Sunday afternoon’s Challenging and Complicated Cases in Cataract Surgery Video Symposium always culminates with the coveted Golden Apple Award for the best teaching video.
This year, the Cataract Clinical Committee received more than 100 videos and distilled them down to six videos for the symposium. The winner, voted by the audience, was Bruno Trindade, MD, PhD, for his case involving dead bag syndrome.
Source: ASCRS
The case was of an 80-year-old woman who denied any history of ocular trauma. She had had cataract surgery 30 years prior and experienced good vision until recently when it decreased to 20/30. Upon examination, there was obvious IOL dislocation, and the posterior capsule was flapping behind it. Dead bag syndrome was the suspected cause.
Dr. Trindade said once in the OR, he observed the IOL sitting further back than initially anticipated. It was brought up with a vitrectomy cutter and positioned in the AC so it could be cut and removed through a 2.4 corneal incision. An anterior vitrectomy was performed through the pars plana, and the capsular bag was removed.
“You can see how thin and clear this capsular bag is for someone who had cataract surgery 30 years ago,” Dr. Trindade said.
From there, a three-piece acrylic IOL was inserted and fixated with intrascleral haptic fixation. Dr. Trindade was confident this was the end of surgery, but no matter what he did, the IOL would not center well. He discovered that the haptic was kinked, so he explanted that lens and tried again with a new lens. This one fixated and centered, and the case was complete. The patient was 20/30 3 months postop.
Histopathology was conducted on the lens capsule, confirming signs of dead bag syndrome. Dr. Trindade described dead bag syndrome as a late cataract complication that everyone has to be aware of. It can happen after uneventful cataract surgery years after the original procedure. It’s presenting features are IOL dislocation and spontaneous capsular rupture. He also advised being careful with PMMA haptic IOLs, which tend to bend. “Have a backup lens in cases like this; they can save the day,” he said.
Editors’ note: Dr. Trindade has no relevant financial disclosures.
