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    Reverse optic capture effective for posterior capsule tears

     

    Surgical options

    The surgical options for a torn posterior are:

    •  Leave the IOL in place and address it if it subluxates further;
    •  Levitate the IOL into the ciliary sulcus (not an option for a single-piece IOL);
    •  Levitate the IOL into the ciliary sulcus and suture the haptics (also not a viable option);
    •  Use the capsulorhexis to capture the optic;
    •  Exchange the IOL for a three-piece IOL in the sulcus

    Dr. Hoffman opted to perform a reverse optic capture. He first injected an OVD in front of the lens and more behind the lens to push the vitreous back behind the capsule. He then used the same viscoelastic cannula to prolapse the optic up in front of the anterior rhexis, which proved to be successful.

    “At this point, the IOL was centered and stable,” Dr. Hoffman commented.

    Recent: Femtosecond laser or manual cataract removal for accommodating IOLs?

    Because vitreous was in the anterior chamber previously, Dr. Hoffman removed the OVD using a 23-gauge vitrector. A 20-gauge irrigating cannula was positioned through the left-hand incision. Hindsight suggested that a 20-gauge vitrector would have prevented fluid from egressing from the bimanual incision.

    After removing as much of the OVD as possible, Dr. Hoffman removed the vitrector and kept the irrigator in the eye. He injected triamcinolone to identify any vitreous in the anterior chamber, and used the irrigator to wash the triamcinolone out of the eye.

    No vitreous in anterior chamber

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    • [email protected]
      I also use the Hoya iSert IOL used in this video. I have had 2 suspected cases of equatorial PC tears both of which did well with IOL rotation away from the suspected tear. No vitreous presentation occurred. The IOLs have stayed stable. This is an excellent technique for securely fixating the IOL. My recommendation when using this IOL is to pull back a little once the optic has cleared the injector so as not to push the IOL too far towards the equator. With the exception of this particular problem, I find this IOL one of the easiest to insert, haptics never stick, excellent optics, and so far a very low PCO rate.

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