Ophthalmic Hyperguide. Section: Cataract and IOLs

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Suresh K. Pandey, MD · Liliana Werner, MD, PhD · David J. Apple, MD · Leonardo P. Werner, MD · Andrea M. Izak, MD · Rupal H. Trivedi, MD

Click on each slide to view a larger image.

	Slide 1A, B, C. Slit-lamp photographs showing three examples of advanced/white cataracts. Courtesy of Abhay R. Vasavada, MD, FRCS, Ahmedabad, India.
	Slide 2 A, B. Gross photographs of human eyes obtained postmortem showing the presence of a white cataract. Anterior (surgeon’s) view. Miyake-Apple posterior view.
	Slide 3 A, B, C. Anterior (surgeon’s) view of a human eye obtained postmortem with advanced/white cataracts showing the staining of the anterior capsule under an air bubble. Fluorescein sodium. ICG. Trypan blue. Visualization of the anterior capsule is enhanced after staining with ICG. Visualization of the anterior capsule is enhanced after staining with trypan blue.
	Slide 3 D, E. Anterior (surgeon’s) view of a human eye obtained postmortem with advanced/white cataracts showing the staining of the anterior capsule under an air bubble. Fluorescein sodium. ICG. Trypan blue. Visualization of the anterior capsule is enhanced after staining with ICG. Visualization of the anterior capsule is enhanced after staining with trypan blue.
	Slide 4 A, B. Anterior (surgeon’s) view of a human eye obtained postmortem with white cataract showing the staining of the anterior capsule using intracameral subcapsular injection of ICG. Cornea and iris were excised to allow better visualization of the anterior capsule. Note the entrapment of the dye into the subcapsular space (arrows). The capsulorrhexis can be initiated by grasping the injection hole.
	Slide 4 C, D. The visualization of the anterior capsule is enhanced by the staining of its posterior surface with the dye.
	Slide 5 A, B. Anterior (surgeon’s) view of a human eye obtained postmortem showing the better contrast against the white cataract provided by the staining of the posterior surface of the anterior capsule with trypan blue.
	Slide 6 A, B, C. Miyake-Apple posterior view of a human eye obtained postmortem showing the progressive leakage of fluorescein sodium into the vitreous cavity after intracameral subcapsular injection. Note that the intensity of the leakage increases as time progresses. A. Five minutes after intracameral subcapsular injection. B. Same globe, 15 minutes after intracameral subcapsular injection. C. Same globe, 2 hours after intracameral subcapsular injection.
	Slide 7A, B. Gross photographs of a human eye obtained postmortem. Cornea and iris were excised to allow better visualization. Anterior (surgeon’s) view showing hydrodissection/hydrodelineation enhanced by trypan blue. Notice the complete (360°) blue-colored fluid wave indicating separation of the nucleus/epinucleus complex. Sagittal section of the same crystalline lens, showing the demarcation zone between the nucleus/epinucleus complex (arrows).
	Slide 8 A, B. Gross photographs of a human eye obtained postmortem taken from an anterior (surgeon’s) view while performing nucleus sculpting. Cornea and iris were excised to allow better visualization. Gimbel’s divide-and-conquer nucleofractis technique. Notice that trypan blue dye enhances visualization of the groove. This is helpful to judge the position of the phaco tip and its relation with the posterior capsule.
	Slide 9 A, B. Gross photographs of human eyes obtained postmortem taken from an anterior (surgeon’s) view after the completion of irrigation/aspiration. Cornea and iris were excised to allow better visualization. Note the cleaned capsular bags, stained green and blue after the use of ICG and trypan blue dyes, respectively. The arrows demonstrate in both cases the staining of the minimal residual cortical material. ICG. Trypan blue.
	Slide 10 A, B, C. Gross photographs of a human eye obtained postmortem showing posterior continuous curvilinear capsulorrhexis (PCCC) after staining of the capsular bag with indocyanine green (ICG). Cornea and iris were excised to allow better visualization. Anterior (surgeon’s) view of the cleaned and stained capsular bag showing initiation of the PCCC. Note that it is easier to visualize the stained posterior capsule flap (PCF) against transparent (non-stained) anterior hyaloid phase (AHP) of the vitreous. The PCCC is in progress. The PCCC is completed. Note the stained PCCC margin; PCF: posterior capsule flap.
	Slide 11 A, B, C. Gross photographs of a human eye obtained postmortem showing posterior continuous curvilinear capsulorrhexis (PCCC) after the staining of the capsular bag with trypan blue. Cornea and iris were excised to allow better visualization. Anterior (surgeon’s) view of the cleaned and stained capsular bag showing initiation of the PCCC. Note that it is easier to visualize the stained posterior capsule flap (PCF) against transparent (non-stained) anterior hyaloid phase (AHP) of the vitreous. The PCCC is in progress. The PCCC is completed. Note the stained PCCC margin; PCF: posterior capsule flap.
	Slide 11 D, E. Higher magnification of the optic-haptic junctions after intraocular lens (IOL) optic capture. Both haptics are present in the capsular bag, and the IOL optic is captured behind the posterior capsule.
	Slide 12 A, B, C. Photographs of a pediatric eye obtained postmortem, taken from anterior (surgeon’s view) illustrating the use of the capsular dye to enhance visualization during various steps of pediatric cataract surgery. A. Posterior capsulorrhexis after the staining of the capsular bag with trypan blue. B. Posterior capsulorrhexis and optic capture of a foldable IOL after the staining of the capsular bag with trypan blue. C. Visualization of a posterior capsule tear after staining of the capsular bag with ICG (arrows).