Cataract Surgery in Complicated Cases


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But the iris can also…. This video features guest surgeon Neto Rosatelli MD from Brazil showing us his approach to cataract surgery in a uveitic…. For the Millennial Eye Live meeting, I am presenting this talk about my top 5 tips for young surgeons…. In this anonymously-submitted case, a small amount of lens cortex was left in the capsular bag at the time of…. In cases where the pupil does not dilate fully, it can be difficult to see the entire capsular bag to….

What happens if the hydro-dissection is insufficient during cataract surgery? The cortex and epi-nuclear shell remain very adherent to the…. In some cataract cases it is helpful to perform hydro-delineation to separate the dense endo-nucleus from the softer epi-nucleus.

Radial keratotomy RK is an out-dated kerato-refractive surgery where radial incisions were made in the cornea in order to cause…. An intumescent white cataract is where the cortex has become opaque and liquified which increases the pressure within the capsular…. Sometimes we attempt to use phaco chop to divide the cataract nucleus, but we are just not able to achieve….

Cataract surgery can provide an incredible refractive result, particularly for small eyes which are highly hyperopic. We can correct 10…. Should we chop the nucleus within the capsular bag or should we bring the nucleus partially out of the capsular…. But as we try to…. A very simple technique for new surgeons who are struggling with the capsulorhexis is to trace the intended path with….

In all surgeries, you must make the effort to create a great incision, which I have previously described as part…. I like the operating room….

Complex Cataract Surgery: multiple challenging issues

With vitreous prolapsed into the anterior chamber, we must perform a vitrectomy before placing the IOL in the eye. Dense white cataracts are challenging for multiple reasons: the opaque lens blocks any red reflex, the capsular bag may be….

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Our ideal capsulorhexis will overlap the optic edge for degrees in order to hold the IOL securely in a…. Illumination through the ophthalmic microscope is important for visualization during cataract surgery. We use a combination of both coaxial and…. We have shown videos for soft posterior subcapsular cataracts where we prolapse the entire lens out of the capsular bag…. With a dense cataract, a fibrous posterior plate can develop within the lens nucleus.

This makes is challenging to split…. Phaco chop is my preferred method of nucleo-fractis for cataract surgery. It is safe, efficient, and minimally invasive, significantly reducing…. Many residents choose divide-and-conquer as the first nucleo-fractis technique to learn during residency training. This technique has been featured here….

Supracapsular phaco techniques are in closer proximity to the corneal endothelium, which can be damaged by the ultrasonic energy from…. We want a capsulorhexis to be just large enough to overlap the optic of the IOL in order to hold….

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For a relatively soft nucleus, such as in a younger patient with primarily posterior subcapsular cataract changes, the supracapsular technique…. When we inject the dispersive viscoelastic at the beginning of the case, our goal is to protect the corneal endothelium…. We often will move the positions of our incisions to provide a better result for the patient or a more…. This is such an important step of cataract surgery that we must review it again as our residents are beginning….

When we break the cataract nucleus into smaller fragments, we can sometimes have one of these small pieces stuck in…. The skills learned from cataract surgery, such as working within the anterior chamber and pivoting within the incisions, can be….

This patient has a relatively opaque cataract with a pre-operative vision of only counting fingers. When we go to perform….

Many resident surgeons find it challenging to learn the technique of phaco chop because of the force vectors which are…. The phaco probe angle changes during the procedure. When we embed the phaco tip into the nucleus, the probe is…. Under topical anesthesia, there are some patients who have a difficult time holding still during critical parts of the surgery….

A properly constructed phaco incision will allow good access to the anterior chamber for cataract surgery and then will seal….

Cataract surgery (phacoemulsification) in difficult cases.

Posterior chamber phakic lens implants can effectively treat a large degree of myopia while retaining the accommodation of a youthful…. Capsular tension rings are flexible plastic loops which are designed to exert outward force at the capsular bag equator to…. Quiz time: What is this large central opacity seen in the anterior chamber? The patient is scheduled for cataract surgery….

It is always an honor when fellow ophthalmologists ask you to perform their cataract surgeries. It can also be stressful…. Placing anesthetic agents in the retro-bulbar space provides excellent anesthesia and akinesia during ocular surgery. We have previously shown the…. This patient has a dense, white cataract with a pre-op vision of just Counting Fingers at 1 meter CF at…. We know that a dispersive viscoelastic will protect the corneal endothelium better during phacoemulsification of the lens nucleus. And a…. We have some amazing surgical technology now with IOLs that give a wide range of vision and can even help….

This patient needs surgery on both eyes.

Cataract Surgery in Complicated Cases

The path to learning surgery is a long and challenging one. True success requires years of dedication and the passion…. Many ophthalmologists will perform tens of thousands of cataract surgeries during their careers and each of these procedures can improve…. I made a video for patients as a step-by-step guide to the experience having cataract surgery at our surgery center…. All surgeons in training must know how to properly…. While we do hold the phaco probe with a pencil grip, we do not use the same angle as writing…. There are intraoperative surprises that may require techniques that are best described as complex cataract surgery.

For example, a case may be longer if the lens requires more phaco time. Also, some cases require unplanned anterior vitrectomy for surgical misadventures.


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The use of a femtosecond laser in laser-assisted cataract surgery is atypical, however it is not, by itself, complex cataract surgery because it represents a variation in surgical instrumentation to perform a capsulorrhexis and lens fragmentation, both elements of routine cataract surgery. In addition, the implantation of a presbyopia-correcting or astigmatism-correcting IOL does not qualify as complex surgery per se.


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If specifically stated in their local policy, a payer may allow the non-routine use of dye in dense, mature, or hypermature cataracts as complex surgery. While there are many subtle variations in cataract surgical technique, they usually fall within conventional routine cataract surgery. The miLoop device is a small nitinol snare activated by a thumb deployment that chops the lens. Fragmenting the crystalline lens is one step in routine cataract surgery to facilitate lens removal with phacoemulsification. The miLoop may be useful in routine and complex cases to facilitate endocapsular nucleus disassembly, capsular stabilization, and cortical release during the procedure.

By themselves, these diagnoses are insufficient to report complex cataract surgery. Privacy Policy Terms of Use. Sign in to access your subscriptions Sign in to your personal account. Create a free personal account to download free article PDFs, sign up for alerts, and more. Purchase access Subscribe to the journal.

Complex Eye Surgery

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Cataract Surgery in Complicated Cases Cataract Surgery in Complicated Cases
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Cataract Surgery in Complicated Cases Cataract Surgery in Complicated Cases
Cataract Surgery in Complicated Cases Cataract Surgery in Complicated Cases
Cataract Surgery in Complicated Cases Cataract Surgery in Complicated Cases
Cataract Surgery in Complicated Cases Cataract Surgery in Complicated Cases
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