Surgery: Phacoemulsification in a Cataract with Dense Asteroid Hyalosis

This video demonstrates a a femtosecond laser assisted cataract surgery using phacoemulsification in a patient with dense Asteroid Hyalosis.

Surgeon: Dr. Kevin M. Barber, President, Advanced Center for Eyecare Global, USA


Dr. Barber: This is a case of femtosecond laser-assisted cataract surgery using phacoemulsification in a patient with dense Asteroid Hyalosis. 2.4mm clear corneal incision was just created and the anterior capsular remnant created by the femtosecond laser is removed. Hydrodissection is gently performed. What makes this case interesting is the dense Asteroid Hyalosis which can obstruct the surgeon’s view, and dampen the red reflex, which will be demonstrated here momentarily.

This nucleus is easily cracked in half and then using a stop and chop technique, the remainder of the nucleus is phacoemulsified and aspirated. As the nucleus is being removed, the lack of a red reflex becomes more and more apparent. Now, in this case, there is a dense epinuclear plate, so switching to the epinuclear setting, gently try to aspirate epinucleus and this was somewhat difficult. Again, as the posterior capsule is difficult to identify with such dense Asteroid Hyalosis.

Irrigation/aspiration now being performed. Again, using the microscope to achieve excellent focus of the posterior capsule with the Y in the Y-axis is quite important. As you can see, visualization is difficult so I decide to switch to a bimanual technique to remove the subincisional cortex as my visualization was quite impaired. By using this bimanual technique, the subincisional cortex is easily and safely removed.

The normal appearance of the posterior capsule is absent in this case because of the Asteroid Hyalosis, therefore we cannot rely on the normal visual clues. So using proper Z focus with the microscope, and possibly converting to slower and lower settings on the phacoemulsification machine, can make a case such as this safer. We attempted ORA intraoperative aberrometry, but as one might suspect, it was not possible due to the dense vitreous opacities. Triamcinolone and moxifloxacin compounded injection was just given through the zonules, tranzonularly. And you can see the interface between the medication injected into the vitreous with the dense Asteroid Hyalosis.

The lens implant is injected into the capsular bag and dialed into proper position.
And irrigation/aspiration is then used to remove the viscoelastic material. The lens is pushed inferiorly and superiorly to try to dislodge any viscoelastic underneath the lens implant.

The wounds are then hydrated and the eye is left to physiologic pressure.

Hope this was helpful, as this case demonstrates the difficulty in visualization that can be presented by dense Asteroid Hyalosis. Thank you for watching.

November 16, 2020

Last Updated: October 31, 2022

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