From the Guidelines
Zonular dehiscence during cataract surgery requires immediate stabilization of the capsular bag using capsular tension rings (CTRs) or capsular hooks to prevent further complications and ensure the best possible outcome for the patient. This complication can occur due to various risk factors such as pseudoexfoliation syndrome, trauma history, or Marfan syndrome, as identified in the clinical objectives of cataract surgery 1. Management of zonular dehiscence involves early recognition of these risk factors and prompt action to stabilize the capsular bag.
Some key considerations in managing zonular dehiscence include:
- Using dispersive viscoelastic to maintain the anterior chamber and protect the vitreous face
- Modifying surgical techniques such as gentle hydrodissection, minimal rotation of the nucleus, and careful phacoemulsification with reduced fluidics settings
- Employing modified CTR devices like Ahmed capsular tension segments for more extensive damage
- Performing prompt anterior vitrectomy if vitreous prolapse occurs, using a vitrector with cut rates of 5000-8000 cuts per minute
Postoperative care is also crucial, with patients being monitored for late complications including intraocular lens decentration, capsular phimosis, and retinal detachment, as outlined in the guidelines for cataract surgery 1. Proper management of zonular dehiscence is essential to minimize the risk of complications and ensure the best possible visual outcome for the patient.
Key aspects of postoperative care include:
- Providing appropriate visual rehabilitation
- Treating any complications that may arise, such as elevated intraocular pressure (IOP) or corneal edema
- Improving patient safety by reducing the risk of traffic accidents, falls, and fractures, as emphasized in the clinical objectives of cataract surgery 1.
From the Research
Zonular Dehiscence in Cataract Surgery
- Zonular dehiscence is a complication that can occur during cataract surgery, where the zonular fibers that support the lens break or separate 2.
- Studies have identified high-risk factors for zonular complications during cataract surgery, including poor mydriasis, shallow anterior chamber, and large lens decentration 2.
- The use of a capsular tension ring (CTR) has been shown to be effective in managing zonular dehiscence and preventing intraocular lens decentration and tilt 3, 4, 5.
Management of Zonular Dehiscence
- A CTR can be inserted before or during cataract removal to maintain or re-establish an extended capsular diaphragm 3.
- The CTR can also be used to prevent capsule damage and provide undisturbed peripheral visualization before IOL implantation 3.
- In cases of profound zonular dialysis or weakness, a CTR designed for scleral fixation can be used 3.
- The use of a CTR has been shown to reduce the incidence of posterior capsule opacification 4.
Clinical Applications
- The CTR has been used in various clinical applications, including the management of zonular dehiscence in infantile glaucoma 6.
- The CTR has also been used as a measuring gauge for in vivo quantification of capsule dimensions and postoperative capsular shrinkage 3.
- The use of a CTR can improve control during primary posterior capsulorhexis and prevent oval distortion along the lens axis postoperatively 3.