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Walter Lisch, MD
Tübingen, West Germany

Arch Ophthalmol. 1987;105(10):1319.

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To the Editor.

—Concerning the recent article by Skuta and colleagues¹: The various degrees of zonular laxity or localized rupture that may accompany pseudoexfoliation syndrome constitute a direct difficulty for planned extracapsular cataract extraction. To minimize intraoperative zonular stress as much as possible, I take the following precautionary measures when performing an extracapsular cataract extraction in the presence of pseudoexfoliation syndrome:

1. I perform an invariable peripheral iridectomy with radial iridotomy when the pupil is insufficiently dilatable.
   
2. A 150° corneoscleral incision is made and then secured with three temporary Barraquer silk sutures (8-0). Sodium hyaluronate is instilled into the anterior chamber. Instillation is followed by point-focal opening of the anterior lens capsule with a 20-gauge needle at the 12 o'clock position and circular excision of the anterior capsule with special capsulotomy scissors (Figure).2 This practically eliminates any traction on the zonular apparatus in contrast to conventional anterior capsulotomy.
   
3. The lens
   

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