Using advanced cataract surgical techniques

The final symposium of the 2025 ASCRS Annual Meeting covered advanced cataract surgical techniques. Richard Tipperman, MD, moderated the session, which was sponsored by the ASCRS Cataract Clinical Committee. Panelists/presenters included Timothy Page, MD, Michael Snyder, MD, Brandon Ayres, MD, Richard Hoffman, MD, Cathleen McCabe, MD, Nicole Fram, MD, Allison Chen, MD, and Jia Yue You, MD.

Some of the topics covered in the session were capsule hooks and segments, CTRs, artificial iris, posterior capsulorhexis, scleral pockets, suture fixation of dislocated IOLs, scleral fixation of IOLs, and pars plana vitrectomy for the cataract surgeon.

Dr. You shares steps for using capsular tension segments.
Source: ASCRS
Dr. Snyder highlights his 10 tips for using artificial irises.
Source: ASCRS

Dr. You discussed using capsular hooks and capsular tension segments, and she shared several steps for using capsular tension segments (CTS):

  1. Limbal peritomy
  2. Scleral groove 1.5 mm from blue zone
  3. Position CTS vertically
  4. Insert straightened Gore-Tex 7-0
  5. Insert 25-gauge hypodermic needle through scleral groove
  6. Dock two needles, passing through central eyelet
  7. Pull out hypodermic needle
  8. Repeat steps 4 and 5 with second pass 2 mm away in scleral groove
  9. Repeat docking process anterior to CTS and without passing through central eyelet
  10. Position the CTS in the bag
  11. Slip knot for Gore-Tex sutures
  12. Hold below knot with needle driver before tightening
  13. Insert IOL (could do before or after CTS)
  14. Carefully adjust Gore-Tex knot tension
  15. Assess for IOL centration
  16. Lock and bury knot
  17. Additional repairs
  18. Consider acetazolamide postop

Dr. Snyder shared 10 tips when using artificial irises:

  1. Use injectors when you can but only fiber-free.
  2. Do not cut the devices (other than for trephination)—pseudo-PIs are unnecessary and create sharp corners.
  3. Order the black color for albinism or isolated IPE atrophy/loss—albino patients will still have some residual photophobia because stray light still enters through scleral wall.
  4. Getting these devices into the capsular bag through capsulorhexis can be challenging—use the conoid injection and overfold technique.
  5. Always place a CTR in the bag.
  6. Always measure the capsular bag (this can be done with an intraocular ruler).
  7. Suture for sulcus placement.
  8. Pull MCTR fixation centripetally to fine-tune centration.
  9. Tether suture to tighten after knot is tied.
  10. Use CTS for late bag-prosthesis subluxation.

Relevant disclosures

Snyder: Alcon, Bausch + Lomb, Johnson & Johnson Vision, VEO Ophthalmics
You: None

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