Topical Phacosection and Stretch Pupilloplasty for a Mature Cataract

Dr. Meda Ravindra manages a mature senile cataract with a fibrotic anterior capsule, atonic iris, and miotic pupil via phacosection under topical and intracameral anesthesia. A microsphincterotomy was performed using microscissors and was followed by a stretch pupilloplasty. The surgery was done under low fluidics, which ensured that the lens-iris-zonule diaphragm was not stretched backwards. The endothelium was maximally protected by continuous infusion of hydroxypropyl ethylcellulose in front of the nucleus. The tunnel involved anterior sclera, and hence the surgically induced astigmatism was about 0.75 D. The tunnel was not stretched when the heminuclei were extracted, so the tunnel closed spontaneously at the end of surgery without needing stromal hydration.

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