Central cortical cleanup and zonular deficiency

Central cortical cleanup and zonular deficiency

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Ahmad M Mansour,1,2 Rafic S Antonios,1 Iqbal Ike K Ahmed3 1Department of Ophthalmology, American University of Beirut, Beirut, Lebanon; 2Department of Ophthalmology, Rafic Hariri University Hospital, Beirut, Lebanon; 3Department of Ophthalmology, University of Toronto, Toronto, ON, Canada Background: tommy todd ointment Complete removal of the cortex has been advocated to prevent posterior capsular opacification but carries the risk of zonular dehiscence, hence there is a need for a safe maximal cortical cleanup technique in eyes with severe diffuse zonulopathy in subjects above age 90.Methods: We used bimanual central cortical cleaning by elevating central fibers and aspirating them toward the periphery.Peripheral cortical fibers were removed passively only when they became loose due to copious irrigation.

A one-piece foldable implant was inserted without a capsular tension ring.Postoperative corticosteroid drops were used.Results: This technique was safely performed in a dozen eyes with severe pseudo-exfoliation or brunescent cataract with weak zonules.

Posterior capsular rupture, iritis, vitreous loss, and lens subluxation were not observed.Moderate capsular phimosis occurred but with maintained central vision.Conclusion: The dogma of “complete cortical cleanup” in severe zonulopathy needs to be revisited in favor of a clear visual axis with maximal preservation of the damaged zonules.

This technique tg02-0325m is ideal in patients above age 90 where posterior capsular opacification and late dislocation of intraocular lens–capsule bag complex are unlikely to occur until several years postoperatively.Keywords: brunescent cataract, cortex aspiration, phacoemulsification, pseudo-exfoliation, weak zonules.