Simple, Safe And Effective: Crack And Segment Removal Technique For Subluxated Cataract

This case report aims to introduce the Crack and Segment Removal technique for subluxated cataract surgery as a safe and effective approach to minimize surgical complications.

Kanaker-Zeytun Medical Center , Yerevan , Armenia

A 77-year-old male patient with a 20-year medical history of hypertension and type 2 diabetes mellitus presented with a complaint of decreased vision in the right eye. Visual acuity in the affected eye was 20/300. Intraocular pressure was within normal range. The patient's ocular examination revealed an immature cortical cataract with partial inferotemporal lens dislocation. Additionally, on the pupillary border, pseudoexfoliation material was noted.

To address the subluxation of the lens, the Crack and Segment Removal technique was utilized. The procedure began with gentle hydrodissection, followed by placement of a capsular tension ring to stabilize the capsular bag. A standard groove was then created, deeper at the center and shallower at the edges, and then it was deepened near the main incision without rotating the nucleus.

Afterwards, the lens was divided into two parts using the chopper and phaco tip again without nucleus rotation. Using ultrasound the pole of the divided lens farther from the main incision was taken, a bit peripheral from the center of the groove, pulled towards the center of the pupil, and rotated 90^o around its horizontal axis.

Lastly, with the help of the chopper, phacoemulsification was conducted.

Next, the second segment was removed by repeating the same technique.

The procedure was completed without any complications .

Postoperatively, the patient's visual acuity improved to 30/40, and the slit-lamp exam revealed a well-centered intraocular lens.

The Crack and Segment Removal technique is a safe and effective approach for subluxated cataract surgery, as demonstrated in this case report. By minimizing the manipulations inside the bag this technique reduces the risk of intraoperative and postoperative complications such as posterior capsule rupture or zonular dehiscence.

 The Crack and Segment Removal technique should be considered as an important addition to the ophthalmologist's surgical armamentarium for subluxated cataract cases.