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Capsulotomy CCC

Capsulotomy CCC. K.Nasrolahi MD 1387. Anterior capulotomy . Can – opener capsulotomy: is performed by making a series of small connected tears in a circle to remove the central segment of anterior lens capsule .

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Capsulotomy CCC

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  1. Capsulotomy CCC K.Nasrolahi MD 1387

  2. Anterior capulotomy Can – opener capsulotomy: is performed by making a series of small connected tears in a circle to remove the central segment of anterior lens capsule

  3. This method permits easy access to and subluxation of the lens nucleus , but it usually result in radial tears in the anterior capsule extending from one or more of the initial puncture sites out to the periphery of the capsule

  4. The radial tears can enlarge during hydrodissection or nucleus manipulatin , and they can affect IOL placement and stabilization

  5. Placement of both IOL haptics in the bag may be difficult , and unequal postoperative contractile forces within the capsular bag may cause IOL dislocation

  6. b) Continuous – tear circular capsulorrhexis provides a more stable smooth edge to the anterior capsular opening

  7. The surgeon begins an anterior capsulorrhexis with a central linear cut in the anterior capsule , using a cystotome needle

  8. At the end of the linear cut, the needle is either pushed or pulled in the direction of the desired tear . Allowing the anterior capsule to fold over upon itself

  9. The surgeon then engages the free edge of the anterior capsule with either forceps or the capsulotomy needle and the flap is carried around in a circular manner as the surgeon directs the tension toward the center of the lens

  10. For maximum control , frequent regrasping of the flap near the tear is helpful

  11. Radial extension of the capsulotomy may occur in the setting of forward displacement of the lens with shallowing of the anterior chamber or anterior traction on the capsular flap

  12. If the capsulorrhexis tear starts to extend too far peripherally , the flap can sometimes be salvaged and the tear brought more centrally

  13. First the surgeon should check for positive vitrous pressure associated with forward displacement of the lens . This may be caused by the capsulotomy instrument , the surgeons fingers , or the lid speculum pressing against the globe It can be corrected .

  14. Refilling the anterior chamber with viscoelastic , and inserting a second instrument ( such as an iris spatula ) through the paracentesis to press posteriorly on the lens may help reduce forward displacement of the lens and allow for redirection of the capsular tear .

  15. Purpose and advantages of capsulorrhexis 1) No tags or flaps anterior capsular remnants interfere with surgery , especially the aspiration of the peripheral cortex

  16. 2) The mechanical forces exerted onto the zonules were minimal with this technique .

  17. 3)The capsular bag is wide open during surgery especially with a closed system approach ;the posterior capsule is ballooned posteriorly .

  18. This gives the surgeon ample space to work in far away from the cornea and with greatly reduced risk of catching the posterior capsule as compared with when it is flaccid .

  19. 4)With an intact capsulorrhexis , manipulations within the capsualr bag such as tilting or cracking the nucleus or implanting an IOL , no longer entail the risk of extending radial teras in the anterior capsulse into the posterior capsule .

  20. 5)Even in the case of a posterior capsule defect , regaedless of its size an intact anterior capsulorrhexis provide the possibility of implanting an IOL safely into the ciliary sulcus

  21. Complication and pitfalls

  22. 1) Discontinuity of the anterior capsular rim . 2) Capsulorhexis with too small a diameter . 3) Viscoelastic incarcerations .

  23. Discontinuity of the anterior capsular rim To avoid this complication the capsulorhexis should never be completed inside out. Stellate bursts originating from initial puncturing attempts with a blunt needle may desroy an intact capsular margin . In the course of surgery to form a discontinuity. The only effective remedy to repair discontinuity by transformation of the tear in to smooth edge.

  24. Discontinuity of the anterior capsular rim

  25. Capsulorhexis with too small a diameter • - In performing the capsulorhexis , the surgen may realize that the original arc is too small • _ The capsulorhexis can be expanded by spiralling outward to the desired diameter and then “closing the circle “

  26. Viscoelastic incarcerations _ If the anterior capsular rim adheres to the anterior IOL surface after implantation , viscoelastics residues may trapped behind the lens. _ If it does , mostly the lense blocks the passage for the viscoelastics in to the anterior chamber and at the same time allows the aqueous to invade the area behind the implant.

  27. Thus pushing the IOL in to the cornea . _ in such a situation an additional puncture of the peripheral anterior or in narrow pupils – posterior capsule is required to provide for a release of the viscoelastics in to the anterior chamber or the vitreous.

  28. Difficult cases Small pupil: 1) Removal of the pupillary membrane 2) Removal of synechiae 3) Bimanual stretching 4) Iris retractors 5)Pupil dilator

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