Nucleus cryoinversion for extraction of highly complicated cataracts

We describe a technique for cataract extraction in vitrectomized eyes that uses secured removal of the nucleus with no manipulation of the capsular bag. After a large scleral tunnel is prepared and a capsulorhexis created, a 20-gauge retinal cryoprobe enveloped in a plastic or a silicone sleeve is introduced into the anterior chamber. The cryoprobe engages the nucleus by a "freeze-grip" and rotates it 180 degrees so that the nucleus is elevated into the anterior chamber with no force applied to the capsule and the cryoprobe supporting it from below. The cryoprobe is replaced by a vectis under the nucleus and with the help of another instrument from above, the nucleus is removed. Aspiration of cortical material under low-pressure fluid maintenance of the anterior chamber completes removal of the cataract. An intraocular lens is then implanted in the ciliary sulcus for maximum capsule support.