EyeWorld Asia-Pacific December 2019 Issue

EWAP DECEMBER 2019 19 FEATURE offer the best long-term results. Dr. Devgan recommended hydrodissection in which he tilts the nucleus on its side then begins to chop and use «…>Vœi“ՏÈwV>̈œ˜° Sometimes signs of zonular weakness appear intraoperatively. “Using phaco chop, we can bring each nuclear half out of the capsular bag and into the iris plane for aspiration. If the shape of the capsulorhexis morphs from round to D-shaped, for example, during VœÀÌiÝ Ài“œÛ> ÕȘ} ˆÀÀˆ}>̈œ˜É aspiration, it indicates zonular œÃà >œ˜} ̅i y>Ì ÃÕÀv>Vi° /…i ideal next step is to implant a capsular tension ring or a Cionni ring to bolster the weak area and to provide stability for IOL implantation,” Dr. Devgan said. In the absence of the appropriate devices, the surgeon can use the IOL’s haptics to provide support. Dr. Devgan suggested implanting the IOL so that one haptic is placed along the area of zonular weakness. This haptic will exert an outward force supporting the capsular bag equator, resulting in a well-centered optic. Femto advantage Dr. Miller relies on a femtosecond laser when zonular weakness threatens to complicate cataract surgery. “Capsulorrhexis is œvÌi˜ ÛiÀÞ `ˆvwVÕÌ ˆ˜ ̅iÃi iÞià because the lens wants to follow you when you’re doing a manual capsulorrhexis. It is also stressful on the remaining zonules. If I can use a femto laser when a lens is not too far displaced, I prefer that. A lens capsule that is less than 2–3 mm off axis, that I can visualize enough to put down the treatment pattern, is a great candidate for a femtosecond laser capsulorrhexis,” Dr. Miller said. EWAP Editors’ note: Dr. Devgan practices at Devgan Eye Surgery, Los Angeles, and has a relevant interest in CataractCoach. com. Dr. Miller is the Kolokotrones Chair in Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, and FGENCTGF PQ TGNGXCPV ƂPCPEKCN KPVGTGUVU