Retro-illumination of capsule makes cataract surgery easier, safer in difficult cases
MILAN — The chandelier light used for vitrectomy can be utilized in cataract surgery to provide better visualization of surgical maneuvers in selected difficult cases, according to one surgeon.
"In cases of dense cataract, vitreous hemorrhage, corneal opacities and small pupil, we have a poor reflex from the retina, and surgery is difficult under standard light," Hideharu Fukasaku, MD, said at the annual joint meeting of Ocular Surgery News and the Italian Society of Ophthalmology.
Fukasaku developed a new technique, called retrolenticular illumination, in which a chandelier light is inserted behind the lens.
"This light source from behind the lens provides a good light brightness, but also gives us a three-dimensional image during cataract surgery," he said.
A standard 23-gauge vitrectomy trocar cannula is placed at 6 o’clock, and indocyanine green is infused to stain the capsule.
"I insert the chandelier light and use it to retro-illuminate the capsule. Capsulorrhexis is easily performed also on dense cataracts, minimizing the occurrence of tears. The three-dimensional image makes surgery easier and safer. After nucleus aspiration, you can perform meticulous cleaning of the capsule from cortex residuals. The capsulorrhexis edge is clearly visible, and you can easily implant the IOL in a perfectly centered position," Fukasaku said.
At the end of surgery, the trocar cannula is removed and no sutures are needed.
The technique, Fukasaku said, is ideal in post-keratoplasty cases and in combined cataract and vitrectomy procedures.
"You can switch to vitrectomy instantly, only changing the infusion," he said.
Disclosure: Fukasaku has no relevant financial disclosures.