Terry Kim, MD Professor of Ophthalmology

Duke University School of Medicine Cornea and Refractive Surgery Services

Duke University Eye Center

Kiawah Eye 2013

Consultant - Alcon - Bausch & Lomb - Ivantis - Ocular Systems Inc. - Ocular Therapeutix - Omerus - Powervision - SARcode Bioscience

61 y/o healthy female patient comes for evaluation of chronic progressive bilateral vision loss ◦ VA CC OD 20/60 OS 20/40 ◦ SLE remarkable for bilateral NS and PSC cataracts

with mild superior lens subluxation and inferior zonular deficiency. No phacodonesis

Patient denies any history of ocular trauma, or previous eye surgery.

Only oral medication is baby aspirin 81 mg

Iris Hooks Capsule Retractors

Modified CTR (M-CTR)

Capsular Tension Segment (CTS)

Expansion of capsular equator Buttress areas of weak zonules Recruit and redistribute tension from existing zonules Recenter a mildly subluxed capsular bag

Capsular Tension Ring (CTR)

Minimal 0-2 clock hours of dialysis

Minimal phacodonesis Haptics in area of dialysis Cautious phaco +/-CTR

Mild <4 clock hours of dialysis

Mild phacodonesis, Ovalization of rhexis

CTR (+/- iris or capsule retractor)

Moderate 4-8 clock hours of dialysis

Moderate phacodonesis, Overt decentration Capsular collapse

M-CTR or CTS (+ iris or capsule retractor)

Severe >8 clock hours of dialysis

Severe phacodonesis M-CTR with double islets (+ retractors) Multiple CTS Suture fixated IOL AC IOL

MST Capsule Retractor Alcon ReFORM CTR

Images shown for educational purposes only

Pt very happy with visual results ◦ VA sc OD 20/25 OS 20/20

SLE: well-centered single-piece PCIOL

No pseudophacodonesis