A Simple, Novel Approach to Capsulorhexis Formation in the Setting of A Mature Cataract and Miotic Pupil

Stephen A LoBue,1,2 Prashant Tailor,3 Thomas D LoBue1 1Department of Ophthalmology, LoBue Laser and Eye Medical Center Inc, Murrieta, CA, USA; 2Lincoln Medical Center, Affiliated to Weill Cornell Medical College, Bronx, NY, USA; 3Medical College of Georgia, Augusta, GA, USACorrespondence: Thomas D L...

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Autores principales:	LoBue SA, Tailor P, LoBue TD
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2019
Materias:	dense cataract miosis ifis dementia novice surgeon pupil ring Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/a610e917331649bba246999e9185ac7e
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spelling	oai:doaj.org-article:a610e917331649bba246999e9185ac7e2021-12-02T09:25:23ZA Simple, Novel Approach to Capsulorhexis Formation in the Setting of A Mature Cataract and Miotic Pupil1177-5483https://doaj.org/article/a610e917331649bba246999e9185ac7e2019-12-01T00:00:00Zhttps://www.dovepress.com/a-simple-novel-approach-to-capsulorhexis-formation-in-the-setting-of-a-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Stephen A LoBue,1,2 Prashant Tailor,3 Thomas D LoBue1 1Department of Ophthalmology, LoBue Laser and Eye Medical Center Inc, Murrieta, CA, USA; 2Lincoln Medical Center, Affiliated to Weill Cornell Medical College, Bronx, NY, USA; 3Medical College of Georgia, Augusta, GA, USACorrespondence: Thomas D LoBueLoBue Laser and Eye Medical Center Inc, 40700 California Oaks Road, Ste 106, Murrieta, CA 92562, USATel +1 951-696-1135Email Thomas.lobue@lobueeyecenters.comPurpose: To report a simple, effective technique for surgeons creating a capsulorhexis in patients with pupillary miosis and a dense, mature cataract.Methods: A single center, two-year retrospective chart review examined 1408 phacoemulsification cataract surgeries. The criteria for inclusion involved a dense, mature cataract and a pupil that was unresponsive to pharmacologic dilation preoperatively. A standardized technique was used for all cases consisting of a 1mm corneal paracentesis and 2.4mm temporal clear corneal incision. Synecholysis was performed if present, followed by the insertion of a 6.25mm malyugin ring under cohesive viscoelastic. The cohesive viscoelastic was removed via the irrigation aspiration tip. The paracentesis was sealed with a small amount of viscoelastic and an air bubble was placed in the anterior chamber. The anterior capsule was then painted with trypan blue. The air bubble and trypan blue were then replaced by a dispersive viscoelastic. Curvolinear capsulorrhexis was performed followed by standard phacoemulsion.Results: Nine patients ranging from 76 ± 12 years (mean ± standard deviation) met the criteria with a 4+ NS (n=5), white mature (n=3), or deep brunescent (n=1) cataract and 3mm pupil preoperatively. Pupillary miosis was caused by posterior synechia in 44.5% of the cases followed by pharmacologic interactions from tamsulosin and donepezil in 22.25% of cases respectively. One case involved idiopathic miosis likely from aging. Capsulorhexis formation was successful in all cases with no capsular tear, vitreous loss, or conversion to extracapsular cataract extraction (ECCE). However, one case had cortex retention requiring a second procedure for removal.Conclusion: Dense, mature cataracts and small pupils both compromise the view for the surgeon and may be significant risk factors for training ophthalmologists. Thus, good visualization of the anterior capsule and peripheral nucleus with our simple technique facilitates a reliable capsulorhexis, potentially limiting the risk of complications for ophthalmic surgeons.Keywords: dense cataract, miosis, IFIS, dementia, novice surgeon, pupil ringLoBue SATailor PLoBue TDDove Medical Pressarticledense cataractmiosisifisdementianovice surgeonpupil ringOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 13, Pp 2361-2367 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	dense cataract miosis ifis dementia novice surgeon pupil ring Ophthalmology RE1-994
spellingShingle	dense cataract miosis ifis dementia novice surgeon pupil ring Ophthalmology RE1-994 LoBue SA Tailor P LoBue TD A Simple, Novel Approach to Capsulorhexis Formation in the Setting of A Mature Cataract and Miotic Pupil
description	Stephen A LoBue,1,2 Prashant Tailor,3 Thomas D LoBue1 1Department of Ophthalmology, LoBue Laser and Eye Medical Center Inc, Murrieta, CA, USA; 2Lincoln Medical Center, Affiliated to Weill Cornell Medical College, Bronx, NY, USA; 3Medical College of Georgia, Augusta, GA, USACorrespondence: Thomas D LoBueLoBue Laser and Eye Medical Center Inc, 40700 California Oaks Road, Ste 106, Murrieta, CA 92562, USATel +1 951-696-1135Email Thomas.lobue@lobueeyecenters.comPurpose: To report a simple, effective technique for surgeons creating a capsulorhexis in patients with pupillary miosis and a dense, mature cataract.Methods: A single center, two-year retrospective chart review examined 1408 phacoemulsification cataract surgeries. The criteria for inclusion involved a dense, mature cataract and a pupil that was unresponsive to pharmacologic dilation preoperatively. A standardized technique was used for all cases consisting of a 1mm corneal paracentesis and 2.4mm temporal clear corneal incision. Synecholysis was performed if present, followed by the insertion of a 6.25mm malyugin ring under cohesive viscoelastic. The cohesive viscoelastic was removed via the irrigation aspiration tip. The paracentesis was sealed with a small amount of viscoelastic and an air bubble was placed in the anterior chamber. The anterior capsule was then painted with trypan blue. The air bubble and trypan blue were then replaced by a dispersive viscoelastic. Curvolinear capsulorrhexis was performed followed by standard phacoemulsion.Results: Nine patients ranging from 76 ± 12 years (mean ± standard deviation) met the criteria with a 4+ NS (n=5), white mature (n=3), or deep brunescent (n=1) cataract and 3mm pupil preoperatively. Pupillary miosis was caused by posterior synechia in 44.5% of the cases followed by pharmacologic interactions from tamsulosin and donepezil in 22.25% of cases respectively. One case involved idiopathic miosis likely from aging. Capsulorhexis formation was successful in all cases with no capsular tear, vitreous loss, or conversion to extracapsular cataract extraction (ECCE). However, one case had cortex retention requiring a second procedure for removal.Conclusion: Dense, mature cataracts and small pupils both compromise the view for the surgeon and may be significant risk factors for training ophthalmologists. Thus, good visualization of the anterior capsule and peripheral nucleus with our simple technique facilitates a reliable capsulorhexis, potentially limiting the risk of complications for ophthalmic surgeons.Keywords: dense cataract, miosis, IFIS, dementia, novice surgeon, pupil ring
format	article
author	LoBue SA Tailor P LoBue TD
author_facet	LoBue SA Tailor P LoBue TD
author_sort	LoBue SA
title	A Simple, Novel Approach to Capsulorhexis Formation in the Setting of A Mature Cataract and Miotic Pupil
title_short	A Simple, Novel Approach to Capsulorhexis Formation in the Setting of A Mature Cataract and Miotic Pupil
title_full	A Simple, Novel Approach to Capsulorhexis Formation in the Setting of A Mature Cataract and Miotic Pupil
title_fullStr	A Simple, Novel Approach to Capsulorhexis Formation in the Setting of A Mature Cataract and Miotic Pupil
title_full_unstemmed	A Simple, Novel Approach to Capsulorhexis Formation in the Setting of A Mature Cataract and Miotic Pupil
title_sort	simple, novel approach to capsulorhexis formation in the setting of a mature cataract and miotic pupil
publisher	Dove Medical Press
publishDate	2019
url	https://doaj.org/article/a610e917331649bba246999e9185ac7e
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A Simple, Novel Approach to Capsulorhexis Formation in the Setting of A Mature Cataract and Miotic Pupil

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