Deslocamento espontâneo do núcleo do cristalino para câmara anterior / Spontaneous dislocation of the lens nucleus to the anterior chamber

Resumo Ruptura espontânea da cápsula anterior do cristalino, evoluindo com deslocamento anterior do núcleo é uma complicação rara da catarata hipermadura. Relatamos o caso de uma paciente do sexo feminino, 79 anos, que se apresentou com ruptura espontânea da cápsula anterior do cristalino com deslocamento anterior do núcleo em olho direito sem histórico de trauma ocular. O diagnóstico foi confirmado pela visualização das abas da cápsula anterior, principalmente quando o núcleo foi removido. Realizamos facoemulsificação do núcleo pelo risco de descompensar a córnea. É importante destacar a raridade do caso, sendo o primeiro relatado no Brasil.

Abstract Spontaneous rupture of the anterior lens capsule, evolving with anterior dislocation of the lens nucleus is a rare complication of hypermature cataract. We report a case of a female patient, 79 years old, who presented with spontaneous rupture of the anterior lens capsule with anterior dislocation of the nucleus in the right eye with no history of ocular trauma. The diagnosis was confirmed by the visualization of the tabs of the anterior capsule, especially when the nucleus was removed. We perform phacoemulsification of the nucleus by the risk of decompensating the cornea. It is important to highlight the rarity of the case, the first being reported in Brazil.

The Effect of Extracapsular Cataract Extraction Using Nucleus Dislocation into Anterior Chamber on Corneal Endothelium

The nucleus delivery method using nucleus dislocation into the anterior chamber is more safe and easier to maintain a intact lens capsule than conventional "push and pull" method when the continous circular capsulorhexis(CCC) has been performed. To investigate the effect on the corneal endothelium of nucleus dislocation method, time analysis on the changes of central corneal endothlial cell density(CECD) in two groups-extracapsular cataract extraction(ECCE) using nucleus dislocation into the anterior chamber group and a conventional ECCE group-was studied for two months. The study was performed on 18 eyes of 18 cataract patients who were operated on with ECCE using nucleus dislocation into the anterior chamber method, and 10 eyes of 10 cataract patients who were operated on with the conventional ECCE method. Central corneal endothelial cell density(CECD) was measured using specular microscopy, preoperatively and at 1 month and 2 months of postoperation. The average postoperative endothelial cell loss at 1 month was 7.20 +/- 2.98% in the experimental group and 7.88 +/- 2.93% in the control group, and at 2 months postoperation was 9.05 +/- 2.96% in the experimental group and 9.34 +/- 2.95% in the control group. The change in CECD between the two groups was not statistically significant.

The effect of extracapsular cataract extraction using nucleus dislocation into anterior chamber on the corneal endothelium

When the continuous circular capsulorhexis (CCC) is being performed, the nucleus delivery using nucleus dislocation into the anterior chamber is safer and easier than using conventional "push and pull" method to maintain an intact lens capsule. This method include such procedures that after CCC, the nucleus being freed in the capsular bag by hydrodissection and hydrodelineation, then hooked with a Sinskey hook and drawn out to the anterior chamber by rotation. It may damage the corneal endothelium because of the manipulation in the anterior chamber. To investigate an effect of this method on the corneal endothelium, we performed two months time analysis of changes of the central corneal endothelial cell density (CECD) in two groups--a group with an extracapsular cataract extraction (ECCE) using nucleus dislocation into the anterior chamber and a group with a conventional ECCE. Eighteen eyes of 18 cataract patients who were operated on with ECCE using nucleus dislocation into the anterior chamber method, and ten eyes of 10 cataract patients who were operated on with a conventional ECCE method were included. The CECD was measured by specular microscopy, preoperatively, postoperatively at 1 month and 2 months. The average endothelial cell loss at postoperative 1 month was 7.20 +/- 2.98% in the experimental group and 7.88 +/- 2.93% in the control group, and at postoperative 2 months was 9.05 +/- 2.96% in the experimental group and 9.34 +/- 2.95% in the control group. The change in CECD between two groups was not statistically significant.