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    Complicated cataract: A case of iatrogenic zonular disinertion

    Toronto, CA—When an overly aggressive attempt to remove tenacious cortex results in iatrogenic zonular dialysis, the first priority for the cataract surgeon should be to take steps to maintain capsule integrity and avoid vitreous prolapse. Removal of residual cortex is also important for the final outcome. 

    Options for management might include cautious endocapsular phacoemulsification by itself, conversion to extracapsular surgery, capsular retractors, implantation of a capsular tension ring (CTR), and use of a sutured capsular tension device.

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    The decision, however, will be best made through careful assessment of the situation once the eye is stabilized, said Iqbal (“Ike”) Ahmed, MD.

    In an intraoperative video, Dr. Ahmed, assistant professor of ophthalmology and vision sciences, University of Toronto, Ontario, Canada, presented his approach to managing this “disinsertion dilemma” in a case involving a 180° zonular dialysis.

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    The patient did not have pseudoexfoliation or other risk factors for zonular weakness, and the surgery was proceeding uneventfully until cortex removal. As the operating surgeon persisted in trying to remove residual cortex, the capsule was aspirated into the instrument tip, resulting in 180° of nasal zonular dialysis with retained cortex in the capsular bag. Fortunately, the capsular bag remained intact, Dr. Ahmed said.

    After stopping the procedure and while keeping the I/A tip in the eye, a cohesive ophthalmic viscosurgical device (OVD) was instilled to reform the anterior chamber and stabilize the eye.

    Dr. Ahmed offered several tips for completing this initial step.


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