Skip to main content
SpringerLink
Log in

Phacoemulsification in Complex Cases

  • Living reference work entry
  • First Online:
Albert and Jakobiec's Principles and Practice of Ophthalmology

  • 33 Accesses

Abstract

Cataract surgery is the most commonly performed ophthalmic surgical operation. Most ophthalmologists learn and use a standardized surgical approach, and truth be told, for the majority of cataract cases, this technique will be sufficient. However, it is a known fact that each eye can present unique challenges, and skilled surgeons will have various techniques in their repertoire that allow them to navigate such obstacles. Additionally, there is a subset of complex cataracts that present a particularly challenging surgical environment. These cases need to be approached with careful planning and consideration in order to ensure optimal surgical outcomes. This chapter reviews key techniques required to address the white cataract, zonular instability, and the particularly challenging, short nanophthalmic eye. It also discusses approaches to floppy iris syndrome and other congenital or trauma-induced iris issues.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. Chang DF, Campbell JR. Intraoperative floppy iris syndrome associated with tamsulosin. J Cataract Refract Surg. 2005;31:664–73.

    Article  PubMed  Google Scholar 

  2. Chang DF, et al. ASCRS White Paper: clinical review of intraoperative floppy-iris syndrome. J Cataract Refract Surg. 2008;34(12):2153–62.

    Article  PubMed  Google Scholar 

  3. Enright JM, Karacal H, Tsai LM. Floppy iris syndrome and cataract surgery. Curr Opin Ophthalmol. 2017;28(1):29–34.

    Article  PubMed  Google Scholar 

  4. Arshinoff SA. Modified SST–USST for tamsulosin-associated intraocular floppy-iris syndrome. J Cataract Refract Surg. 2006;32(4):559–61.

    Article  PubMed  Google Scholar 

  5. Chang DF. Use of Malyugin pupil expansion device for intraoperative floppy-iris syndrome: results in 30 consecutive cases. J Cataract Refract Surg. 2008;34(5):835–41.

    Article  PubMed  Google Scholar 

  6. Takmaz T, Can I. Clinical features, complications, and incidence of intraoperative floppy iris syndrome in patients taking tamsulosin. Eur J Ophthalmol. 2007;17(6):909–13.

    Article  CAS  PubMed  Google Scholar 

  7. Lockington D, Gavin MP. Intraoperative floppy-iris syndrome: role of the bimanual approach. J Cataract Refract Surg. 2009;35(6):964.

    Article  PubMed  Google Scholar 

  8. Agarwal A, Kumar DA, Nair V. Cataract surgery in the setting of trauma. Curr Opin Ophthalmol. 2010;21(1):65–70.

    Article  PubMed  Google Scholar 

  9. Charters L. ‘Telling it like it is’ lives up to name: open forum: second annual meeting provides cataract surgeons with advice, experience of world experts. Ophthalmology Times, 1 April 2012, p. 26+

    Google Scholar 

  10. Arbisser LB, et al. Management of vitreous loss and dropped nucleus during cataract surgery. Ophthalmol Clin N Am. 2006;19(4):495–506.

    Google Scholar 

  11. Apple DJ, et al. Irreversible silicone oil adhesion to silicone intraocular lenses: a clinicopathologic analysis. Ophthalmology. 1996;103(10):1555–62.

    Article  CAS  PubMed  Google Scholar 

  12. Allingham RR, Liu Y, Rhee DJ. The genetics of primary open-angle glaucoma: a review. Exp Eye Res. 2009;88:837–44.

    Article  CAS  PubMed  Google Scholar 

  13. Stein JD, Pasquale LR, Talwar N, et al. Geographic and climatic factors associated with exfoliation syndrome. Arch Ophthalmol. 2011;129(8):1053–60.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Pasquale LR, Jiwani AZ, Zehavi-Dorin T, et al. Solar exposure and residential geographic history in relation to exfoliation syndrome in the United States and Israel. JAMA Ophthalmol. 2014;132(12):1439–45.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ritch R. Exfoliation-the most common identifiable cause of open-angle glaucoma. J Glaucoma. 1994;3:176–8.

    CAS  PubMed  Google Scholar 

  16. Jehan FS, Mamalis N, Crandall AS. Spontaneous late dislocation of intraocular lens within the capsular bag in pseudoexfoliation patients. Ophthalmology. 2001;108:1727–31.

    Article  CAS  PubMed  Google Scholar 

  17. Crandall AS. Pseudoexfoliation syndrome and cataract surgery. Adv Ophthalmol Optomet. 2016;1(1):31–44.

    Article  Google Scholar 

  18. Jacob S, Agarwal A, et al. Trypan blue as an adjunct for safe phacoemulsification in eyes with white cataract. J Cataract Refract Surg. 2002;28:1819–25.

    Article  PubMed  Google Scholar 

  19. Gimbel HV, Willerscheidt AB. What to do with limited view: the intumescent cataract. J Cataract Refract Surg. 1993;19:657–61.

    Article  CAS  PubMed  Google Scholar 

  20. Vajpayee RB, Angra SK, et al. Capsulotomy for phacoemulsification in hypermature cataracts. J Cataract Refract Surg. 1999;25:1157–60.

    Article  CAS  PubMed  Google Scholar 

  21. Chakrabarti A, Singh S, Krishnadas R. Phacoemulsification in eyes with white cataract. J Cataract Refract Surg. 2000;26:1041–7.

    Article  CAS  PubMed  Google Scholar 

  22. Figueiredo CG, Figueiredo J, Figueiredo GB. Brazilian technique for prevention of the Argentinean flag sign in white cataract. J Cataract Refract Surg. 2012;38:1531–6.

    Article  PubMed  Google Scholar 

  23. Hausmann N, Richard G. Investigations on diathermy for anterior capsulotomy. Invest Ophthalmol Vis Sci. 1991;32:2155–9.

    CAS  PubMed  Google Scholar 

  24. Fritz WL. Fluorescein blue, light-assisted capsulorhexis for mature or hypermature cataract. J Cataract Refract Surg. 1998;24:19–20.

    Article  CAS  PubMed  Google Scholar 

  25. Michalos P, Avila EN. “Capsulocopsis”: a new surgical instrument and method for capsulotomies. Ophthalmic Surg Lasers. 1996;27:476–8.

    Article  CAS  PubMed  Google Scholar 

  26. Brierley L. Vacuum capsulorhexis. J Cataract Refract Surg. 1995;21:13–5.

    Article  CAS  PubMed  Google Scholar 

  27. Melles GRJ, de Waard PWT, Pameyer JH, Beekhuis WH. Trypan blue capsule staining to visualize the capsulorhexis in cataract surgery. J Cataract Refract Surg. 1999;25:7–9.

    Article  CAS  PubMed  Google Scholar 

  28. Pagon RA. Ocular coloboma. Surv Ophthalmol. 1981;25:223–36.

    Article  CAS  PubMed  Google Scholar 

  29. Nordlund ML, Sugar A, Moroi SE. Phacoemulsification and intraocular lens placement in eyes with cataract and congenital coloboma: visual acuity and complications. J Cataract Refract Surg. 2000;26:1035–40.

    Article  CAS  PubMed  Google Scholar 

  30. Watt RH. Inferior congenital iris coloboma and IOL implantation [letter]. J Cataract Refract Surg. 1993;19:669–71.

    Article  CAS  PubMed  Google Scholar 

  31. Mizuno H, Yamada J, Nishiura M, et al. Capsular tension ring use in a patient with congenital coloboma of the lens. J Cataract Refract Surg. 2004;30:503–6.

    Article  PubMed  Google Scholar 

  32. Cionni RJ, Karatza EC, Osher RH, et al. Surgical technique for congenital iris coloboma repair. J Cataract Refract Surg. 2006;32:1913–6.

    Article  PubMed  Google Scholar 

  33. Siepser SB. The closed chamber slipping suture technique for iris repair. Ann Ophthalmol. 1994;26(3):71–2.

    CAS  PubMed  Google Scholar 

  34. Stewart DH 3rd, Streeten BW, Brockhurst RJ, et al. Abnormal scleral collagen in nanophthalmos. An ultrastructural study. Arch Ophthalmol. 1991;109:1017–25.

    Article  PubMed  Google Scholar 

  35. Relhan N, Jalali S, Pehre N, et al. High-hyperopia database. Part I: Clinical characterization including morphometric (biometric) differentiation of posterior microphthalmos from nanophthalmos. Eye (Lond). 302016:120–6.

    Google Scholar 

  36. Steijns D, Bijlsma WR, Van der Lelij A. Cataract surgery in patients with nanophthalmos. Ophthalmology. 2013;120(2):266–70.

    Article  PubMed  Google Scholar 

  37. Day AC, Foster PJ, Stevens JD. Accuracy of intraocular lens power calculations in eyes with axial length <22.0 mm. Clin Exp Ophthalmol. 2012;40(9):855–62.

    Article  PubMed  Google Scholar 

  38. Rajendrababu S, Babu N, Sinha S, et al. A randomized controlled trial comparing outcomes of cataract surgery in nanophthalmos with and without prophylactic sclerostomy. Am J Ophthalmol. 2017;183:125–33.

    Article  PubMed  Google Scholar 

  39. Chang DF. Pars plana vitreous tap for phacoemulsification in the crowded eye. J Cataract Refract Surg. 2001;27(12):1911–4.

    Article  CAS  PubMed  Google Scholar 

  40. Kumar S, Miller D, Atabara NA, et al. A quantitative animal model of traumatic iridodialysis. Acta Ophthalmol. 1990;68(5):591–6.

    Article  CAS  Google Scholar 

  41. Lian RR, Siepser SB, Afshan NA. Iris reconstruction suturing techniques. Curr Opin Ophthalmol. 2020;31:43–9.

    Article  PubMed  Google Scholar 

  42. Snyder M, Lindsell L. Nonappositional repair of iridodialysis. J Cataract Refract Surg. 2011;37(4):625–8.

    Article  PubMed  Google Scholar 

  43. Horlock N, Vögelin E, Bradbury ET, et al. Psychosocialoutcome of patients after ear reconstruction: a retrospective study of 62 patients. Ann Plast Surg. 2005;54:517–24.

    Article  CAS  PubMed  Google Scholar 

  44. Arndt EM, Travis F, Lefebvre A, et al. Beauty and the eye of the beholder: social consequences and personal adjustments for facial patients. Br J Plast Surg. 1986;39:81–4.

    Article  CAS  PubMed  Google Scholar 

  45. Bardak Y, Ozerturk Y, Durmus M, et al. Closed chamber iridodialysis repair using a needle with a distal hole. J Cataract Refract Surg. 2000;26(2):173–6.

    Article  CAS  PubMed  Google Scholar 

  46. Vera V, Naqi A, Belovay G, et al. Dysphotopsia after temporal versus superior laser peripheral iridotomy: a prospective randomized paired eye trial. Am J Ophthalmol. 2014;157(5):929–35.

    Article  PubMed  Google Scholar 

  47. Okamoto Y, Yamada S, Akimoto M. Suturing repair of subtotal iridodialysis. Int Ophthalmol. 2018;38(1):395–8.

    PubMed  Google Scholar 

  48. Yousif MO. Single suture customized loop for large iridodialysis repair. Clin Ophthalmol. 2016;10:1883–90.

    Article  CAS  Google Scholar 

  49. Nunziata BR. Repair of iridodialysis using a 17-millimeter straight needle. Ophthalmic Surg Lasers. 1993;24:476–80.

    Article  Google Scholar 

  50. Wachler BB, Krueger RR. Double-armed McCannell suture for repair of traumatic iridodialysis. Am J Ophthalmol. 1996;122:109–10.

    Article  CAS  PubMed  Google Scholar 

  51. Agarwal T, Singh D, Panda A. Guide needle-assisted iridodialysis repair. J Cataract Refract Surg. 2011;37(10):1918.

    Article  PubMed  Google Scholar 

  52. Özdek S, Özmer M. A simple surgical technique for repair of iridodialysis. Turk J Med Sci. 2009;39(2):317–9.

    Google Scholar 

  53. Frisina R, Parrozzani R, Tozzi L, et al. Pupil cerclage technique for treatment of traumatic mydriasis. Eur J Ophthalmol. 2020;30(3):480–6.

    Article  PubMed  Google Scholar 

  54. Narang P, Agarwal A. Single-pass four-throw technique for pupilloplasty. Eur J Ophthalmol. 2017;27:506–8.

    Article  PubMed  Google Scholar 

  55. Ogawa GSH. The iris cerclage suture for permanent mydriasis: a running suture technique. Ophthalmic Surg Lasers. 1998;29(12):1001–9.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. CHU de Québec, Université Laval, Québec, QC, Canada

    Jeb Ong

  2. Sutter Santa Rosa Regional Hospital, Santa Rosa, CA, USA

    Arwa Alsamarae

  3. The University of Utah, Salt Lake City, UT, USA

    Arwa Alsamarae

  4. John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA

    Alan S. Crandall

  5. Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, ON, Canada

    Ike Ahmed

  6. Prism Eye Institute, Oakville, ON, Canada

    Ike Ahmed

Authors
  1. Jeb Ong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Arwa Alsamarae
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alan S. Crandall
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ike Ahmed
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Ophthalmology, Oregon Health & Science University Department of Ophthalmology, Portland, OR, USA

    Daniel Albert

  2. Massachusetts Eye and Ear, Boston, MA, USA

    Joan Miller

  3. Department of Ophthalmology, University of Illinois at Chicago Department of Ophthalmology, Chicago, IL, USA

    Dimitri Azar

  4. Department of Ophthalmology, Harvard Medical School, Boston, MA, USA

    Lucy H. Young

Section Editor information

  1. Department of Ophthalmology, University of Illinois at Chicago, Chicago, IL, USA

    Dimitri T. Azar

  2. Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA

    Douglas Koch

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Ong, J., Alsamarae, A., Crandall, A.S., Ahmed, I. (2021). Phacoemulsification in Complex Cases. In: Albert, D., Miller, J., Azar, D., Young, L.H. (eds) Albert and Jakobiec's Principles and Practice of Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-319-90495-5_195-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-90495-5_195-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-90495-5

  • Online ISBN: 978-3-319-90495-5

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation