4/1/15

1

Phacorefractive surgery in special cases: subluxated

crystalline lens and microspherophakia

Bruna Ventura, MD Recife - Brazil

Marcelo Ventura

Bruna Ventura

“The mind that opens to a new idea never returns to its original size”

Albert Einstein

•  Woman, 19 y.

•  Low vision since chidhood

•  Double lesion of mitral valve

Marcelo Ventura, MD, PhD

Bruna Ventura, MD

Marcelo Ventura

Bruna Ventura

Bruna Ventura, MD

4/1/15

2

Ophthalmic exam:

•  Exotropia

•  Refraction:

OD: -12.00 +1.00 a 50o (20/100)

OE: -11.00 +4.50 a 110o (20/100)

Marcelo Ventura, MD, PhD

Bruna Ventura, MD

Marcelo Ventura

Bruna Ventura

Bruna Ventura, MD

OD

Marcelo Ventura, MD, PhD

Bruna Ventura, MD

Marcelo Ventura

Bruna Ventura

Bruna Ventura, MD

OS

Marcelo Ventura, MD, PhD

Bruna Ventura, MD

Marcelo Ventura

Bruna Ventura

Bruna Ventura, MD

4/1/15

3

MAIN CHALLENGES

•  Capsulorrhexis

•  Centration of

bag/IOL complex

Marcelo Ventura, MD, PhD

Bruna Ventura, MD

Marcelo Ventura

Bruna Ventura

Bruna Ventura, MD

FEMTOSECOND LASER

VENTURA AMPUTATED IOL HAPTIC TECHNIQUE1-4

1- Ventura M et al. Intraocular lens implantation with one loop haptic amputed for congenital subluxation lens surgical treatment. In: Surgical and medical management of pediatric ophthalmology. 2007;248-54; 2- Ventura M et al. Arq Bras Oftalmol 2010;73(2):135-40; 3- Arraes C et al. Arq Bras Oftalmol 2010;73:171-4; 4- Hoffman R et al. J Cataract and Refract Surg 2013:1904-15.

Marcelo Ventura, MD, PhD

Bruna Ventura, MD

Marcelo Ventura

Bruna Ventura

Bruna Ventura, MD

FEMTOSECOND LASER

•  Main incision: steep meridian

•  Intrastromal relaxing incision (1 x 45 @ 268o)

Ø Astigmatism OS:

•  Topography: - 0.80 x 94º

•  IOL Master: -1.00 x 88º

Ø Capsulotomy

Marcelo Ventura, MD, PhD

Bruna Ventura, MD

Marcelo Ventura

Bruna Ventura

Bruna Ventura, MD

4/1/15

4

Marcelo Ventura, MD, PhD

Bruna Ventura, MD

Marcelo Ventura

Bruna Ventura

Bruna Ventura, MD

Marcelo Ventura, MD, PhD

Bruna Ventura, MD

Marcelo Ventura

Bruna Ventura

Bruna Ventura, MD

↑ Fragilidade zonular

TÉCNICA QUIRÚRGICA

Partial centration with CTR

Sutura del anillo endocapsular/ LIO

STRESS

IOL with amputated haptic ↓ stress in contralateral zonule

Final centration

Bruna Ventura, MD

VENTURA AMPUTATED IOL HAPTIC TECHNIQUE

POSSIBLE SOLUTION FOR SUBLUXATION

4/1/15

5

REQUIREMENTS:

•  Subluxation < 210°

•  No vitreous in AC

•  Zonular remnant in the area of subluxation

VENTURA AMPUTATED IOL HAPTIC TECHNIQUE

Marcelo Ventura, MD, PhD

Bruna Ventura, MD

Marcelo Ventura

Bruna Ventura Marcelo Ventura, MD, PhD

Bruna Ventura, MD

Marcelo Ventura

Bruna Ventura

Bruna Ventura, MD

OPTION IN PATIENTS WITH:

•  Marfan syndrome

•  Microspherophakia

•  Traumatic lens subluxation

VENTURA AMPUTATED IOL HAPTIC TECHNIQUE

Marcelo Ventura, MD, PhD

Bruna Ventura, MD

Marcelo Ventura, MD, PhD

Bruna Ventura, MD

Marcelo Ventura

Bruna Ventura

Bruna Ventura, MD

•  1st POD OS:

•  VA wo: 20/30

Marcelo Ventura, MD, PhD

Bruna Ventura, MD

Marcelo Ventura

Bruna Ventura

Bruna Ventura, MD

4/1/15

6

•  21st POD OS:

•  Ref: -0.25 +0.25 x 90 (20/20)

Marcelo Ventura, MD, PhD

Bruna Ventura, MD

Marcelo Ventura

Bruna Ventura

Bruna Ventura, MD