COMPARATIVE STUDY BETWEEN DIFFERENT TECHNIQUES USED TO AVOID EXTENSION OF CAPSULOREHXIS IN INTUMESCENT AND MORGAGNIAN CATARACT

To compare the efficacy and safety ( rate of extension of capsulorehxis) of using these techniques  in intumescent and morgagnian cataract to avoid the extension of the anterior capsulorehxis 

The Memorial Institute For Ophthalmic Research

Prospective interventional comparative study of (80) eyes ( 40 eye in each group) (52 males and 28 female) aged between 50-85 years with  intumescent cataract. .Inclusion Criteria : patients with  intumescent or morgagnian cat, normal u/s , fit for phaco.Excluison Criteria : patient not fit for phaco ,the cat. not intumescent .

Surgical Technique : 

  1^st technique: after staining of anterior capsule, fill the anterior chamber with healon , make puncture in the capsule then elevate small flap using cystotome needle  then using methyl cannula attached to 5cm syringe start to make manual suction from the small opening in the anterior capsule to absorb the liquefied material with repeated injection of healon in the periphery to push the liquefied material toward center until absorption of most liquefied material and flatting of the anterior capsule then complete the capsulorehxis.2^nd technique: after staining of anterior capsule, fill the anterior chamber with healon , use the needle of 3 cm syringe and connect it to the aspiration of the phaco machine , penetrate the anterior capsule direct by the tip of needle then apply mechanical aspiration of the liquefied material without open the capsule (closed system), also I can use this needle to reach to the periphery of the lens and aspirate fluid from periphery until the anterior capsule become flat then start the anterior capsulorehxis   

1^st technique the rate of complications was 6 cases ( 15%) . 3 of these cases occurred at the 1^st step during puncture of the capsule or creation of the small flap lead to Argentina flag ,while the other 3 cases there was peripheral extension due to absorption of the flap in the cannula during aspiration or  poor absorption of liquefied material from the periphery of lens that cause high pressure in the periphery cause extension of capsulorehxis .

2nd  technique the rate of complications  was 2 cases ( 5% )of cases. one case occurred due to failure of absorption of most liquefied material due to the small gauge of needle used and the thick liquefied material and the other case occurred due to sudden collapse of anterior chamber due to failure to absorb the liquefied material so I apply high vacuum to absorb the liquefied material but the tip of needle came into AC causing absorption of healon and collapse of AC.

1) Both techniques improve the rate of complications that occurred with intumescent cat

2) The 2^nd technique is more safe and efficient than 1^st one

3) Although 2^nd technique give better results but some cases still need to use 1^st technique due to the small gauge of the needle and the need to use the large cannula to absorb the thick liquefied material