Traumatic Cataract Surgery with Capsular Tension Ring

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Traumatic Cataract Surgery with Capsular Tension Ring

Indications

Zonular weakness, zonular dialysis, or zonule loss following trauma

Lens subluxation

Support of capsular bag during phacoemulsification

Prevention of capsular bag aspiration during irrigation/aspiration of cortex

Support of capsular bag after phacoemulsification

Improvement of intraocular lens (IOL) centration

Reduced risk of capsular fibrosis and posterior capsule striae.

Preoperative Procedure

1. Perform a careful slit lamp examination of the cornea, anterior chamber, iris, and lens.

2. Measure the intraocular pressure.

3. Observe closely for phacodonesis, zonular dehiscence, and vitreous in the anterior chamber.

a. Quantitate the number of clock hours of zonular dehiscence.

b. Document the exact areas of zonular compromise (helpful in guiding which direction the capsular tension ring [CTR] is placed).

4. Perform dilated ophthalmoscopy to rule out an intraocular foreign body (avoid scleral depression if ruptured globe suspected).

5. B-scan ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI) (if no metallic foreign body suspected), or ultrasound biomicroscopy (UBM) may be indicated to rule out an occult foreign body.

6. Perform A-scan and keratometry measurements of both eyes. (Fellow eye measurements may be necessary in cases of severe corneal trauma.) See Chapter 8.

Timing of Procedure

At the Time of Initial Corneoscleral and Iris Repair

If surgical visualization is adequate, consider removal of a traumatic cataract, preferably with IOL implantation.

Delayed Procedure

Severely traumatized eyes (e.g., with significant fibrinous reactions and corneal or iris injuries) may be delayed for cataract extraction until the eye is less inflamed after ruptured globe repair.

Elective Procedure

Dislocated or subluxated lenses with intact anterior capsules may be removed electively, unless intraocular pressure is elevated.

Preoperative Procedure

See the section on Conjunctival Lacerations in Chapter 28 for complete preoperative supportive measures.

Pupil Dilation

1. Tropicamide 1%, phenylephrine 2.5%, and cyclopentolate 1% every 15 minutes (for 3 total doses) beginning 1 hour before surgery.

2. Optional: Topical nonsteroidal anti-inflammatory agent (e.g., flurbiprofen 0.3% [Ocufen, Allergan, Inc., Irvine, CA, US]) every 30 minutes beginning 2 hours before surgery to minimize intraoperative miosis.

Preoperative Antibiotic Drops

Antibiotic drops (e.g., moxifloxacin 0.5% [Vigamox, Alcon, Inc., Fort Worth, TX, US], gatifloxacin 0.3% [Zymar, Allergan, Inc.]) are administered before surgery.

Instrumentation

CTRs

Morcher; distributed by FCI Ophthalmics Inc.

Three sizes available: 14 (12.3 mm): for axial lengths < 24 mm (all compress 2–3 mm); 14A (14.5 mm): for axial lengths > 28 mm; 14c (13 mm): for axial lengths 24–28 mm