Cataract Surgery Complex Case Management

EHUD I. ASSIA, MD The combination of advanced glaucoma and phacodonesis with lens subluxation suggests pseudoexfoliation (PXF) syndrome, which needs to be ruled out. Another potential cause is high myopia, in which significant phacodonesis is not uncommon. Cataract extraction is certainly indicated, not only to remove the opaque media but also because of the patient’s glaucoma. Anterior displacement of the unstable lens may play a role in the high IOP, and removal of the crystalline lens is often associated with decreased pressure. Intracapsular cataract extraction and the implantation of either an ACIOL (angle or iris supported) or a suturefixated PCIOL are valid options. My preference, however, would be to preserve the posterior capsule by fixating the lens capsule to the scleral wall. The Cionni Rings for Sclera Fixation and the Ahmed Capsular Tension Segments (CTS) (both from Morcher GmbH, Stuttgart, Germany; distributed in the United States by FCI Ophthalmics, Marshfield Hills, MA) were shown to be highly effective for fixation of the capsular bag to the scleral wall. I have developed with Hanita Lenses (Kibbutz Hanita, Israel) an alternative device, the AssiAnchor (not available in the United States), which clips to the anterior capsule Phacodonesis and a Subluxated Crystalline Lens