A resident was performing phacoemulsification surgery on an uncomplicated cataract case. The lens was inappropriately manipulated, causing it to break up into pieces and fall into the vitreous cavity. To detect this, the surgeon would check for a tilted or eccentric lens, phacodonesis, an interval between the iris and lens margins, vitreous prolapse into the anterior chamber, sudden deepening of the anterior chamber, focal iridodonesis, and an iridolenticular gap. To complete the surgery, the surgeon would use a capsular tension ring. Settings on the machine that would need to be changed include lowering the flow rate, vacuum, and bottle height.

1. Dr Md Anisur Rahman Anjum
Associate Professor
National Institute of Ophthalmology
Dhaka. Bangladesh
MARCH 19, 2014 anjumk38dmc@gmail.com 1

2. phaco emulsification
was going on by a
resident in
uncomplicated case.
Q 1 What happened
to the lens ?
Q 2 How will you
detect it? Mention 4
points
Q 3 Which device will help you to complete the surgery?
Q 4 Mention 3 settings in your machine that you will
change for continue the surgery

3. 1) Inappropriate manipulation or mechanical
force with any instrument such as forceps and
chopper.

4. 2)
i. Tilted or eccentric lens.
ii. Phacodonesis.
iii. Interval of red reflex between the margin of the iris
and lens.
iv. Vitreous prolapse into the anterior chamber.
v. Most significantly, sudden deepening of the anterior
chamber is frequently the first sign of zonular
disruption or posterior capsular tear.
vi. Focal iridodonesis.
vii. Iridolenticular gap

5. 3)
Capsular Tension Ring. (CTR)
4)
i. low flow rate.
ii. low vacuum and
iii. low bottle height