Intracapsular Cataract Extraction ICCE John Hovanesian, MD

I'm Dr. John Hovanesian.

In this video, we'll talk about
intracapsular cataract extraction,

a useful technique for cataract surgery

when the zonular support for the lens

is either weak or absent.

This 47 year old patient
has a subluxated lens

and has vitreous
in the anterior chamber,

showing us that we will see
vitreous during this

intracapsular cataract surgery.

In this procedure, the conjunctiva
is recessed

from the superior limbus using

Westcott scissors and tooth forceps,

and we can achieve hemostasis
with diathermy or cautery.

Next, a partial thickness incision
is made

at the limbus superiorly
to about 50% thickness.

This allows a two-plane incision

that will next enter
the anterior chamber

as we use a keratome blade.

This wound with the keratome
or other instrument

is then extended left and right
to allow just enough access

that we can place our two safety sutures

before opening the rest of the incision.

Our safety sutures are 9-0 nylon

and are loops so that the suture
won't be in the way

of the next step when we want
to remove the lens.

Before we remove the lens,

we have to extend the incision
left and right

between the loops of the suture,
and this allows then

the assistant to lift the cornea
while the surgeon,

using a Weck-Cel sponge,
dries the lens surface,

which allows the cryoprobe
to stick to the lens.

In this case, some vitreous comes forward,

and still the cryoprobe
sticks to the lens

because the interface
between the two is dry.

The surgeon next rocks
or moves the lens back and forth

in order to loosen zonular attachments

while slowly removing it from the eye.

Next, the vitreous attachments
are cut using scissors,

and we have an aphakic eye with some
vitreous prolapse.

Air is used to tamponade this vitreous,

and the large amounts of it
that are coming forward

are swept with a blunt spatula,

and some additional vitreous removal

with scissors is performed.

Now that the vitreous is out of the way,

we can tighten down the sutures,

which allow us a much more closed

and therefore safe system.

Next, we can perform
some mechanical vitrectomy

to remove any smaller amounts
of vitreous

that are coming forward.

Once we're free
of any remaining vitreous,

we can place Miochol in the eye
and perform

a peripheral iridotomy,
before placing the sheets glide,

which will direct the lens implant
into the anterior chamber.

The lens is an Alcon multiplex
anterior chamber lens,

and it's directed carefully over
the sheets glide into the chamber,

and then the glide is removed.

With the glide out of place,
we can then tuck

the trailing haptic into the
superior anterior chamber angle.

And next, we can use a Sinskey hook,

or other instruments
like a Kuglen hook,

to manipulate the lens to be sure

that its foot plates are properly
positioned in the angle.

The remaining sutures are placed
in a Seidel test

can then confirm that we have
a completely sealed incision,

or else additional sutures are placed.

Finally, we pull forward
the remaining conjunctiva

and use just the fibrinogen component
of fibrin tissue sealant

to secure it to the limbus
over the wound.

I'm Dr. John Hovanesian.
Thanks for watching.