Management of Posterior Lenticonus

Dr. Allon Barsam shows how he performed cataract surgery in an 11-year-old patient with posterior lenticonus. He begins with trypan blue to visualize the anterior capsule. He then irrigates with a dispersive then cohesive viscoelastic to protect the endothelium in this young patient. Capsulorhexis is initiated with a cystotome and then forceps are used to prevent tearing of the delicate elastic capsule. Gentle viscodissection is performed, followed by phacoemulsification on a slow-motion setting with reduced aspiration. The soft lens matter and epinuclear shell is gathered by bimanual technique during vitrectomy, which reduces traction on the vitreous. A 3-piece IOL is folded rather than injected into the anterior chamber, due to the large ellipsoid posterior capsule defect.