Achieving successful capsulorhexis in intumescent white mature cataracts to prevent Argentinian flag sign - A new multifaceted approach to meet the challenge

Purpose:To present a case series of intumescent white cataract cases managed by a new surgical technique to attain a single stage Continuous Curvilinear Capsulorhexis (CCC).Methods:The series included 60 eyes of 60 patients with white cataract which underwent preoperative anterior chamber depth, lens thickness and ultrasonographic A-scan for intralenticular spikes. A partial size main port (~1.8mm) is created as the first entry into the anterior chamber (AC). A 30-gauge needle of insulin syringe entered through a limbal stab incision is used to decompress the anterior and posterior intralenticular compartments. Following which a standard size, one stage capsulorhexis was performed in a trypan blue stained capsule using microcapsulorhexis forceps entered through the partial sized trapezoidal main port. The main port was secondarily enlarged for phacoemulsification.Results:Based on the intraoperative findings, 43 eyes were categorized as Intumescent type-1 cataracts i.e., with presence of actual liquefied cortex aspirated using 30-gauge needle and 17 eyes as Intumescent type-2 cataracts, i.e., presence of swollen lens without any obvious liquefied cortex. Standard size, circular and centred CCC was achieved in 100% of the cases and no Argentinean flag sign was noted. Surgeon perceived raised intralenticular pressure in 41% of the cases in type-1 subset and 61% cases in type-2 subset (P-0.06). Posterior capsular plaque was observed in 22% of the cases, adherent cortex in 25% and anterior capsular plaque in 5% of the cases. At 6weeks follow up 92% patients had best corrected visual acuity of 20/40 or better.Conclusion:A multi-layered approach can help in attaining successful CCC in cases of white mature cataract with high intralenticular pressure.     

Cortical and subcapsular cataracts: significance of physical forces

Cortical cataracts usually begin with either sharp limited clear fluid clefts, resulting in opaque spokes, or clear lamellar separations, resulting in cuneiform opacities. They do not commence prior to 45 years of age. From this age on an increase in lens nuclei hardening can be detected. Therefore, during disaccommodation in older lenses, mechanical shear stresses must develop between the soft remaining cortices and the harder nuclei. These shear stresses are significant regarding the different cortical ruptures in predisposed lenses: in a privileged radial direction (according to zonular traction) of the sharp limited cortical spokes, or in parallel microridges at the commencement of lamellar separations, as observed when a rubber surface slides against a harder object. In pure cortical cataracts the ion pump (K+ > Na+) and investigated metabolic parameters remain largely intact. Therefore, it is not surprising that, in contrast to subcapsular cataracts, subcapsular opacities do not occur. Subcapsular cataracts are known to be caused by a variety of factors: aging, diabetes, corticosteroids, iridocyclitis, or X-ray, among many others. In contrast to cortical cataracts, subcapsular cataracts were found to be closely associated with ion pump damage (Na+ > K+) and a variety of metabolic activity alterations. In subcapsular cataracts passive fluids (from the vitreous and camera anterior) enter externally through the lens capsule. This initially forms numerous free clear, secondary grey, subcapsular fluid vacuoles. If the ion pump (metabolic barrier) is more severely damaged fluids may also enter the lens nucleus (secondary grey nuclear cataract), which rarely results in intumescent cataract. In cortical and subcapsular cataracts and lens perforations the main cause of grey opalescence appears to be the result of lens proteins (water-soluble crystalline) coming into direct contact with free fluids (water). In cortical cataracts this happens in the area of sharp limited mechanical cortical ruptures (fluid clefts), and in subcapsular cataracts during passive, external fluid entry, resulting in subcapsular fluid vacuoles and opacities, and also later grey-white nuclear opacities. The importance of water contact with water-soluble lens crystallines in behalf of light scattering and turbidness also has been investigated experimentally.     

Role of Scheimpflug imaging for assessment of posterior lens capsule in pediatric traumatic cataract

Purpose:To find the accuracy of Scheimpflug imaging for the evaluation of posterior lens capsule and to assess the incidence of pre-existing posterior capsular tear (PCT) in pediatric traumatic cataracts.Methods:It was a prospective, non-randomized, and interventional study. Scheimpflug imaging was done preoperatively to detect pre-existing PCT in pediatric traumatic cataracts after blunt trauma. All patients underwent cataract extraction with intraocular lens implantation. Intraoperatively, the posterior capsule status was noted and compared with the preoperative Scheimpflug images.Results:Forty-seven eyes of 47 children having traumatic cataracts following closed-globe injury were included. There were 32 males and 15 females with a mean age of 10.91 ± 2.75 years. The mean duration of performing the Scheimpflug imaging from injury was 41.7 ± 7.78 days. Preoperative Scheimpflug imaging showed intact posterior lens capsule in 36 eyes and PCT in 11 eyes. Intraoperative, 37 eyes had an intact posterior lens capsule and 10 eyes had PCT. The Scheimpflug imaging did not detect the PCT in three eyes (false-negative), and in four eyes, PCT was detected falsely on Scheimpflug imaging (false-positive). The sensitivity and specificity of the Scheimpflug imaging were 70 and 89.18%, respectively. The accuracy of the technique was 85.11%.Conclusion:Scheimpflug imaging is a useful modality for the detection of PCT preoperatively in cases with doubtful posterior lens capsule integrity.     

Cataract in childhood: photograph methods in assessment.

The slit-lamp examination of the child's lens with cataract can yield useful prognostic signs, especially when this is supplemented by slit-image photography and measurement. A normal lens size for the subject's age is a good prognostic sign and is usually associated with a static cataract or with very slow deterioration in a developmental cataract. A small lens and absence of the anterior subcapsular clear zone are each associated with progressive cataract. Nuclear lamellar cataracts are shown to become smaller in diameter with time, which favours medical treatment with mydriasis.     

Results of cataract surgery in renal transplantation patients

PURPOSE: To evaluate the results of conventional extracapsular cataract extraction and phacoemulsification cataract surgery, in renal transplant patients. METHODS: A total of 11 eyes of eight renal transplant recipients who underwent cataract surgery in Ankara between 1995 and January 2001 were evaluated. Each individual underwent routine ophthalmologic examination including visual acuity with Snellen chart testing, slit-lamp examination, intraocular pressure measurement, and fundus examination. Of these, seven patients had posterior subcapsular cataracts and four had nuclear cataracts. Conventional extracapsular cataract extraction (cECCE) was performed in four eyes with single-piece all-polymethylmethacrylate posterior chamber intraocular lens implantation. The other seven eyes were treated with small-incision phacoemulsification and implantation of a foldable hydrophilic acrylic lens. RESULTS: We observed intraoperative posterior capsule rupture and vitreous loss in one patient, postoperative intraocular tension elevation in one patient, and sterile suture infiltration in one patient in our series. Average of the visual acuities 6 months after the operation was 20/30 (range, 20/60-20/20). CONCLUSIONS: In this, the first published report to describe outcomes of cataract surgery in renal transplant patients, most complications were associated with high of steroids use and immunosuppressives, and were independent of the type of cataract surgery used, either ECCE or phacoemulsification surgery. The study suggests the need for additional care before, during, and after operation.     

Intralenticular implant study in pigmented rabbits: Opacity lensmeter assessment

Purpose:To quantitatively analyze the clarity of regenerated lens material afterendocapsular lens extraction and restoration of the lens capsular bag with and without implantation of an intralenticular disc lens.Setting:Shepherd Research Center, Allergan, Irvine, California, USA.Method:The clarity of regenerated lens material was evaluated by Interzeag OpacityLensmeter 701 (OLM) recordings after endocapsular lens extraction in New Zealand/Dutch Belt pigmented rabbits with (n = 21) and without (n = 16) placement of a disc-shaped intralenticular implant in the capsular bag. Postoperative objective measurements were performed at 1, 2, and 3 weeks and 1, 2, 3, and 6 months. Comparisons were made between young and adult rabbits.Results:Mean OLM results were similar in both groups at weeks 1, 2, 3, and 4. After 1 month,, progressive central compaction of early irregular regenerated lens fibers was associated with increased OLM readings that were higher in the intralenticular implant group than in the control group. Regenerated lens opacification was greater in tissue posterior to the intralenticular lens than in that anterior to the disc lens.Conclusion:Insertion of an intralenticular disc lens into the lens capsule bag was associated with poor optical clarity primarily of the posterior regenerated lens tissue. The OLM was useful in assessing the degree of opacification of the regenerated lenses.     

Analysis of postoperative visual and surgical outcome following surgery for absorbed cataract in pediatric age group and the intraoperative difficulties

Purpose:To analyze the postoperative visual and surgical outcomes following surgery for pediatric-absorbed cataracts and intraoperative difficulties.Methods:This prospective longitudinal study included 43 eyes (30 children) with absorbed cataracts aged between 6 months and 18 years (either sex). All children underwent best-corrected visual acuity (BCVA), anterior and posterior segment evaluation, rubella titer estimation, intraocular lens (IOL) power calculation, superior small incision cataract surgery with or without posterior capsulotomy/anterior vitrectomy/IOL implantation under general anesthesia, visual rehabilitation, and were followed up for 1 year.Results:The mean age was 7.89 ± 4.84 years. Preoperative BCVA distance: 39 eyes had either perception of light (PL) or counting finger close to face (CFCF); near BCVA: all eyes had either PL or N36. Postoperative (12 months) distant BCVA: a majority of the eyes (27) had 6/60–1/60, 11 eyes had 6/18–6/36; near: N18 in 19 eyes, N6 in 7 eyes. Anterior continuous curvilinear capsulorrhexis (ACCC) was possible in eight eyes. Cortical aspiration was difficult in 16 eyes (peripheral calcified ring). A majority (32 eyes) underwent in the sulcus implantation (in-the-bag: eight eyes); two eyes: no IOL, one eye: secondary IOL. Eleven eyes had early postoperative inflammation. At 12 months, one eye underwent membranectomy for visual axis opacification and 38 eyes had well-centered IOLs.Conclusion:Surgery in absorbed cataracts is challenging because of the anatomic disorganization of the absorbed lens. By adopting appropriate surgical methods and good visual rehabilitation, one can achieve satisfactory surgical and visual outcomes, highlighting the need for surgical intervention.     

Vitrector-assisted anterior capsulorhexis in adult intumescent cataract

Performing capsulorhexis in white intumescent cataracts during phacoemulsification surgery is challenging for cataract surgeons because of high intralenticular pressure and reduced red reflex. Capsulorhexis extension to the periphery of the lens is a common occurrence due to lens intumescence. We used a vitrectomy cutter to create an initial tear in the anterior capsule and simultaneously remove a part of milky fluid coming out of the intumescent lens. Once the lens was decompressed, capsulorhexis was completed using capsulorhexis forceps. This technique helped in controlling capsulorhexis in eyes with intumescent cataracts by reducing the intralenticular pressure and thereby preventing unexpected radial capsular tear.     

Optical coherence tomography of macularthickness after cataract surgery

Purpose:To evaluate macular thickness changes after uneventful cataract surgery using optical coherence tomography (OCT) and compare the findings with those of flare and cell measurements of the anterior chamber.Setting:Clinique Sourdille, Nantes, France.Methods:In this retrospective study, 41 eyes having uneventful cataract surgery witha clear corneal small incision and intracapsular fixation of a foldable intraocular lens were evaluated by OCT and laser flare and cell measurements preoperatively and 1, 8 to 12, and 30 to 60 days postoperatively.Results:Some postoperative increase in macular thickness was noted in 11 eyes.This was not related to a higher postoperative flare. Visual consequences were proportional to the macular elevation.Conclusion:Clinical and subdinical thickness changes, without breakdown of theblood-aqueous barrier, can be detected after cataract surgery. Most of these changes resolve spontaneously, but their mid- and long-term significance is unknown.     

Prefoveolar Membrane in Macular Hole Opercula Formation

Purpose To better understand the process of macular hole opercula formation by both optical coherence tomography and intraoperative observations.Methods Seventy-nine eyes of 71 consecutive patients with stages 1 to 3 idiopathic macular holes were studied using optical coherence tomography (OCT). In eyes with stage 1 or 2 holes undergoing vitrectomy, meticulous observation of the posterior hyaloid and the macular hole was carried out before and after peeling of the posterior hyaloid.Results In 6 of 12 eyes with stage 1 holes, OCT showed tiny steps on the anterior wall of the foveal cyst, connecting to the detached posterior hyaloid face. In eyes with stage 2 holes, opercula were incompletely detached and connected to the hole edge. In eyes with stage 1 holes that were operated on, a small semitransparent opacity was noted at the posterior hyaloid face after peeling of the posterior hyaloid in the absence of defects of the anterior wall of the cyst. In 10 of 12 eyes with stage 2 holes undergoing vitrectomy, the size of the foveal opening remained unchanged after peeling of the posterior hyaloid, and a semitransparent opacity was observed at the detached hyaloid face. All opercula in stage 3 holes that were clearly imaged by OCT were positioned above the plane of the posterior hyaloid face.Conclusions These findings suggest that the anterior wall of an evolving macular hole is composed of two layers: a prefoveolar membrane and the inner retinal layer. The prefoveolar membrane may play an important role in both persistent vitreofoveal adhesion and macular hole opercula formation. Jpn J Ophthalmol 2004;48:478–485 © Japanese Ophthalmological Society 2004     

Choroidal changes by ocular coherence tomography in white dot syndrome

PurposeTo evaluate the findings of optical coherence tomography (OCT) in the acute and convalescent stages in patients with white dot syndrome. Patients were followed up at our clinic for at least 6 months.Materials and methodsA consecutive case series of patients with white dot syndrome were enrolled in this study. Only patients with disease onset less than 1 week were included in this study. Slit-lamp biomicroscopy, indirect ophthalmoscopy, fluorescein angiography, indocyanine green angiography (ICGA), OCT, visual field test, and corrected decimal visual acuity test were performed on all patients.ResultsA total of eight eyes from eight patients were analyzed in this study, including cases with acute zonal occult outer retinopathy (AZOOR), punctate inner choroidopathy and AZOOR, multiple evanescent white dot syndrome, and multifocal choroiditis. In the acute stage, OCT demonstrated diffuse or segmental attenuation/loss of inner segment/outer segment (IS/OS) signal. Choroidal thickening with increased choroidal vascular porosity as compared with the fellow eyes was noted in all eyes. The ICGA showed hypofluorescence patches in the late phase. In the convalescent stage, complete or partial restoration of photoreceptor IS/OS was noted along with a partial or complete resolution of choroidal thickening and choroidal vascular porosity in OCT. The ICGA also demonstrated resolved choroidal hypofluorescence in the convalescent stage.ConclusionChoroidal thickening and increased choroidal vascular porosity in addition to disruption of photoreceptor IS/OS were characteristic OCT features of white dot syndrome. Recovery of vision was accompanied with restoration of OCT findings in both retina and choroid.     

Phacoemulsification in eyes with corneal opacities after deep anterior lamellar keratoplasty

To evaluate the maneuverability and efficacy of phacoemulsification and intraocular lens (IOL) implantation in eyes with corneal opacities after deep anterior lamellar keratoplasty (DALK), twelve eyes of 12 patients with mild to moderate corneal opacities after DALK and coexisting cataracts were analyzed retrospectively. Phacoemulsification and IOL implantation assisted with anterior capsule staining, as well as non-invasive optical fiber illumination, were performed on all eyes. No intraoperative or postoperative complications were noted. Mean corrected distance visual acuity (logMAR) improved from 1.24±0.17 to 0.73±0.22. Post-phaco intraocular pressure was maintained between 13 to 20 mm Hg in all cases throughout the follow-up period. Mean endothelial cell density decreased from 2258.42±205.94 to 1906.25±174.23 cells/mm2. Phacoemulsification and IOL implantation are safe and valid in eyes with mild to moderate corneal opacities after DALK and coexisting cataracts when assisted with anterior capsule staining and non-invasive optical fiber illumination.     

Complication rate and risk factors for intraoperative complications in resident-performed phacoemulsification surgery

Background/Aim

To determine the complication rate and risk factors for intraoperative complications in resident-performed phacoemulsification surgery at a tertiary care center during the first 100 surgeries.

Methods

Retrospective chart review of the first 100 performed phacoemulsification cases of six consecutive residents. Posterior capsule tear, vitreous loss, and dislocation of lenticular fragments into the vitreous were defined as intraoperative complications. Patient characteristics considered risk factors for surgery were identified and correlated with the occurrence of intraoperative complications.

Results

Complications occurred in 23 of 600 operations (3.8?%). Surgery was complicated by posterior capsular tear in 23 eyes (3.8?%) with vitreous loss in 17 eyes (2.8?%) and loss of lenticular fragments into the vitreous in seven eyes (1.2?%). Eyes with dense nuclear sclerosis (p?=?0.002) and white cataracts (p?=?0.019) were associated with a statistically significantly greater incidence of posterior capsular tears and vitreous loss (p?=?0.007 and p?=?0.027 respectively). An intraocular lens was implanted in 591 eyes as intended.

Conclusions

Residents achieve an acceptable complication rate during their initial 100 phacoemulsification cases.     

Prevalence of Macular Abnormalities Identified Only on Optical Coherence Tomography in Korean Patients Scheduled for Cataract Surgery

PurposeTo assess the prevalence of macular abnormalities identified only on macular optical coherence tomography (OCT) which were not suspected by biomicroscopic fundus examination, and examine the clinical outcome of patients with these macular abnormalities during preoperative evaluation for cataract surgery in a large series of Korean patients.MethodsMacular OCT was performed on patients scheduled for routine cataract surgery by the same physician at Seoul St. Mary’s Hospital, between June 2018 and November 2019. The patients’ medical records were reviewed retrospectively to obtain demographic data and the results of preoperative evaluation before cataract surgery. Patients were divided into two groups based on the preoperative macular OCT results: normal and abnormal OCT groups.ResultsNine hundred eighty-seven eyes (698 patients) were included in this study. Macular OCT identified abnormalities in 44 eyes (4.5%) of 35 patients (5.0%). Twenty-one eyes (2.1%) had age-related macular degeneration, 20 eyes (2.0%) had epiretinal membrane, and three eyes (0.3%) had lamellar hole. Patients with macular abnormalities identified on macular OCT had a statistically significant higher mean age than those who had normal OCT findings (p < 0.001). Best-corrected visual acuity was worse in patients with abnormal macular OCT after cataract surgery (p = 0.048).ConclusionsIn the preoperative evaluation for cataract surgery in Korean patients, one in every 20 patients had macular abnormalities identified only on macular OCT in spite of unremarkable macular findings on biomicroscopic funduscopy. Age was significantly higher in patients with abnormal macular OCT findings. Thus, inclusion of macular OCT examination in preoperative screening before routine cataract surgery would be beneficial.     

糖尿病黄斑水肿的临床诊断方法比较

目的 对比分析糖尿病黄斑水肿患者光学相干断层扫描(optical coherence tomo-graphy,OCT)、荧光素眼底血管造影(fluorescein fundus angiography,FFA)及裂隙灯显微镜下+90 D前置镜检查所观察到的图像特征,探讨3种检查方法的诊断价值.方法 分析51例(94眼)临床确诊为糖尿病视网膜病变患者的OCT、FFA及裂隙灯显微镜下+90 D前置镜检查结果,将结果进行一致性比较,并观察分析OCT、FFA图像特征,所得结果行单因紊方差分析.结果 OCT与FFA及FFA与+90 D前置镜检查结果有较好的一致性,符合率分别为88.3%、69.1%.OCT、FFA与+90 D前置镜裂隙灯显微镜下检查结果对糖尿病黄斑水肿的检出率分别是86.2%、83.0%及62.8%.OCT所测得的黄斑中心凹平均视网膜厚度值在无渗漏时最低,并随局限性渗漏、弥漫性渗漏、局限合并弥漫性渗漏、黄斑囊样水肿依次增加,经比较它们之间的差异均具有统计学意义(F=40,P均<0.05).结论 OCT能客观的提供糖尿病患者黄斑区结构的变化,尤其对+90D前置镜裂隙灯显微镜下检查及FFA还没有明确变化的早期黄斑水肿诊断敏感.三者的联合应用为揭示糖尿病病理机制、临床诊断糖尿病黄斑水肿、判断糖尿病黄斑水肿的类型及其最佳治疗方案提供参考依据.     

Perforating ocular trauma due to shotgun pellet - Clinical profile and visual outcome

Purpose:The aim of this study was to determine visual and anatomical outcome of perforating injuries due to shotgun pellet.Methods:This was a prospective observational study carried out between July 2016 and Jan 2019 at a tertiary care referral center in Srinagar, Jammu and Kashmir. A total of 172 eyes with perforating injuries of 170 patients were included in the study and were followed up for 6 months with best-corrected visual acuity, slit-lamp examination for status of anterior chamber and lens, fundus examination for status of retina and media, intraocular pressure measurements, and OCT (optical coherence tomography) and FFA (fundus fluoresceine angiography) in selected cases. The relative improvement of visual acuity after treatment was interpreted by applying paired two-tailed t tests. Prognostic significance of other variables was calculated using Chi-square and Chi-square for linear trend tests, for two dependent outcome variables of good outcome and poor outcome.Results:WHO category 4 visual impairment was found in 66 (38.4%) eyes, whereas category 0 was found in 24 (14%) of eyes. Retina was found to be attached 99 (57.6%) of study eyes.Conclusion:Perforating injury is a severe form of ocular trauma with grave consequences in terms of functional and anatomical outcome.     

Anterior chamber intraocular lens - An effective alternative in traumatic and surgical aphakia in the era of scleral-fixated intraocular lens

Purpose:To evaluate outcomes of anterior chamber intraocular lens (ACIOL) implantation with vitrectomy in eyes with surgical or traumatic aphakia, and subluxated or dislocated lens.Methods:In this retrospective study, we evaluated patients who underwent pars plans vitrectomy with ACIOL implantation from April 2016 to March 2019. Patients with minimum follow-up period of 1 year and operated by single surgeon were included. Ophthalmic history, indication for surgery, BCVA, IOP, slit-lamp examination, and fundus assessment findings were noted. Postoperatively best-corrected visual acuity (BCVA), intraocular pressure (IOP) and complications if any were noted.Results:Ninety eyes of 88 patients were included in the study. The mean age of the patients was 60.2 ± 10.2 yrs. Majority (75.6%) were males and 24.4% were females. Indications for pars-plana vitrectomy (PPV) with ACIOL implantation were nucleus drop in 16.6%, IOL drop in 25.5%, large posterior capsular rupture (PCR) with vitreous disturbance or zonular dehiscence (ZD) during cataract surgery in 33.3%, more than 180° subluxation of lens in 10% and traumatic lens or intraocular lens (IOL) drop in 14.4% cases. Preoperative and postoperative mean Log MAR visual acuity was 1.59 ± 0.44 and 0.36 ± 0.33 respectively, with few complications like cystoid macular edema (CME) in 8.8%, persistently raised IOP in 4.4%, persistent uveitis in 2.2%, retinal detachment (RD) in 2.2%, and tilted IOL in 1.1% cases.Conclusion:Out of different options available for secondary IOL implantation in patients with poor capsular support ACIOL has the advantages of cost-effectiveness, small learning curve, faster surgical time with a lesser rate of complications like IOL tilt, vitreous hemorrhage, and suture erosion as compared to scleral-fixated IOL (SF-IOL). Comparable visual outcome can be obtained by proper patient selection in these cases.     

Inter-observer agreement and sensitivity of Optomap images for screening peripheral retinal lesions in patients undergoing refractive surgery

Purpose:The aim of this study was to compute the sensitivity, specificity and inter-reader variability of ultra-widefield retinal imaging (Optomap 200Tx) for screening retinal lesions before myopic refractive surgery.Methods:Two hundred and eight eyes of 109 consecutive refractive surgery candidates were included in this study. All subjects underwent Optomap 200Tx, mydriatic slit-lamp lens examination and dilated retinal examination with scleral indentation by a retinal specialist. Retinal findings by indirect dilated examination by retinal specialist was considered as the gold-standard. Sensitivity analyses for the readers were calculated between the Optomap images and the gold-standard retinal examination.Results:Seventy-three of the 208 eyes (35.1%) had peripheral retinal lesions diagnosed by the retinal specialist on dilated fundus examination. Peripheral lesions were seen on the Optomap images in 111 (53.4%) eyes. Compared to the dilated retinal examination, the detection rate with the Optomap 200Tx was 78.1% and specificity rate was 60%. The accuracy rate between the 3 readers ranged from 72% to 87%. The highest accuracy was noted with the reader post 1 year of retinal training (86.54%).Conclusion:The Optomap 200Tx showed a high sensitivity and moderate specificity for identifying peripheral retinal lesions in eyes undergoing refractive surgery. The Optomap examination is a convenient, fast and feasible method for detecting the pathological fundus changes in myopic eyes. The reliability of the examination improves when the images are interpreted by a reader with prior retinal training.     

Induction of cataracts of varying degrees of hardness in human eyes obtained postmortem for cataract surgeon training

PURPOSE: To report a method of inducing nuclear cataracts of varying degree of hardness using intralenticular injection of the Karnovsky solution. METHODS: Twelve postmortem human eyes were prepared according to the Miyake-Apple posterior video technique. After performing capsulorhexis and hydrodissection/delineation, 0.2 ml of the Karnovsky solution was injected into the lens nucleus of the eyes. Manual extracapular cataract extraction techniques and various two-handed phacoemulsification maneuvers were then practiced at various time intervals after the injection. RESULTS: Uniform nuclear cataracts with varying degrees of hardness were successfully induced in all globes. The optimum dose of the Karnovsky solution and time for induction of nuclear hardness of grade 3 (ideal for practicing two-handed phacoemulsification maneuvers) were 0.2 ml and 15 minutes, respectively. CONCLUSION: The Karnovsky solution can be successfully used for the induction of hard, uniform nuclear cataracts for learning/practicing extracapular cataract extraction and phacoemulsification.