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Rotating the Intraocular Lens to Prevent Posterior Capsular Opacification in Cataract Surgeries
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Posterior-assisted levitation in cataract surgery.

James S Schutz1, Nikolaos A Mavrakanas

  • 1Ophthalmology Service, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland. js485squid@yahoo.com

Current Opinion in Ophthalmology
|October 16, 2009
PubMed
Summary
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Posterior-assisted levitation (PAL) is a valuable surgical technique for managing lens subluxation during phacoemulsification. Despite criticism, PAL can prevent vitreous complications and avoid the need for further procedures like trans pars plana vitrectomy-lensectomy.

Area of Science:

  • Ophthalmology
  • Surgical Techniques
  • Cataract Surgery

Background:

  • Posterior capsule rupture and zonular dehiscence can lead to lens subluxation during phacoemulsification.
  • Posterior-assisted levitation (PAL) is a maneuver to manage these complications.
  • PAL is often underutilized by less experienced surgeons.

Purpose of the Study:

  • To review the utility and safety of Posterior-assisted levitation (PAL).
  • To address criticisms of PAL by vitreoretinal surgeons.
  • To compare PAL outcomes with alternative management strategies.

Main Methods:

  • Review of existing literature and surgical case management.
  • Analysis of complication rates associated with PAL.
  • Comparison with trans pars plana vitrectomy-lensectomy (TPPV-lensectomy) for vitreous lens luxation.

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Main Results:

  • PAL can facilitate completion of phacoemulsification and intraocular lens implantation, avoiding conversion to open-eye procedures.
  • PAL prevents nucleus or lens luxation into the vitreous, thus avoiding trans pars plana vitrectomy-lensectomy (TPPV-lensectomy).
  • No large studies demonstrate excessive complications with PAL compared to TPPV-lensectomy for vitreous lens subluxation.

Conclusions:

  • Posterior-assisted levitation (PAL) is a simple and effective technique for managing specific intraoperative complications during cataract surgery.
  • In cases where PAL fails or complete lens luxation occurs, referral for trans pars plana vitrectomy-lensectomy (TPPV-lensectomy) is indicated.