R 250
Special challenges to small incision cataract surgeryS. l. Masket
Presently, cataract surgery can be considered a restorative and refractive surgical procedure. In fact, over the wide range of possible optical errors, lens replacement surgery is arguably the most accurate refractive procedure available. Central to the concept of refractive cataract surgery is the reduction of incision size to 3.2 mm or less. The literature is replete with reports that indicate that incisions of that size and smaIler induce reproducible and minor changes in presurgical astigmatism. Furthermore, these changes stabilize weIl within two weeks following the procedure. However, certain cataract case types bave presented challenges to the use of small incision cataract surgery.
These include:
1) miotic pupil
2) mature cataract
3) zonule weakness or absence
4) prior ocular surgery - vitrectomy
5) prior refractive surgery
6) high ametropia
Most of these obstacles can be surmounted by improvising and. extrapolating from routine surgery. Unfortunately ~ however, certain categories of cases may still require cataract removal and/or lens replacement through a larger incision.
This presentation discusses methods to overcome the more common obstacles to small incision surgery and reviews cases not amenable to small incision refractive cataract surgery.
Advanced Vision Care, 2080 Century Park East Suite 911, Los Angeles, CA 90067, USA