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Central cortical cleanup and zonular deficiency

BACKGROUND: 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...

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Autores principales: Mansour, Ahmad M, Antonios, Rafic S, Ahmed, Iqbal Ike K
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5063496/
https://www.ncbi.nlm.nih.gov/pubmed/27784979
http://dx.doi.org/10.2147/OPTH.S116314
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author Mansour, Ahmad M
Antonios, Rafic S
Ahmed, Iqbal Ike K
author_facet Mansour, Ahmad M
Antonios, Rafic S
Ahmed, Iqbal Ike K
author_sort Mansour, Ahmad M
collection PubMed
description BACKGROUND: 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 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.
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spelling pubmed-50634962016-10-26 Central cortical cleanup and zonular deficiency Mansour, Ahmad M Antonios, Rafic S Ahmed, Iqbal Ike K Clin Ophthalmol Expert Opinion BACKGROUND: 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 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. Dove Medical Press 2016-10-04 /pmc/articles/PMC5063496/ /pubmed/27784979 http://dx.doi.org/10.2147/OPTH.S116314 Text en © 2016 Mansour et al. This work is published and licensed by Dove Medical Press Limited The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
spellingShingle Expert Opinion
Mansour, Ahmad M
Antonios, Rafic S
Ahmed, Iqbal Ike K
Central cortical cleanup and zonular deficiency
title Central cortical cleanup and zonular deficiency
title_full Central cortical cleanup and zonular deficiency
title_fullStr Central cortical cleanup and zonular deficiency
title_full_unstemmed Central cortical cleanup and zonular deficiency
title_short Central cortical cleanup and zonular deficiency
title_sort central cortical cleanup and zonular deficiency
topic Expert Opinion
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5063496/
https://www.ncbi.nlm.nih.gov/pubmed/27784979
http://dx.doi.org/10.2147/OPTH.S116314
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