rop loose zonules and heme

by Cataract Surgery
7:25
here we show a recent case that was tricky.

the patient had ROP with a dense cataract that was left for a while due to her monocular status. she had weak zonules which is common with conditions such as ROP that lead to nystagmus in my exoperience. her cataract came out nicely but when i tried to place the CTR the bag was too loose and a ring alone was not enough. as such we placed an IOL in the sulcus and then used McCannel sutures to secure the IOL. unfortunately she had a fair amount of hemorrhage after placing the suture. rather than using the siepser sliding technique as described by david chang to fix the IOL i used the old mccannel technique which was simpler around the heme. so far so good with her IOL fixation and centration.

thanks for any comments or suggestions.

In this video:

Added about 7 months ago
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Howard Levy
Howard Levy
It appears to me that the placement of the CTR might have contributed to the zonular dehiscence. Do you think that Dr. Little's technique on CTR placement using 2 angled McPherson's might have lessened you the need for suture placement? I tried this technique for the first time last week. It is by no means as easy as the video suggests but it does seem to cause less stress on the zonule.
May 3 at 9:05pm
Cataract Surgery
Cataract Surgery
howard i think you are right. brian little's fish tail technique might have helped in this case. i have a video of this technique on this page. thanks for your comments. tom o
May 4 at 5:36am
Daniel Braun
Daniel Braun
Hey Dr. O; I... See More´m a 4th year resident in a big Hospital in Madrid-Spain and have not got the chance to perform this kind of surgery yet (IOL suturing). I hope, that in the near future, I have the chance to perform this kind of surgery, with half the skills that you have shown!
I´ve got three questions for you:
1) Why do you prefer to place sutures to the Iris instead of ciliary sulcus (scleral) to secure the IOL?,
2) As it appears that at the nasal-inferior zone (6-8 o´clock)you had enough capsular-zonular support, would you consider placing just one suture (on the less supported side)?,
3) It seems that the final position of IOLs sutured to the Iris, is very close to the Iris. Do you think it would be convenient to perform a surgical Iridectomy or a YAG Iridotomy (previous or after surgery) in order to prevent a pupillary block?
July 8 at 5:41pm
Daniel Braun
Daniel Braun
Again big compliments for your great surgical skills and thanks for sharing all these videos, I´m making good use of many of your tips… and thanks in advance for the answers to my questions, that I know, you´ll so kindly answer!
Daniel
July 8 at 5:41pm
Cataract Surgery
Cataract Surgery
daniel 1) i prefer the iris fixation as it seems that the 10-O prolene suture lasts nearly forever on the iris and the 10-O at least in the sclera only lasts 7-8 years. also it is easier to do iris fixation in many ways as it easily allows for a small incision. 2) you could place just one suture but i usually place 2. 3) i dont think you need... See More a PI when placing an IOL in the sulcus. as the IOL is behind the iris and very thin it is very hard to get iris bombe i think PIs are of course mandatory when placing an AC IOL. thanks for your questions. tom o
August 4 at 7:08pm