Inside-out and outside-in: Tips and tricks in posterior lenticonus

Area of Science:

• Ophthalmology
• Surgical Techniques
• Congenital Disorders

Background:

• Posterior lenticonus is a congenital condition involving thinning and bowing of the posterior lens capsule.
• Cataract formation in posterior lenticonus results from intra-lenticular pressure bulging the thinned capsule.
• Surgical management is challenging due to variable presentations, from thin capsules to pre-existing dehiscence.

Purpose of the Study:

• To highlight surgical management tips for various posterior lenticonus scenarios.
• To illustrate techniques for addressing intraoperative challenges in posterior lenticonus surgery.

Main Methods:

• Avoiding hydro-dissection to prevent capsule extension or rupture.
• Identifying posterior capsule rupture via the 'fish-tail sign'.
• Modifying lens matter aspiration based on capsule integrity: 'inside-out' for defects, 'outside-in' for intact capsules.

Main Results:

• The 'fish-tail sign' aids in suspecting posterior capsule rupture intraoperatively.
• Tailoring aspiration technique ('inside-out' vs. 'outside-in') is crucial for managing capsular defects.
• Adequate anterior vitrectomy is essential to prevent postoperative complications.

Conclusions:

• Surgical success in posterior lenticonus depends on recognizing and adapting to capsule integrity.
• Specific techniques, like modified aspiration, are vital for safe and effective cataract removal in these cases.