In this video, Dr Suresh K Pandey and Dr Vidushi Sharma from Suvi Eye Institute, Kota, India demonstrate surgical management of Capsule Conraction Syndrome. This 78-year-old man was seen for progressive decease of vision 6 months after an uneventful phacoemulsification. His ophthalmic surgical history included phacoemulsification with implantation of foldable hydrophobic acrylic IOL with PMMA haptics in the capsular bag. Slit-lamp biomicroscopy showed phimosis of anterior capsular opening with presence of capsular band- an entity decscribed as capsular contraction syndrome (CCS). Surgical removal of fibrous band/capsular peeling was attempted in topical anesthesia. Capsular contraction syndrome is defined as an exaggerated reduction in anterior capsulotomy and capsular bag diameter after phaco surgery. It frequently occurs with continuous curvilinear capsulorrhexis. It can lead to extensive reduction of capsulotomy opening, malpositioning of opening. Raraly, CCS can be associated with 360° zonular dehiscence and posterior dislocation of IOL with the bag. This causes significant visual disability and further need of posterior segment surgery, which can be associated with complications like retinal dialysis and detachment. Conditions that predispose to capsular contraction syndrome are pseudoexfoliation, advanced age, uveitis, pars planitis and myotonic muscular dystrophy. In our case the cause of CCS was due to PXF.
Awareness of this newly recognized complication may justify performing additional surgical techniques during phaco in high-risk patients. Maneuvers like anterior capsular nicks at the margins of capsulorrhexis after implantation of IOL, use of an IOL designed to provide maximal peripheral capsular bag expansion, use of capsular tension ring or Nd:YAG radial anterior relaxing capsulotomies within 4 weeks of cataract surgery reduce the effect of the fibrotic contraction process in the capsular bag. This lessens the chronic zonular traction that could cause spontaneous IOL dislocation and retinal detachment. In some cases of capsular contraction syndrome, the thickened fibrotic tissue may become so dense that radial incisions are impossible. In this instance, surgeons can use an Nd:YAG laser to release the ring of capsular tissue from around the phimotic opening. For dense CCS, surgical "peeling" of capsular band can be an appropriate options as in this case.
About Dr Suresh K Pandey- A medical graduate of Rani Durgawati University, Medical College, Jabalpur, M.P., India; Dr. Pandey completed his residency in Ophthalmology from prestigious Postgraduate Institute of Medical Education and Research, Chandigarh, India. He worked in University of Utah, USA & University of Sydney, Australia from1998 to 2006. Dr. Pandey returned to India in 2006 to establish SuVi Eye Institute and Research Center at Kota, Rajasthan, India (www.suvieye.com). Dr. Pandey has presented more than 150 scientific papers in various international ophthalmological meetings and authored more than 100 scientific papers/communications, 50 textbook chapters, and 10 ophthalmic textbooks. In 2005, Dr. Pandey was invited to demonstrate Live Surgery at international meeting at Milan, Italy. Dr. Pandey received several prestigious awards for his research & surgical innovations, which include Best-of-Show Video Award, Best Poster Award, Best-Paper-of-the-Session Award for the surgical videos, scientific posters and papers in the national and international ophthalmology congresses. Most recently, Dr. Pandey has been selected for Achievement Award by the American Academy of Ophthalmology. Dr. Pandey can be reached at Suvi Eye Institute and Research Center, C 13 Talwandi, Kota, Rajasthan, India; E-mail- suvieye@gmail.com, www.suvieye.com
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Phacoemulsification of Brunescent Catataract, Dr Vidushi Sharma, Suvi Eye Institute, India.mpgby Drsureshkpandey2,510 views
good work doc
vrijbhushan 1 year ago
wow
supastauk 1 year ago