Staging a Support Structure - A Novel IOL Scaffolding Technique for Surgically Managing Hypermature Cataract

Abstract Hypermature cataract (HMC) presents an immemorial challenge to even the most skilled surgeons, despite the advancements in ophthalmology. HMC can obscure a hard, brunescent nucleus underneath it. It can present with secondary complications such as phacomorphic or phacolytic glaucoma, which requires medically management before surgical intervention. This manuscript describes a technique for performing safe phacoemulsification and manual small incision cataract surgery (MSICS) on HMC using intraocular lens (IOL) as a scaffold. In this approach, the IOL acts as a scaffold to prevent rupture of the vulnerable posterior capsule during cataract surgery and acts as a barrier to prevents the nuclear fragments from falling posteriorly into the vitreous cavity if posterior capsular rupture (PCR) occur. The scaffold provided stable inflation of the capsular bag. It also prevented the dehiscence of weak zonular fibers by minimizing stress on the zonular apparatus. Thus, we could prevent PCR with a successful in-the-bag IOL.