Cataract surgical problem: Reply 11
The best cataract surgical method would be phacoemulsification via a clear corneal temporal incision. This should provide the easiest access for phacoemulsification. I would use a Viscoat sandwich technique and create a 5.5 mm anterior capsulorhexis. The edge of the anterior capsule remnant should just overlap or become adjacent to the edge of the 6.0 mm Alcon SA60 IOL. If the pupil were too small to ensure this size, I would expand it with a Graether pupil expander or Grieshaber iris hooks. I would probably use a divide-and-conquer technique with a 45-degree tip.
Contrary to many other surgeons' experience, I seem to create more zonular stress when I use a chop technique. No matter which technique is used, “kinder and gentler” should be the theme, especially during the fracture steps. Advantec technology will allow efficient grooving without creating zonular pressure and provide exquisite low-amplitude quadrant aspiration. Careful, gentle removal of cortical strands is also important. By using a smaller (0.2 mm diameter) I/A tip, I can grasp a smaller clump of cortex and create less localized zonular stress. I would position the IOL without rotation.
Finally, I would try to make sure the patient used prednisolone acetate 1% 4 times a day for 2 weeks and twice a day for 2 more weeks. I might be tempted to examine the patient 2 and 4 weeks postoperatively to check for signs of excessive capsule contraction and be prepared to create radial relaxing incisions in the anterior capsule remnant with an Nd:YAG laser as early 4 weeks postoperatively.© 2002 by Lippincott Williams & Wilkins, Inc.