About Video

This video describes during the injection of a foldable IOL it may happen that the leading haptic turns upside-down, resulting in problems to get the IOL correctly into the capsular bag. This requires careful manipulation with Simcoe cannula to get it into the right position. This is ok with biconvex IOLs without an optic/haptic angulation. For upside-down IOLs with optic/haptic angulation, a repositioning would be necessary to achieve the correct refraction. In Coloboma patients, phaco is challenging and should be done only by experienced surgeons. The surgeon prefer to start with a sector iridectomy to create more space for phaco procedure. After staining the capsule with Trypan Blue, a CCC is carefully performed. An initial opening with a cystotome before using the forceps may be easier. All following steps need to be done very carefully and only low phaco power should be applied. The next three surgeries deal with posterior polar cataract. This type of cataract needs very special care, because there may be a pre-existing hole in the capsular bag. After CCC, the hydrodissection needs to be done very carefully, and the surgeon should observe how the fluid wave moves around the posterior capsule. This will indicate whether there is a pre-existing hole or not. Then follows a thorough hydrodelineation until the Golden Ring appears. To avoid pressure on the nucleus during surgery, which may lead to nucleus drop into the vitreous, the whole phaco procedure should be done with little phaco power under reduced bottle height. Also avoid any pressure in further procedures unless you are sure that there is NO pre-existing hole in the posterior capsule. In posterior polar cataract, most phaco surgeons recommend only hydredelineation. During the next surgery, the nucleus dropped into the vitreous and could not be rescued. The vitreoretinal surgeon took over. He first removed the cortex with a vitreous cutter. Then he caught the nucleus with the cutter and lifted it up into the anterior chamber. Finally, the nucleus was extracted with the ‘Fish-hook’. At the end, a 6-mm optic PMMA IOL was inserted into the sulcus. As the other eye of the patient had a typical posterior polar cataract, we assume that this was the main reason for the dropped nucleus.