Cortex Aspiration Following Trypan Blue Staining of Anterior Capsule in White Cataracts

1
Cortex Aspiration Following Trypan Blue Staining
of Anterior Capsule in White Cataracts

• Rana Altan-Yaycioglu, Aysel Pelit, Yonca A. Akova
• Baskent University, Faculty of Medicine,
• Department of Ophthalmology

The authors have no financial interest in any
company that makes/develops/provides ophthalmic
products or services
2
Introduction

• White mature cataract challenge to the surgeon
• Reduced visibility
• Raised intracapsular pressure
• Liquefied lens contents are expelled through the
  opening
• Uncontrolled rapid tearing toward the periphery
• Aim
• To evaluate the results of phacoemulsification in
  white cataracts

3
Materials Methods

• 46 consecutive patients with white cataracts
• Jun 2005 - July 2007
• Same surgeon (RAY)

4
Materials Methods

• Surgery
• Air-bubble injection
• Anterior capsule trypan blue 0.05 staining
• Anterior chamber filled with dispersive
  viscoelastic
• Controlled proceeding - 26 Gauge tuberculin
  syringe (unbent)
• pierce the anterior capsule
• aspirate liquefied cortex material
• Continuous curvilinear capsulorhexis 5.0 to 5.5
  mm
• Gentle hydrodissection
• Phacoemulsification - in usual way

5
Materials Methods

• Patients demographics
• Staining patterns
• Intraoperative complications
• Postoperative complications
• were evaluated

6
Results

• Age 61.9 7.8 years
• 18 female, 28 male
• DM 16 patients
• High blood pressure 16 patients
• Pseudoexfoliation - 18 patients
• BCVA, mean SD
• Preop HM logMar 3.00
• Postop 0.7 0.3 (Snellen) logMar 0.14 0.24

7
Results

• Dilated pupil diameter
• Range between 3 and 9 mm
• Mean 6.9 1.3 mm
• All patients stained well with trypan
• Posterior synechia, 1 patient
• iris hooks used
• Capsular tear extending into the periphery
• 1 patient
• changed to ellipsoidal capsulorhexis

8
Results

• Fragile capsule, broke into pieces during rhexis
• larger capsulorhexis encircling the previous one
• uneventful surgery
• Zonular dehiscence - 2 patient
• 1 patient developed partial zonular dialysis
• Posterior capsular rupture - 3 patient
• unrelated to the capsulorhexis
• intraocular lenses - into the sulcus
• Postoperative complications - none

9
Conclusion
White cataracts with swollen cortex material may
possess a challenge to cataract surgeon resulting
inevitable capsular tear

• Central piercing of anterior capsule with unbent
  26-Gauge needle
• Followed by immediate aspiration of liquefied
  cortex material
• ? lowers the intracapsular pressure
• Subsequent safe capsulorhexis possible

10
Conclusion

• According to our results we believe that
• Aspiration of cortical material before
  capsulorhexis right after piercing the capsule
• Enables safe capsulorhexis in white cataracts
• Reduces the chance of Argentinean flag