Cataract surgery zonular dialysis remains a challenge for surgeons who perform phacoemulsification and implantation of intraocular lenses as the basis for writing his article
Cataract Surgery Zonular Dialysis
Cataracts are a major cause of blindness in the world. Cataract is an aging-related vision disorder that causes vision to become cloudy and cloudy cloudy. Cataracts make you look like behind a thick dusty window. Cataract surgery is one of the safest and most frequently performed surgical procedures worldwide. Cataract surgery with zonular dialysis remains a challenge for even the most experienced surgeons. The ability to do surgery with small incisions with zonular dialysis depends on the lens density and the stability and strength of the remaining zonules. The first opportunity to diagnose zonular abnormalities is during preoperative examination. Diagnosing zonular abnormalities must include potential risk factors for zonular damage, such as trauma, previous ocular surgery, and systemic conditions such as Marfan syndrome and homocystinuria.
In the case of zonular dialysis, preoperative planning becomes more important. Patients must be made aware that surgery and postoperative care may be more complicated and prolonged. Patients should also be counseled about potential needs for vitrectomy, for dislocated lens fragments, and for a greater risk of retinal detachment and cystoid macular edema with loss of vitreous. Any improper movement of the lens capsule during the hydroduction or lens carving must be considered. If there is zonular dialysis, abundant viscosity of chondroitin sulfate (dispersive) should be used to prevent anterior vitreous prolapse. Capsular hooks and CTRs can be placed before the phacoemulsification begins to stabilize the capsule and prevent vitreous prolapse.
The development of capsular tension rings (CTR) is an important milestone in the history of cataract surgery. The capsular tension ring help’s to avoid capsular collapse and vitreous presentation during surgery and maintains a circular contour of the capsular bag. These tools help provide the capsular stability that is indispensable for safe phacoemulsification and IOL implantation in difficult cases. While conventional CTR in helping cases of zonular weakness and rupture does not provide protection in cases of progressive zonulopathy that can produce capsular abnormalities over time after surgery. In a subset of moderate to severe zonular compromises, surgeons may consider using a modified CTR. Preoperative detection of zonular weakness during biomicroscopy will help prevent intraoperative shock and facilitate phacoemulsification. The capsular tension ring can provide an alternative way to manage zonular dialysis during the phacoemulsification and implantation of the posterior space intraocular lens.
In this case, it may be safer to remove the lens through a manual extrapapsular approach to a large incision or even a planned pars plana vectectomy. When choosing a surgical approach in the presence of zonular dialysis, one must consider other eye variables. Matters considered such as pupil size, corneal endothelial health, lens density, and surgeon familiarity with capsular hooks and CTR. Intraoperative complications and use of capsular voltage rings (CTR) were identified. The start and end of the best-vision correction (BCVA) postoperatively is determined by procedure. Univariate and multivariate linear regression analysis was performed to determine the relationship with postoperative BCVA, and further subgroup analysis was carried out in groups determined by the use of CTR. The overall incidence of zonular dialysis is low. Intra-operative use of RKpT shows early and medium-term BCVA improvement and should be considered in all cases of zonular dialysis.
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