Cataract surgery in gross zonular weakness

Zonular weakness can be caused by disease or trauma, and its presence can make cataract surgery more challenging. Fortunately, there are adjunctive devices to effectively manage it and achieve successful outcomes. Certain diseases of the eye are associated with zonular weakness or insufficiency.

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Taming the soft cataract

In this technique, we sculpt a central bowl, followed by delivery and removal of the residual nuclear rim. Our technique is reminiscent of the process of eating escargot— hence the name. The technique is done within the capsular bag and with minimal stress on the zonules.

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Nucleus Drop

Dropped nucleus as a result of posterior capsule damage represents a serious complication that may occur during cataract surgery. In the event that the nucleus drops into the vitreous cavity, it is important to deal with the dropped lens without causing further intra- or postoperative complications.

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Anterior Chamber IOL, Vitreous in AC

Anterior chamber lenses sit close to the corneal endothelium, and as a result the patient will lose some endothelial cells over time. That could lead to corneal edema—or even a corneal transplant. For that reason, many surgeons think of anterior chamber IOLs as making the most sense when a patient is older.

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Brunescent Cataract

Brunescent cataracts are very advanced nuclear cataracts that have become brown and opaque. A brunescent, or brown, cataract is often correlated with the maturity of a cataract and can cause decreased visual acuity. Brunescent cataracts can cause poor contrast and color discrimination, especially at the blue end of the visible light spectrum.

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Scleral Fixation of Subluxated Bag

Ab externo fixation refers to scleral fixation in which sutures are passed from the outside to the inside of the eye. The location of the ciliary sulcus is established using external landmarks. 9-0 or 10-0 double-armed polypropylene suture (Prolene) can be utilized, although Gore-tex is becoming more popular.

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