Bayer Acquires Perfuse in $2.45 Billion Deal

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Bayer expands ophthalmology pipeline with acquisiton of Perfuse Therapeutics; Viridian announces new phase 3 data for its investigational subcutaneous injection for chronic thyroid eye disease; and Steven Dell, MD discusses the impact of declining reimbursement could on ophthalmic practices. Learn more about your ad choices. Visit megaphone.fm/adchoices

The Devil Beneath the White Cataract

Tips for managing a fibrotic anterior capsule.

Ahmed Assaf, MD, PhD, FRCSEd, FEBO

Cataract and Refractive Surgery Today

KEY TAKEAWAYS White cataracts with anterior capsular fibrosis can hide dangerous capsular tension despite a smooth preoperative appearance A mini-capsulorhexis, OVD support, blunt dissection, microscissors, and microforceps can release fibrotic adhesions while limiting radial tear risk Diffuse zonular weakness may require pressure equalization, low-energy phacoemulsification, fibrotic remnant removal, and sulcus placement of a three-piece IOL with optic capture Often resembling a smooth summer moon, white cataracts can be deceptively beautiful under the microscope, but significant surgical challenges may lie beneath them. Sometimes, the anterior capsule is not only pressurized but also severely fibrotic, creating a complex situation in which performing the capsulorhexis becomes unpredictable and potentially dangerous. Successful surgery requires careful visualization, controlled decompression, and deliberate mechanical dissection of the fibrotic capsule. This article uses a case example to highlight practical pearls for safely managing a white cataract with a fibrotic anterior capsule. THE HIDDEN CHALLENGE In the case example, the cataract initially had a smooth and uniform appearance at the surgical microscope, but the underlying pathology soon revealed itself. The anterior capsule was stained with trypan blue dye under air to enhance visualization. Immediately afterward, severe corrugation of the capsule became evident, an early sign of significant underlying tension and fibrosis. The corrugation suggested that the anterior capsule was tethered by fibrotic adhesions to deeper structures of the lens (Figure 1).

Vitreous Sensing Vitrectomy

Maria Berrocal, MD and Jordan Deaner, MD

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Can inflow rate be used to detect whether a vitrectomy probe is actively removing vitreous? In this episode of Clinical Minute: Retina, host Maria Berrocal, MD, speaks with Jordan Deaner, MD, about a novel technique for sensing vitreous during surgery. Dr. Deaner describes a study using porcine eyes to evaluate inflow rate as a proxy for vitreous removal across all vitrectomy gauges, cut rates, and vacuum settings, and discusses how the viscosity difference between vitreous and BSS produces a measurable, consistent signal. They explore the clinical implications of this approach, review potential audible and visual intraoperative cues, and discuss why higher cut rates may improve the efficiency of vitreous removal.