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To report a new sign of zoular weakness during cataract surgery. To our knowledge, this is the first time this sign of zonular weakness is reported.
Ten eyes underwent cataract surgery using phacoemulsification by one surgeon (DA). Mean age was 74 years. They all have visually significant cataracts. Preoperatively, during slit-lamp exam, zonular weakness was not noted. Intraoperoperatively, during removal of the trypan blue out of the anterior chamber, reflux of the trypan blue under the pupillary margin back into the anterior chamber was noted. When surgery continued, other well-known signs of zonular weakness were observed.
All ten eyes underwent cataract surgery had zonular weakness. This was confirmed by observing other well-known signs of zonular weakness during cataract surgery. Two of the eyes also needed capsular tension ring implantation to stabilize the lens capsular bag.
It seems that zonular weakness causing the lens to displace posteriorly causing more space between the lens and the iris that acts a pocket and holds more trypan blue during anterior capsule staining. During removal of the trypan blue with anterior chamber washout, more trypan blue is refluxing into the anterior chamber from this pocket.