CataractCoach™ 2944: traumatic cataract with tough surprise

Added: 2026-05-31

[00:00:00][music] >> Cataractcoach.com a traumatic cataract with a tough surprise. You never know what you will encounter with these traumatic cataract cases. So, starting off here, you can see a lot of synechiae and not the best dilation. You have a white cataract as well. So, breaking some of the synechiae with some viscoelastic always a smart move here.

[00:00:20]Get those separated off. And you're going to have to expand the pupil a little bit more. Also, check in the pre-op period with a gonio prism. Is the angle of the eye okay, too? Any other damage?

[00:00:30]And now there's a lot of trypan blue here. I'd rather put just a little bit on the anterior lens capsule and paint it on because what if there's zonalopathy? All that trypan injected, something can go back into the vitreous cavity and you'll lose your red reflex.

[00:00:45]So, here's a little more of that Yep, a little little sphincter cutting here.

[00:00:48]So, using the scissors to make little cuts in the iris sphincter, maybe you can help dilate the pupil a little better that way. I typically don't do that. I just use couple iris hooks or choppers and stretch the pupil out or if you need to use iris hooks.

[00:01:00]No harm in putting an iris hooks in this case, but look at that beautiful dilation. Now, interesting kind of lamellar cataract. I don't think that's the lens capsule bag equator. I think that's just a weird kind of lamellar change in the lens provider, but let's find out. So, getting a rhexis done here. Not such an easy rhexis.

[00:01:17]Cutting having cut the capsule with the forceps and scissors, too. And now using the forceps.

[00:01:22]Get some sort of capsular opening here.

[00:01:24]And now let's go in with the phaco probe. It's pretty soft. I bet you can suck it out pretty quickly. This aspirate [snorts and clears throat] like that. Here comes the side port for another instrument, your chopper. And then you just aspirate it. Goes down easy. Yeah, I sped the video up. Don't worry about that. I know my my my audience, we want to be efficient here.

[00:01:41]Maximum learning, minimum time. I got you.

[00:01:43]So, cleaning all this stuff here. The lens material comes up pretty easily. A little bit of nuclear sclerosis there, not much. You can see it comes up pretty easy with that phaco probe. Very little phaco energy, but what's that hazy whitish stuff here?

[00:01:56]I think it's fibrosis of the posterior capsule. So, the question is what do you do here? You can try with the I probe clean up as much as you can, but I think you've got actual like thick fibrosis. I don't see a plaque that can be peeled off, either. You know, recently we've had some good videos of peeling off the plaque. Here's another reason why I would have put an iris hook in the beginning of the case. It's just easier for me, but if you've got great skills like this surgeon, hey, you can do without. Now, let's see. Oh, going with a bent cystotome. Maybe trying to peel off some of that plaque. Or maybe do a posterior rhexis, kind of poking in there. I don't even know if you got through, did you?

[00:02:28]That's a dense-looking plaque there.

[00:02:30]Try to grab it with the forceps. Can you get it out? There's something. You peeled up something. You know, really good job, but look at that. You peeled off That's pretty good, but it's still kind of opaque back there.

[00:02:40]And what are you going to do? Poke through the capsule and do a posterior rhexis? Let's see. through the posterior capsule?

[00:02:48]And I think you certainly have enough support for a sulcus lens.

[00:02:52]And yeah, there's the capsule open a little bit. Some viscoelastic. You don't want the air bubbles, but And what are we going to do now? Can you get a rhexis torn on this thing?

[00:03:02]You know, sometimes you can't. Sometimes you just got to use a vitractor. You put a vitractor in there and you just kind of nibble away at that capsular opening.

[00:03:08]I don't think you're going to get a rhexis done here.

[00:03:11]So, let's see. Try again. Can you get the rhexis done? Mm.

[00:03:15]Yeah, you just don't want to tear. It's so fibrotic.

[00:03:18]Although you're tearing it pretty well.

[00:03:20]I just chew it up with the vitractor like that, you know. You'd be done in a second.

[00:03:25]But let's see what we got here. At least get open centrally so the patient has a good central visual acuity and a clear visual axis.

[00:03:32]So, grabbing onto that tissue. Can you get it turned around more? Let's find out.

[00:03:38]Oh, there's the cutter. Good job with the cutter. Yeah, just use the cutter there.

[00:03:43]And then remove some of that capsule there, that fibrotic area. I do just enough to clear the patient's visual axis there. I wouldn't do a huge amount.

[00:03:52]I'd aim for maybe like four-ish millimeters. That'll give you plenty of overlap to get the lens in and just That looks pretty good right there.

[00:04:00]Pretty good.

[00:04:02]And if there's too much fibrotic stuff, yeah, you may want to trim that down a bit, too. But just make sure you got enough support to get the IOL there. And if you get an I you can get an optic capture even better. And now oh, micro scissors always a cool instrument to have on the tray.

[00:04:16]And is there one little piece of lens material on top of the iris there temporally?

[00:04:20]Ah, we'll find out. And so now let's see what we're going to do. Get the lens in.

[00:04:24]Here comes the lens. They have three-piece lens. That'll give you a lot more options. I didn't enlarge the incision slightly, too, so I might separate.

[00:04:31]So, getting that one trailing haptic to the side so it's not in the way. And here comes the lens. Let's see. 7L rule.

[00:04:36]That looks correct. 7L.

[00:04:38]And then get that dialed in. Looks like the sulcus placement.

[00:04:42]That's a nice result there. Would you do a pupilloplasty, too, now? Or you just wait and see?

[00:04:47]Uh it's a good question. I think you could just wait and see. You may want to do a little pupilloplasty so that iris is looking a little ratty.

[00:04:54]Yeah, maybe bring the pupil down just a little bit. One maybe one or two sutures there just to bring it down to make it pretty.

[00:05:00]And so for the pupilloplasty, as you know, we're going to do 10-0 polypropylene on that long CIF-4 needle.

[00:05:06]And then here we go. Maybe just leave it be as is and patient will be pretty happy. Interesting case. You never know what you're going to get with traumatic cataract. Remember, check out the surgery channel on Cataractcoach.com. I promise you'll love it.