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Cataract Symposium Controversies in Cataract Surgery

Moderator:-Ahmed Ghoneim

Speakers:-Ahmed Assaf

-Ahmed Elmasry

-Abd elmagid Tag eldin

-Hisham Fawzy

-Khaled Fawzy

-Mahmoud Afify

-Sherif Gamal Eldin

Management of lens subluxation

AHMED GHONEIM,MD.Prof. of Ophthalmology

Faculty of Medicine-Tanta University

Fellow Of Mainz University

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Case (1):At the beginning what u think about the capsule.

Respect the capsule all the time

Ahmed Ghoneim,MD

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OK…What u think about the zonule ??

Ahmed Ghoneim,MD

Look very carefully ??

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Corrugations at ant.capsule..

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Slow Motion…

How much?? Stretching the

zonule

Ahmed Ghoneim, MD

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Max. zonular

strech 3.82 mm

1.6 mm

How much??

Stretching the zonule

Ahmed Ghoneim, MD

How much ?? Streching the

capsule

62%

6 mm = 9.72

5.5 mm = 8.91

5 mm = 8.1

Ahmed Ghoneim, MD

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Case No.(2):Extensive sublaxation.

Video

Ahmed Ghoneim, MD

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I-Xtensive

capsular

sublaxation

• TraditionalCTR cant beused in suchcondition.

Ahmed Ghoneim, MD

I-Xtensive capsular

sublaxation

• Cionni CTR.

Ahmed Ghoneim, MD

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Video

Ahmed Ghoneim, MD

Video

Ahmed Ghoneim, MD

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Ahmed Ghoneim, MD

Video

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steps

2

1

5

4

3

4

8

6

7

9

Extensive subluxation 2 A, still needs more..

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Ahmed Ghoneim, MD

Ahmed Ghoneim, MD

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I-Xtensive capsular

sublaxation

• Cionni CTR.

Ahmed Ghoneim, MD

Endocapsular Hooks & Cionni Capsular Rings

Ahmed Ghoneim, MD

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Ahmed Ghoneim, MD

Ahmed Ghoneim, MD

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Ahmed Ghoneim, MD

Ahmed Ghoneim, MD

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Ahmed Ghoneim, MD

Ahmed Ghoneim, MD

Adjust the eyelet above the capsule

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Ahmed Ghoneim, MD

Ahmed Ghoneim, MD

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Ahmed Ghoneim, MD

Ahmed Ghoneim, MD

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Ahmed Ghoneim, MD

Ahmed Ghoneim, MD

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Case:What to do, still needs more..

What to do ??

Ahmed Ghoneim, MD

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What do you Need??

Ahmed Ghoneim, MD

Worst Scenario??

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Worst Scenario??

Worst Scenario??

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Worst Scenario??

Case:Extensivesubluxation, still needs more..

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You need More to Do…

Ahmed Ghoneim,MD

Ahmed Ghoneim, MD

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II- Capsular hooks

Vs Iris hooks:

• It is designed such

that the hook is

angled to be in the

plane of ant.

capsule so it is easy

to get firm and

reliable grip onthe capsule edge.

Ahmed Ghoneim,MD

Respect the capsule all the time

Ahmed Ghoneim,MD

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Capsular hooks

Vs Iris hooks:

• The iris hookscomes in atangle with therim not in theplane of therim to besupported.

Ahmed Ghoneim, MD

Use capsular hooks before hydro…

Ahmed Ghoneim, MD

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Use capsular hooks after hydro…

Ahmed Ghoneim,MD

Use capsular hooks before hydro…

Ahmed Ghoneim,MD

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Ahmed Ghoneim,MD

Adjust the Capsular Hooks….

Ahmed Ghoneim, MD

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Your 4th hand…

Ahmed Ghoneim, MD

Respect the capsule & iris all the time

Ahmed Ghoneim, MD

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Ahmed Ghoneim, MD

Case:Traumaticsublaxation with CTR,Pupilloplasty..

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Think …before

Ahmed Ghoneim,MD

Still need more…

Ahmed Ghoneim, MD

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CTR,phaco & pupiloplasty

Ahmed Ghoneim, MD

Case:

What u think to do in such situation.

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Vit. after implantation I

Ahmed Ghoneim, MD

Vit. after implantation II

Ahmed Ghoneim, MD

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Vit. after implantation I

Ahmed Ghoneim, MD

Case :

Zonulardehiscence..Pupilsnap sign ??

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Ahmed Ghoneim, MD

Pupil Snap sign.slow

Ahmed Ghoneim, MD

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Pupil snap sign

Ahmed Ghoneim, MD

Case No:

Pupil snap sign. See it again. Change your decision ??

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Pupil Snap sign

Pupil Snap Sign

Slow motion ?? Pupil snap sign

Pupil Snap Sign

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Pupil Snap sign.cont

Pupil Snap Sign

Ahmed Ghoneim, MD

Case :

Simple but tricky.

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Ahmed Ghoneim, MD

Ahmed Ghoneim, MD

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I NEVER FORGET

Ahmed Ghoneim, MD

Always look .. Not to forget ??

Ahmed Ghoneim, MD

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