1. Cases of Lens Capsular Enlargement
Case conference
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2. AC rupture during incision or CTR ins.
Classification
Accidental
Intentional
Radial tear
uneven CCC
Incomplete/
Small CCC
AC rupture during incision or CTR ins.
2 stage CCC in mature cat
or congenital cat
in PC rupture
PCCC
or PC opacity
Small CCC
Incomplete/uneven CCC
AC rupture during incision or CTR ins.
2 stage CCC in mature cat
PCCC
in PC rupture
or congenital cat
or PC opacity
Anterior
Posterior
Radial tear

3. Case 1 : AC rupture F 56 Dec VA(OS) onset) several yrs History VA
DM/HBP (-/+) for 7rys, po medi.
Ocular op/trauma(-/-)
Gls (+) Eye drop (-) VA
OS 0.2 (0.8 x +4.00Ds -1.00Dc Ax85) MR
OD +4.25Ds -1.00Dc Ax105 / OS +4.00Ds -1.00Dc Ax85
IOP 17/18mmHg
LOCS : OS 2233
Axial length OS 21.63(IOLm) ACD K 43.50/43.25
Phaco+PCL(OS)
<MI60, 30.0D, -2.35DT (IOL m, SRK-T), -1.2DT (IOL m, Hoffer Q) >

5. Case 2 : 2 stage CCC in mature cat
F 57 Dec VA(OS)
History
DM/HBP (+/+)(3yr po medi/3yr po medi)
Ocular op/trauma(+/-) Phaco+PCL(OD)
<Miniflex ,+23.0 D, DT(A-scan, SRK-T)>
VA OD 1.0 / OS FC30 (n-c) MR
OD +0.50Ds -1.00Dc Ax100 OS error
IOP 14/17mmHg
LOCS : OS 5555
Axial length OS 22.78(Ascan) K 44.50/45.00
Phaco+PCL(OS)
<NY60, D, -0.17DT(A scan, SRK-T)>
SMI : 0 (autoK와 topoK 불일치)(Topo K) Combo-Prechopper 사용안함 ORGC 5.3 mm 사용함 ICG dye 사용함 hypermature cat 으로 ICG dye 사용 후 small CCC 시행하고 I&A 하여 lenticular pressure & intraocular pressure 를 낮추고 ORGC 넣고 CCC 시행함

7. Case 3 : Uneven CCC M 87 Dec VA(OD) History
DM/HBP (-/+) for 4 month po medi
Ocular op/trauma(-/-)
VA OD 0.16(0.25) / OS 0.2(0.32) MR
OD +2.50Ds -0.50Dc Ax90
OS -0.50Ds -1.25Dc Ax55
IOP 17/20 mmHg
LOCS : OD 3343
Axial length OD 23.71(Ascan) K 43.75/44.25
Phaco+PCL(OD)
<Asphina, +19.0D, -0.26DT(IOLm, SRK-T)>
CCC후 roundability 좋음.
centering 9시 방향으로 치우쳐서 3시방향 CCC 넓힘./OD

9. Case 4 : PCCC in PC rupture
M 51 Dec VA(OD) for 10 yrs
History
DM/HBP (-/-)
Ocular op/trauma(-/-)
VA OD 0.5 (n-c) / OS 0.63 (n-c) MR
OD -4.50Ds -1.00Dc Ax120
OS -3.75Ds -1.00Dc Ax50
IOP 16/15 mmHg
LOCS : OD 2221
Axial length OD (Ascan) K 43.50/44.50
Phaco+PCL(OD)
<ZA9003, +18.0D, -0.23DT(IOLm, SRK-T)>
Polishing 도중 Post. capsule tear가 발견됨 --> Incomplete PCCC가 됨 --> PC가 intact 부분으로 haptic이 가게 (12시, 6시방향) 위치시킴 (IOL in the bag)/OD

11. Case 5 : PCCC in congenital cataract
M 33 Dec VA(OS) onset) at birth
History
DM/HBP (-/-),
Ocular op/trauma(-/-)
VA OD 1.0 / OS 0.63(n-c) MR
OD -0.75Ds -0.25Dc Ax 124
OS error
IOP 20/19 mmHg
LOCS : OD 1123
Axial length OD 23.88(Ascan) K 44.00/43.25
Phaco+PCL(OS)
<EC-1PAL, D, DT(IOLm, SRK-T)>

13. Lens Capsular enlargement
References
1. Cataract Surgery, 3rd Edition Cataract Surgery, 3rd Edition
2. Essentials of Cataract Surgery
3. Posterior capsule staining and posterior continuous curvilinear capsulorhexis in congenital cataract. J Cataract Refract Surg 2002
4. Intraoperative Management of Posterior Capsule Tears in Phacoemulsification and Intraocular Lens Implantation. Ophthalmology 2001;108:2186–2192.
Review
Lens Capsular enlargement

14. Capsulorrhexis Using lens capsule's shearing property
Gives mechanical and structural integrity
Advantages
No tags or flaps of anterior capsule remnants
Mechanical forces exerted onto the zonules are minimized
Closed-system approach: the posterior capsule is ballooned posteriorly
No risk of extending radial tears in the anterior capsule into the posterior capsule
Even in the case of a PC defect, an intact anterior capsulorrhexis provides the possibility of implanting an IOL safely into the ciliary sulcus
After cataract manage
Thus, successful round & proper sized CCC is important

15. Challenge requiring enlargement
Radial tear
AC deeping with viscoelastics
puncture the capsule again with a 30-gauge needle or vannas scissors
Pull leading edge flap to backward &centrally
Small CCC
Incomplete/uneven CCC
AC rupture during incision or CTR ins.
In congenital cataract or PC opacity or PC rupture
PCCC is required

16. Posterior CCC Indication congenital cataract
prevent extension of inadvertant PC tear
For in the bag lens implantation in small PC tear
Removal of PC plaque
Prevent PCO

17. PCCC in congenital cataract
To prevent PCO or secondary membrane formation
Difficulty
thin, transparent, elastic pediatric posterior capsule.
Primary PCCC : up to 6–8 yo.
Procedure
A 26-gauge needle puncture
PCCC accomplished aiming at a size of 3.5–4mm by using the ACCC principles and strategies
Additional viscoelastic material can be placed through the central puncture of the posterior capsule to push the vitreous face away
PCCC should be concentric to and smaller than the ACCC

18. PCCC in PC rupture
A CCC made in the PC thus behaves like a CCC and is resistant to radial tears
PCCC technique allows safe and secure in-the-bag IOL Placement
Small tears in the PC at the end of phaco or during I/A can be converted to a PCCC -> in the bag
Large tears in the PC can be converted to a PCCC ->anterior rhexis fixation
Sustaining the integrity of the capsular bag when a vitrectomy is required.

19. Summary
CCC gives mechanical and structural integrity during phacoemulsification
Proper enlargemnet of CCC should be done if required in situations like
Radial tear
Small CCC
Incomplete/uneven CCC
AC rupture during incision or CTR ins.
PCCC is required
In congenital cataract or PC opacity
PCCC enables IOL in the bag insertion in cases of PC rupture

20. Thank you!