataracts and compared it with the standard "needle decompression capsulorhexis" technique. Six hundred and eight eyes of 420 patients with intumescent or non-intumescent mature white cataracts who had undergone phacoemulsification or manual small incision cataract surgery with "flow capsulorhexis" (Group 1) or "needle decompression capsulorhexis" (Group 2) were assessed. The mean continuous curvilinear capsulorhexis (CCC) completion time was 6.6 ± 3.4 seconds in Group 1 and 10.4 ± 4.2 seconds in Group 2 (P < 0.001). The mean number of times for an ophthalmic viscosurgical device (OVD) supplement was 0.4 ± 0.2 and 1.8 ± 0.8 in Group 1 and Group 2, respectively (P < 0.001). CCC success rate was 95.8% in Group 1 and 87.2% in Group 2 (P = 0.001). The new technique was observed to have better outcomes in terms of surgical time, OVD supplement times, and success rate than the standard needle decompression technique.

[Shifts in the diameter of continuous circular capsulorhexis based on the Gullstrand eye model with the Callisto Eye System during cataract surgery].

Objective: To investigate the disparity between the set value of the capsulorhexis ring diameter in ophthalmic surgical navigation systems and the actual capsulorhexis ring diameter projected onto the lens surface. Methods: It was a cross-sectional study. Based on the Gullstrand eye model, the theoretical diameter of the capsulorhexis ring projected onto the lens plane through the cornea was calculated using the law of refraction in the Callisto Eye System. When the anterior chamber depth (ACD) ranged from 2.0 to 4.0 mm and the corneal curvature ranged from 40.00 to 48.00 D, the capsulorhexis ring diameters were calculated after projecting capsulorhexis rings with set diameters of 5.5 mm and 6.0 mm onto the lens plane. Additionally, 40 patients (40 eyes) aged 40 to 85 years who underwent cataract phacoemulsification combined with intraocular lens implantation at the Sixth People's Hospital of Shanghai Jiao Tong University School of Medicine were selected to validate the theoretical calculations. Among them, 15 were male, and 25 were female, and they were divided into three groups based on the ACD: group A (13 eyes) with ACD<3.0 mm; group B (16 eyes) with 3.0 mm≤ACD<3.5 mm; group C (11 eyes) with ACD≥3.5 mm. One week after surgery, anterior segment images of the eyes were taken, and the actual capsulorhexis ring diameter was measured using the Photoshop image processing software and compared with the set and calculated values. Results: When the capsulorhexis ring diameters were set at 5.5 mm and 6.0 mm and the corneal curvature was calculated based on the Gullstrand Eye model at 43.05 D, a linear negative correlation was found between ACD and the capsulorhexis ring diameter projected onto the lens plane (P<0.001). When the ACD was set at 2.5, 3.0, and 3.5 mm, and the capsulorhexis ring diameters were set at 5.5 and 6.0 mm, a linear negative correlation was observed between corneal curvature and the capsulorhexis ring diameter projected onto the lens plane (P<0.001). When the capsulorhexis ring diameter was set at 5.5 mm and the patient ACD and corneal curvature data were used for calculations, the capsulorhexis ring diameters projected onto the lens plane for groups A, B, and C were (5.09±0.05) mm, (4.97±0.05) mm, and (4.91±0.07) mm, respectively. When the capsulorhexis ring diameter was set at 6.0 mm, they were (5.56±0.05) mm, (5.44±0.05) mm, and (5.37±0.08) mm, respectively. One week after surgery, the actual measurements of capsulorhexis ring diameters for groups A, B, and C were (5.44±0.20) mm, (5.27±0.28) mm, and (5.25±0.41) mm, respectively, and the differences compared to the calculated values were not statistically significant (all P>0.05), but the differences compared to the set values were statistically significant (all P<0.001). Conclusion: The capsulorhexis ring diameter projected onto the lens surface by the Callisto Eye system was reduced by 7.33% to 10.48% compared to the set value, and the degree of reduction increased with the increase of ACD and corneal curvature.

CAPSULaser - a new modality in the portfolio of cataract surgeons.

To assess the efficiency and safety of capsulorhexis with CAPSULaser in comparison with standard capsulorhexis performed manually by emerging and established surgeons. Specialized Eye Hospital-Varna Bulgaria. Prospective, randomized, non-masked study. Patients were randomized to the M group (manual CCC), L group (laser CCC), and 2 surgeons. The manual CCC was targeted at 5.5 mm. The laser CCC was sized at 5.3 mm and measured with the same caliper device during photomicroscopy. The inclusion criteria were otherwise healthy eyes with cortical, nuclear, or subcapsular cataracts of any maturity with a biomicroscopically deep anterior chamber and preoperative pupil wider than 6.5 mm. The surgical time was measured for the entire procedure and only for capsulotomy. Sixty eyes of 60 patients, aged 65.8 ±â€…11 years, were prospectively recruited. Two surgeons (one with 3 years and one with 30 years of experience) performed the same types and number of procedures. The experienced surgeon was 2 times faster when performing manual capsulorhexis, but the time for CAPSULaser was almost the same. The size of the "laser" CCC was planned to be 5.3 and ended up with a minimum of 5.4 in 4 weeks; however, no lens prolapse from the CCC was observed. Utilization of the CAPSULaser in cataract surgery is easy and achievable for surgeons at any stage of their careers and provides controlled, well-centered capsulorhexis with no more adverse events than conventional surgery. The limitations are the requirement for a minimal pupil size of 6 mm, a deep anterior chamber, and a transparent cornea.

Dead bag syndrome-in the capsular bag subluxated intraocular lens centration and refixation: A new technique.

We describe a technique of scleral IOL fixation and optic centration of in the capsular bag subluxated IOL in a patient of "dead bag syndrome." A 29-year-old male diagnosed case of thalassemia presented with painless progressive diminution of vision in the left eye following uncomplicated sequential phacoemulsification in both eyes 15 years back. The right eye revealed completely centered IOL with significant amount of anterior capsular opacification (ACO), while the left eye revealed inferior subluxation of the IOL within capsular bag. The capsular bag was dilated, diaphanous with clear anterior and posterior capsule without any evidence of capsular fibrosis or opacification. Thus, a diagnosis of "dead bag syndrome" was made. The haptics were sutured to sclera (Hoffman's pockets) using two loops of 9-0 polypropylene, passed anterior and posterior to IOL haptics within the capsular bag. Postoperatively, the patient had a vision of 20/40 with a centered intraocular lens.

Postoperative intraocular lens stability following cataract surgery with or without primary posterior continuous curvilinear capsulorrhexis: an intra-individual randomized controlled trial.

PURPOSE: To evaluate the effect of primary posterior continuous curvilinear capsulorrhexis (PPCCC) on the positional stability of IOLs. METHODS: This study is a prospective intra-individual comparative randomized controlled trial including 31 patients (62 eyes). Eyes of the same patient were randomly assigned to the PPCCC group (18 right eyes and 13 left eyes) or group without PPCCC (NPCCC group). Eyes in both groups were implanted with a one-piece foldable hydrophobic acrylic IOL via routine cataract surgery. Patients in the PPCCC group underwent additional manual PPCCC before IOL implantation. Examinations were performed 1 day, 1 week, 1 month and 3 months postoperatively. IOL tilt (x, y), decentration (x, y), anterior chamber depth (z) and refractive prediction error data were collected and analyzed with Pentacam. RESULTS: Postoperatively, the range of IOL position change over 3 months in PPCCC group was comparable to NPCCC group, which indicated smaller value in every tilt and decentration index. PPCCC eyes showed comparable tilt and decentration with NPCCC eyes in this study endpoint: mean tilt (x, y), decentration (x, y) and anterior chamber depth (ACD) were 1.04 ± 0.56°, 0.90 ± 0.64°, 0.239 ± 0.140 mm, 0.233 ± 0.133 mm and 4.01 ± 0.32 mm, respectively, in the PPCCC group vs. 1.09 ± 0.76°, 1.10 ± 0.82°, 0.252 ± 0.153 mm, 0.244 ± 0.155 mm and 4.01 ± 0.38 mm, respectively, in the NPCCC group. Refractive prediction error in the PPCCC group demonstrated a mild hyperopic shift vs. the NPCCC group (0.13 ± 0.50 vs. 0.05 ± 0.39; p = 0.208), and corrected distance visual acuity (CDVA) did not differ between the two groups (0.027 ± 0.014 vs. 0.059 ± 0.185; p = 0.377). CONCLUSIONS: Comparable IOL tilt, decentration, ACD and refractive prediction error were observed in PPCCC eyes with that underwent routine cataract surgery. Little IOL position fluctuation and good visual acuity were shown in PPCCC group over time. TRAIL REGISTRATION: The study was registered at the Chinese Clinical Trial Register Center on May 27th, 2020 (protocol code ChiCTR2000033304, 27/05/2020).

Assessing the validity of flap motility sign in predicting the extent of anterior capsular tears in phacoemulsification.

Capsulorhexis is an integral step of cataract surgery, and continuous curvilinear capsulorhexis is crucial during phacoemulsification to prevent intraoperative complications. However, sometimes during phacoemulsification in complicated and hard cataract cases, rhexis extension may occur, resulting in posterior capsular rent, nucleus drop, cortex drop, and aphakia. It may not always be possible to continue with phacoemulsification in all cases. In this perspective, the authors describe a novel flap motility sign (FMS) to predict the extent of anterior capsular tear during phacoemulsification. A total of 21,678 patients underwent phacoemulsification for three years, from July 2016 to June 2019. One hundred and twenty-one patients had an anterior capsular tear. There were 102 cases (84.3%) with pre-equatorial tears and 19 cases (15.70%) with postequatorial tears. All pre-equatorial flaps were everted and fluttering, and all postequatorial flaps were inverted and nonfluttering. Posterior capsule rupture (PCR) was observed in all 19 cases of postequatorial flaps (100%). No PCR was observed in patients with fluttering and everted flaps (0%). In-the-bag and scleral-fixated intraocular lens implantations succeeded in pre-equatorial and postequatorial tears, respectively. There was no case of a nucleus drop. This study validates FMS as a predictor for identifying the extent of anterior capsular tears, thereby determining the endpoint of safe phacoemulsification and the site for intraocular lens implantation. Pre-equatorial tears allow for the continuation of safe phacoemulsification and in-the-bag intraocular implantation. Postequatorial tears necessitate timely conversion to small-incision cataract surgery or extracapsular cataract extraction.

Different strokes for anterior capsulorhexis in pediatric cataract.

Background: A successful outcome in pediatric cataract surgery is determined by an intact, curvilinear anterior capsulotomy which is dependent on the type and density of cataract, the morphology of the anterior capsule, and associated anterior segment pathologies. Purpose: This video highlights 10 different techniques which can be used for capsulorhexis in pediatric cataract. Synopsis: The choice of technique for capsulorhexis in pediatric cataract is on case basis, namely the gold standard manual capsulotomy aided by rhexis forceps (1. Standard capsulorhexis/2. Vitrector, Vitrectorhexis), with an assistance from capsular staining (3. Blue-rhexis), or by coaxial illumination (4. Coaxial-rhexis) or by just the sheen of capsule (5. Sheen-rhexis). The anterior chamber can be maintained using ophthalmic visco-elastic device (Visco-rhexis) or by irrigation fluid (6. Hydro-rhexis). A speed-breaker in the routine capsulotomy is the presence of plaque which is managed by rhexis forceps (7. Plaque-rhexis) or by a vitrector (vitrectorhexis) or a pair of micro-scissors (8. Scissor rhexis). Above all, the technology of femto-second-laser-assisted (9. Femto-rhexis) and zepto-pulse-precision capsulotomy (10. Zepto-rhexis) is also illustrated. Highlights: This video highlights the 10 different techniques of capsulorhexis in pediatric cataract surgery. Video Link: https://youtu.be/TgDrk5RYdbI.

Evaluation of continuous curvilinear capsulorhexis based on a neural-network.

PURPOSE: Continuous curvilinear capsulorhexis (CCC), as a prerequisite for successful cataract surgery, is one of the most important and difficult steps in phacoemulsification. In clinical practice, the size and circularity of the capsular tear and eccentricity with the lens are often employed as indicators to evaluate the effect of CCC. METHODS: We present a neural network-based model to improve the efficiency and accuracy of evaluation for capsulorhexis results. The capsulorhexis results evaluation model consists of the detection network based on U-Net and the nonlinear fitter built from fully connected layers. The detection network is responsible for detecting the positions of the round capsular tear and lens margin, and the nonlinear fitter is utilized to fit the outputs of the detection network and to compute the capsulorhexis results evaluation indicators. We evaluate the proposed model on an artificial eye phantom and compare its performance with the medical evaluation method. RESULTS: The experimental results show that the average detection error of the proposed evaluation model is within 0.04 mm. Compared with the medical method (the average detection error is 0.28 mm), the detection accuracy of the proposed evaluation model is more accurate and stable. CONCLUSION: We propose a neural network-based capsulorhexis results evaluation model to improve the accuracy of evaluation for capsulorhexis results. The results of the evaluation experiments show that the proposed results evaluation model evaluates of the effect of capsulorhexis better than the medical evaluation method.

30G needle aspiration - A modified technique of capsulorhexis in pediatric cataract with high intra-lenticular pressure.

This surgical technique describes a modification of the continuous curvilinear capsulorhexis (CCC) to achieve an adequate-sized capsulorhexis in pediatric cataracts with high intralenticular pressure. Performing CCC in pediatric cataracts is challenging, especially when the intralenticular pressure is high. This technique involves 30 G needle decompression of the lens to reduce positive intralenticular pressure and subsequent flattening of the anterior capsule. This minimizes the chances of extension of CCC without using any special equipment. This technique was used in two eyes of two patients (age 8 and 10 years) with unilateral developmental cataracts. Both surgeries were performed by a single surgeon (PKM). In both eyes, a well-centered CCC was achieved with no extension, and a posterior chamber intraocular lens (IOL) was placed in the capsular bag. Thus, our technique of 30 G needle aspiration could be extremely useful to achieve an adequately sized CCC in pediatric cataracts with high intralenticular pressure, especially for beginner surgeons.

[Hybrid (femtolaser) phacoemulsification: technical aspects and functional results]. / Gibridnaya (femtolazernaya) fakoemul'sifikatsiya: tekhnologicheskie aspekty i funktsional'nye rezul'taty.

This article summarizes scientific and practical results of hybrid femtosecond laser-assisted phacoemulsification (HFE) including study of clinical and technical aspects of the intervention and evaluation of post-surgical functional state of the eye on the basis of clinical, morphological and biomechanical data. The HFE technology should be considered the method of choice for microinvasive phaco surgery, its main advantage being the possibility of controlled handling of such important surgical stages as anterior circular continuous capsulorhexis and nucleus fragmentation on a closed eyeball, which significantly reduces the risk of complications and decreases of effective ultrasound time.

[Current possibilities of laser surgery on anterior eye segment]. / Sovremennye vozmozhnosti lazernogo vozdeistviya na struktury perednego segmenta glaza.

The article summarizes the experience of recent years in the development and implementation of novel original laser technologies used in surgery of the anterior segment of the eye. The presented technology of laser activation of scleral hydropermeability (LASH) in glaucoma is based on the effect of enhanced transscleral filtration and has been shown as effective and safe, which was confirmed by the results of a comprehensive clinical and experimental study. Development of another technique was associated with the need to improve the safety of laser interventions in anterior capsule contraction syndrome in pseudophakia, and resulted in a proposition to change the configuration of the anterior lens capsule incision from the usual linear-radial to T-shaped laser anterior capsulorhexis. The proposed technology of laser photomydriasis based on near-infrared radiation of the diode laser (0.810 µm) has shown its effectiveness and gentle nature (absence of atrophy of the iris stroma and post-burn pigmentation) in ectopias and pupil deformity.

A safe and successful capsulorhexis technique for the intumescent cataracts; modified two-stage continuous curvilinear capsulorhexis.

BACKGROUND: Capsulorhexis is the most important step in intumescent cataract due to the high risk of radial extension of the capsular tear during the cataract surgery. The aim of this study is to present modified the two-stage capsulorhexis technique for intumescent cataract. MATERIALS AND METHODS: The two-stage capsulorhexis technique was used in this study. A small size capsulorhexis approximately 1.5-2 mm diameter was created in the first stage. Liquefied cortex was aspirated with a 25 G cannula to equalize anterior chamber pressure and intracapsular pressure after the small size capsulorhexis. In the second stage, a 5-6 mm capsulorhexis size was performed for a safe phacoemulsification. RESULTS: A total of 73 consecutive patients with intumescent cataract were evaluated in this study. There were 39 male cases and 34 female cases. Mean age was 66 years ± 8 (between 53 and 84 years). A well centered complete continuous curvilinear capsulorhexis approximately 5-6 mm size was achieved in 72 of 73 cases (98.6%). Peripheral extension of capsulorhexis occurred in one eye during the second stage capsulorhexis. In this case, the capsule was cut with Vannas scissors and the capsulorhexis was completed. The rest of surgery was continued with a standard procedure and in-the-bag IOL implantation was done. CONCLUSIONS: This technique facilitates the creation of a safe capsulorhexis compared to the one-stage capsulorhexis technique. Surgeons may consider this technique to perform a safe phacoemulsification in the intumescent cataracts.

Influence of design parameters and capsulorhexis on intraocular lens stabilities: A 3D finite element analysis.

BACKGROUND: Current treatment of cataract widely used in clinics is by removal of the opacified content from the lens capsule which is followed by insertion of an artificial intraocular lens (IOL). The IOL needs to remain stabilized in the capsular bag for the eye to achieve desired optical quality. The present study aims to investigate how different design parameters of the IOL can influence the axial and rotational stabilities of IOLs using Finite Element Analysis. METHODS: Eight designs of IOL with variations in types of optics surface, types of haptics and haptic angulation were constructed using parameters obtained from an online IOL databank (IOLs.eu). Each IOL was subjected to compressional simulations both by two clamps and by a collapsed natural lens capsule with an anterior rhexis. Comparisons were made between the two scenarios on axial displacement, rotation, and distribution of stresses. RESULTS: The clamps compression method set out by ISO does not always produce the same outcome as the in-the-bag analysis. The open-loop IOLs show better axial stability while the closed-loop IOLs show better rotational stability when compressed by two clamps. Simulations of IOL in the capsular bag only demonstrate better rotational stability for closed-loop designs. CONCLUSIONS: The rotational stability of an IOL is largely dependent on its haptic design whilst the axial stability is affected by the appearance of the rhexis to the anterior capsule which has a major influence on designs with a haptic angulation.