1. PHACOEMULSIFICATION IN INTUMESCENT MATURE CATARACT: Managing a run-out capsulorhexis DR.MANISH MAHENDRA KHAIRABAD EYE HOSPITAL & P.N.MAHENDRA EYE INSTITUTE KANPURINDIA The Author has no financial interest in the subject matter of this poster

2. INTRODUCTION White Cataracts 4 Types Golden Nuclear Hue & Hard Consistency Golden Nuclear Hue & Hard Consistency Swollen Intumescent Cataract Swollen Intumescent Cataract Morgagnian Cataract Morgagnian Cataract White Cortical Cataract – Spoking White Cortical Cataract – Spoking Clefting Clefting Cortico-capsular Adhesions Cortico-capsular Adhesions

3. INTUMESCENT MATURE CATARACT Etiology Etiology Characteristics * Depth Of AC < 2.0 mm * Angle Of AC < 40 Degree * Lens Thickness > 5.50 mm * Shape Of Lens : Decrease The Aspect Of Biconvex Lens And It Becomes Spheroidal. Imbibe Aqueous Through Semipermeable Lens Capsule Lens Swells 1) UNANTICIPATED ELEVATED ENDOCAPSULAR PRESSURE ENDOCAPSULAR PRESSURE 2) COMPROMISED VISUALISATION OF THE CAPSULORHEXIS THE CAPSULORHEXIS TWO DIFFICULTIES HydroStatic Or Intra Lenticular Pressure Phacomorphic Glaucoma MATURE CATARACT

4. MAKING OF “A” FLAG Initial Entry Initial Entry (Puncture) Of Ant.Cap Egress Of Liquified Cortex High IntraLenticular Pressure Radial Tear Radial Tear ( ARGENTINA FLAG ) ( ARGENTINA FLAG )

5. METHOD If Rhexis is going radial,what to do? If Rhexis is going radial,what to do? - Immediately Stop Performing The Rhexis - Immediately Stop Performing The Rhexis - Fill The AC With High Molecular Weight - Fill The AC With High Molecular Weight Viscoelastics Viscoelastics - Make Sure Nothing Is Pressing On The - Make Sure Nothing Is Pressing On The Globe (Finger,Lid Speculum,Pt Squeezing Globe (Finger,Lid Speculum,Pt Squeezing Lids) Lids)

6. METHOD Managing The Torn Rhexis Small cut by Vannas Scissor In the Periphreal Upper Part of the Torn Rhexis Use of Utrata Forcep to complete a Superior semi circle of the Modified Rhexis Nick in the Peripheral Lower Part of the Torn Rhexis Use of Utrata Forcep to complete the Inferior semi circle Rhexis Forcep completing the Inferior Modified Rhexis “Modified Rhexis” Superior and Inferior Semi Circles

7. METHOD Management Phaco Chopping – Most Appropriate SupraCapsular Phacoemulsification (Avoid Stressful Cracking) Low Bottle Ht/Low Flow Rate/Low Vacuum Phaco Fortunately These Cataracts Are Not Too Hard To Crack IOL Implantation In The Bag, Taking Care Not To Enlarge The Existing Tear & Placing The Haptics Perpendicular To It

8. METHOD Steps To Avoid Argentina’s Flag Puncture And Aspirate The Liquified Cortex And Decrease The Intralenticular Pressure Puncture And Aspirate The Liquified Cortex And Decrease The Intralenticular Pressure Use Liberal HPMC Or High Mol.Wt. Viscoelastics (Ofcourse Better) Use Liberal HPMC Or High Mol.Wt. Viscoelastics (Ofcourse Better) Aim For A Small Rhexis Aim For A Small Rhexis

9. RESULT By applying modified techniques By applying modified techniques - Modified Capsulorhexis - Modified Capsulorhexis - Phaco Chop(Avoid Stressful Cracking) - Phaco Chop(Avoid Stressful Cracking) SupraCapsular Phacoemulsification SupraCapsular Phacoemulsification - Lower Phaco Parameters - Lower Phaco Parameters one can manage these Intumescent Mature Cataracts with Run-out Capsulorhexis and do successful phacoemulsification one can manage these Intumescent Mature Cataracts with Run-out Capsulorhexis and do successful phacoemulsification

10. CONCLUSION Thorough Pre-Surgical Evaluation Is A Must In These Types Of Cataracts Thorough Pre-Surgical Evaluation Is A Must In These Types Of Cataracts Careful Surgical Planning Careful Surgical Planning Skillful & Dilligent Surgical Technique Skillful & Dilligent Surgical Technique + GOOD FORTUNE GOOD FORTUNE Prevents Argentinean Flag Formation