-: This video describes the diagnosis
and surgical technique used for management
of bilateral anterior lenticonus of Alport syndrome.
The examination of the patient showed a conical protrusion
of anterior lens capsule manifesting
as a central symmetrical oil droplet sign.
This was best documented on anterior-segment OCT.
Now we proceed towards the video.
After making the side port incision,
the capsulorrhexis is initiated
with a cystotome at a mid-peripheral position,
avoiding the central bulge.
A main clear corneal incision of 2.75 millimeters
is created, and after maintaining the anterior chamber
with hydroxypropyl methylcellulose,
the rhexis is completed with pediatric rhexis forceps.
Capsulorrhexis in cases of lenticonus
is technically challenging.
The ultrastructural fragility of the capsule may cause rips
and runoffs and can lead
to an inadvertent posterior extension during capsulorrhexis
and posterior capsule rupture.
After completing the capsulorrhexis,
a gentle but thorough hydrodissection
from several sites is done.
Great caution is exercised
when there are associated posterior
subcapsular opacities or posterior lenticonus,
as hydrodissection carries a heightened risk
of causing a PC rupture.
Hydrodelineation is carried out
and the lens cortex is aspirated
using the principle of engage, detach,
and suck in a circular manner to prevent undue stress
on the zonules.
Note that there are no associated
posterior capsular abnormalities in this case,
and the capsule is intact.
The capsule is polished thoroughly,
bag is inflated, and the IOL is injected and dialed.
Stromal hydration is performed.
A suture is placed in the end to close the wound
in order to prevent wound leakage
resulting from fish mouthing
of incision lips due to decreased scleral rigidity
and tissue elasticity.
The patient was successfully managed
with vision of 6/9 at 1 month post-op in both eyes.
Thank you for watching.