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O C T O B E R 2 0 1 4 | O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E
N
ine times out of 10, cataract cases go off as planned,
but your surgeons need to react to unexpected
developments to ensure one of surgery's most rou-
tine procedures remains just that. Here's what 3
leading eye docs have to say about managing the
rare, but potentially devastating, mishaps that can occur before,
during and after surgery.
Capsular tear
It's not overly difficult to tear the capsular bag, says Paul Rosenblum,
MD, a cataract surgeon in Jupiter, Fla. He says capsular tear occurs in
less than 1% of his cases, but it's involved in most of the complications
he faces. When it occurs, the cataract drops into the back of the eye
where it can't be reached with ordinary anterior segment techniques.
A retinal surgeon must perform corrective surgery at a later date.
"If the complication is managed well, you can still achieve good out-
comes," says Dr. Rosenblum. "But if not, secondary complications can
occur, including retinal tears or detachments, infection and retinal
swelling — although these complications are extraordinary rare."
Robert F. Melendez, MD, a cataract and refractive surgeon at Eye
Associates of New Mexico in Albuquerque, says history of eye disease
or past trauma are red flags of a loose capsular bag. Even in expected
routine cases, he'll know something is amiss after he makes the first
manual slice of the capsulorhexis — if a femtosecond laser is making
the cut, you're not getting the same feel and feedback, says Dr.
Melendez.
When the bag feels loose, he makes the incision slightly larger —
approximately 6.25 mm instead of his standard 5.75 mm — to relieve
stress on the zonules. He considers the larger capsulorhexis a safety
measure that lets him prolapse the lens into the anterior chamber if
O P H T H A L M O L O G Y
