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- Medically Reviewed by Mr Mfazo Hove Consultant Ophthalmologist
- Author: Chris Dunnington
- Published: December 23, 2024
At Blue Fin Vision® Eye Clinic on Harley Street in London, we understand that the prospect of cataract surgery can be daunting, especially when complicated by conditions like phacodonesis. This guide will explore how phacodonesis can impact your cataract surgery, what to expect, and how our expert team ensures the best possible outcomes for our patients.
Understanding Phacodonesis
Before delving into its effects on cataract surgery, let’s briefly explain what phacodonesis is. Phacodonesis refers to the trembling or vibration of the lens within the eye, typically observed during eye movement. This condition is often a sign of weakened zonules, which are the fibres that hold the lens in place.
The Impact of Phacodonesis on Cataract Surgery
Phacodonesis can significantly influence the approach to and outcomes of cataract surgery. Here’s how:
Increased Risk of Complications
Patients with phacodonesis are at a higher risk of experiencing complications during cataract surgery. The primary concern is the increased likelihood of zonular dialysis, which occurs when the zonules supporting the lens break or become detached during the procedure.
Important: Diagnosis of phacodonesis is the single risk factor that increases the risk of complications the most. These cases require careful planning and preparation.
Need for Additional Surgical Techniques
The presence of phacodonesis often necessitates the use of specialised surgical techniques and tools to ensure a successful outcome. These may include:
- Capsular Tension Rings (CTRs): These devices help stabilise the capsular bag during surgery, providing additional support to weakened zonules.
- Modified Capsular Tension Devices: In cases of more severe zonular weakness, devices such as the Ahmed Capsular Tension Segment or the Cionni Ring may be employed.
- Scleral Fixation: In some instances, the intraocular lens (IOL) may need to be fixed to the sclera (the white part of the eye) for added stability.
Extended Surgery Duration
Due to the need for additional care and potentially more complex surgical techniques, cataract surgery in patients with phacodonesis may take longer than standard procedures.
Potential for Lens Dislocation
In severe cases of phacodonesis, there’s a risk of lens dislocation during surgery. This can complicate the procedure and may require additional interventions to manage.
Preoperative Considerations
At Blue Fin Vision® Eye Clinic, we take several steps to prepare for cataract surgery in patients with phacodonesis:
Comprehensive Eye Examination
A thorough eye examination is crucial to assess the extent of phacodonesis and plan the surgical approach accordingly. This may include:
- Slit-lamp examination to evaluate lens movement
- Ultrasound Biomicroscopy (UBM) to assess zonular integrity
- Optical Coherence Tomography (OCT) to examine the retina and optic nerve
Risk Factor Assessment
We carefully evaluate potential risk factors that may have contributed to the development of phacodonesis, such as:
- Pseudoexfoliation Syndrome: A common cause of zonular weakness
- High Myopia: Can be associated with lens instability
- Previous Eye Trauma: May have weakened the zonular apparatus
- Systemic Conditions: Such as Marfan’s syndrome or diabetes, which can affect eye structures
Surgical Planning
Based on the preoperative assessment, our experienced surgeons at Blue Fin Vision® develop a tailored surgical plan. This may involve:
- Selecting appropriate intraocular lenses
- Deciding on the use of capsular support devices
- Planning for potential complications
Advanced Lens Options
At Blue Fin Vision®, we offer a range of advanced lens options for patients with phacodonesis:
- Intracapsular lens: For cases where the capsular bag can be preserved
- Sulcus lens: When additional support is needed
- Sclera fixated lens: For cases of severe zonular weakness
- Anterior chamber IOL: As an alternative option in complex cases
For patients desiring premium lens options, we can discuss the possibility of a sulcus-based monofocal lens with a subsequent Sulcoflex Trifocal lens.
The Surgical Procedure
Cataract surgery in patients with phacodonesis requires a delicate approach and expert handling. Here’s what you can expect during the procedure at our London eye clinic:
Anaesthesia
Local anaesthesia is typically used, but the specific type may depend on the severity of phacodonesis and other factors.
Incision and Capsulorhexis
The surgeon makes a small incision in the cornea and creates a circular opening in the lens capsule (capsulorhexis). Extra care is taken during this step to avoid putting undue stress on the weakened zonules.
Lens Removal
The cataractous lens is carefully removed using phacoemulsification. In cases of phacodonesis, surgeons may opt for gentler techniques such as a supracapsular flip or a well-controlled chop to preserve the zonules as much as possible.
Capsular Support
If significant phacodonesis is present, a Capsular Tension Ring may be inserted at this stage to stabilise the capsular bag.
IOL Implantation
An artificial intraocular lens is implanted. The type of IOL and implantation technique will depend on the stability of the capsular bag and zonules.
Additional Measures
In cases of severe zonular weakness, additional steps may be taken, such as scleral fixation of the IOL or the use of modified capsular tension devices.
Postoperative Care and Outcomes
After cataract surgery, patients with phacodonesis require careful monitoring:
Immediate Postoperative Period
- Close monitoring for signs of IOL decentration or dislocation
- Vigilant observation for potential complications such as elevated intraocular pressure
Follow-up Appointments
Regular follow-up appointments are crucial to ensure proper healing and to address any concerns promptly.
Visual Outcomes
With appropriate management, many patients with phacodonesis can achieve visual outcomes like those without the condition. However, the recovery period may be slightly longer, and additional interventions might be necessary in some cases.
Why Choose Blue Fin Vision® Eye Clinic for Your Cataract Surgery?
At Blue Fin Vision®, located on prestigious Harley Street in London, we offer:
- Expert Surgeons: Our team has extensive experience in managing complex cases, including cataract surgery in patients with phacodonesis.
- Advanced Technology: We utilise state-of-the-art diagnostic and surgical equipment to ensure the best possible outcomes.
- Personalised Care: We tailor our approach to each patient’s unique needs, ensuring optimal results.
- Comprehensive Support: From initial consultation through to postoperative care, we provide unwavering support throughout your journey.
New for 2025: In-House Vitreo-retinal Capabilities
We’re excited to announce that in 2025, Blue Fin Vision® has invested in a full Vitreo-retinal equipment package. This allows us to manage dropped nuclei and complex cataract surgeries, such as those involving phacodonesis, in-house. This advancement means we can avoid the need to refer these cases as emergencies to the NHS if complications arise during surgery.
Conclusion
While phacodonesis can complicate cataract surgery, with expert care and advanced techniques, excellent outcomes are achievable. At Blue Fin Vision® Eye Clinic in London, we’re committed to providing the highest standard of care for all our patients, including those with complex eye conditions.
If you’ve been diagnosed with phacodonesis and are considering cataract surgery, we invite you to schedule a consultation with our specialists. Let us help you navigate this journey with confidence, ensuring the best possible outcome for your vision and eye health.
Remember, your vision is precious, and at Blue Fin Vision® Eye Clinic, we’re here to help you see clearly and live fully. Don’t let phacodonesis hold you back from experiencing the benefits of cataract surgery. Contact us today to take the first step towards clearer vision.
