Endocapsular surgery and capsular bag fixation of intraocular lenses in phacolytic glaucoma.

Performing endocapsular surgery can be more difficult in eyes with phacolytic glaucoma because the capsule is fragile and zonules are weak. In this study, I investigated the safety and efficacy of a technique for performing endocapsular surgery with and without posterior chamber intraocular lens (IOL) implantation in 19 eyes of 19 patients with phacolytic glaucoma. This technique involves aspiration of the fluid cortex from the capsular bag using a 26 gauge bent needle. After anterior capsulotomy with angled Vannas scissors, the nucleus is delivered using minimal pressure on the irrigating vectis. The remaining cortex is completely removed using minimal irrigating fluid. At the end of the procedure, a posterior chamber IOL is inserted in the bag as indicated. A V-shaped anterior capsulectomy is completed using Vannas scissors, without exerting traction on the zonules. Intraoperatively, internal structures can be clearly visualized and the entire procedure performed with minimal trauma to the fragile lens capsule and zonular apparatus. I encountered no major complications. Follow-up ranged from 12 to 36 months with satisfactory visual outcome and good intraocular pressure control without antiglaucoma medication in all patients.