Cortex Aspiration Following Trypan Blue Staining of Anterior Capsule in

White Cataracts

Rana Altan-Yaycioglu, Aysel Pelit, Yonca A. Akova

Baskent University, Faculty of Medicine, Department of Ophthalmology

The authors have no financial interest in any company that The authors have no financial interest in any company that makes/develops/provides ophthalmic products or servicesmakes/develops/provides ophthalmic products or services

Rana Altan-Yaycioglu, et al. ASCRS 2008, Chicago, IL

Introduction• White mature cataract – challenge to the

surgeon−Reduced visibility−Raised intracapsular pressure−Liquefied lens contents are expelled through

the opening Uncontrolled rapid tearing toward the

periphery

Aim• To evaluate the results of

phacoemulsification in white cataracts

Rana Altan-Yaycioglu, et al. ASCRS 2008, Chicago, IL

Materials & Methods

• 46 consecutive patients with white cataracts

• Jun 2005 - July 2007

• Same surgeon (RAY)

Rana Altan-Yaycioglu, et al. ASCRS 2008, Chicago, IL

Materials & Methods

• Surgery−Air-bubble injection−Anterior capsule trypan blue 0.05% staining−Anterior chamber filled with dispersive

viscoelastic−Controlled proceeding - 26 Gauge tuberculin

syringe (unbent) • pierce the anterior capsule • aspirate liquefied cortex material

−Continuous curvilinear capsulorhexis – 5.0 to 5.5 mm

−Gentle hydrodissection−Phacoemulsification - in usual way

Rana Altan-Yaycioglu, et al. ASCRS 2008, Chicago, IL

Materials & Methods

• Patients demographics

• Staining patterns

• Intraoperative complications

• Postoperative complications

were evaluated

Rana Altan-Yaycioglu, et al. ASCRS 2008, Chicago, IL

Results

• Age 61.9 ± 7.8 years• 18 female, 28 male

• DM – 16 patients• High blood pressure – 16 patients• Pseudoexfoliation - 18 patients

• BCVA, mean ± SD−Preop HM [logMar 3.00]−Postop 0.7 ± 0.3 (Snellen) [logMar 0.14 ±0.24]

Rana Altan-Yaycioglu, et al. ASCRS 2008, Chicago, IL

Results

• Dilated pupil diameter −Range between 3 and 9 mm−Mean 6.9 ± 1.3 mm

• All patients stained well with trypan

• Posterior synechia, 1 patient −iris hooks used

• Capsular tear extending into the periphery – 1 patient changed to ellipsoidal capsulorhexis

Rana Altan-Yaycioglu, et al. ASCRS 2008, Chicago, IL

Results

• Fragile capsule, broke into pieces during rhexis larger capsulorhexis encircling the previous one uneventful surgery

• Zonular dehiscence - 2 patient−1 patient developed partial zonular dialysis

• Posterior capsular rupture - 3 patient −unrelated to the capsulorhexis − intraocular lenses - into the sulcus

• Postoperative complications - none

Rana Altan-Yaycioglu, et al. ASCRS 2008, Chicago, IL

Conclusion

• Central piercing of anterior capsule with unbent 26-Gauge needle

• Followed by immediate aspiration of liquefied cortex material

lowers the intracapsular pressure

• Subsequent safe capsulorhexis possible

White cataracts with swollen cortex material may possess a challenge to cataract surgeon resulting inevitable capsular tear

Rana Altan-Yaycioglu, et al. ASCRS 2008, Chicago, IL

Conclusion

According to our results we believe that

• Aspiration of cortical material before

capsulorhexis right after piercing the

capsule

−Enables safe capsulorhexis in white cataracts

−Reduces the chance of Argentinean flag