Phacoemulsification in Mature Cataract with Rhexis Run Away скачать в хорошем качестве

Phacoemulsification in Mature Cataract with Rhexis Run Away

In intumescent cataract there is raised intralenticular pressure that leads to high chances of rhexis run away. To reduce intralenticular pressure preoperatively, Nd YAG anterior capsulotomy was done. In these cases, capsule is stained with trypan blue dye for better visualization and visco-cohesive like sodium hyaluronate is used to maintain anterior chamber. First a small rhexis to be made, then viscous cortex and epinucleus to be aspirated with phaco probe. Alongside this, try to rotate nucleus with chopper so that fluid from periphery should come out, which further reduces intralenticular pressure. Make sure that phaco probe tip should not come in contact with capsule margin as capsule is thin and fragile in such cases. Always bring phaco sleeve anteriorly so that only phaco tip opening is visible. After aspiration of viscous fluid with phaco tip, allow anterior chamber to get collapse so that viscous fluid comes out from capsular bag. Now, form anterior chamber with sodium hyaluronate and enlarge the rhexis. Then proceed with phacoemulsification taking care not to put much stress on zonules. In this case, despite taking all precautions, while enlarging the rhexis, rhexis run away was noted. Then we tried to enlarge the rhexis by giving another nick but it also tends to run away. Finally we gave a nick near the primary tear site and completed the rhexis with utrata forceps. Once the rhexis run away, phaco should be performed with care and at low parameters. AC waxing and waning should be avoided as it puts further pressure on tearing edge of the capsule. Always inject viscoelastic while taking out phaco and I/A handpiece. Overfilling of AC with viscoelastic should be avoided as it further put positive pressure on tearing edge of capsule. Minimize the manipulation in the torn area of rhexis. Preferred technique in such cases is to do direct chop. If not comfortable with direct chop, then one can proceed with stop and chop. Last pieces of nucleus to be taken out slowly at further low vacuum to avoid any surge. In this case, while taking out last nucleus pieces, we noticed complete tear in the posterior capsule but vitreous face was intact and we decide to implant three piece IOL in the sulcus. Then cortex was aspirated carefully. Wound was hydrosealed and case concluded. DR D D VERMA DIRECTOR D D EYE INSTITUTE, PHACO, CORNEA & REFRECTIVE SURGEON IN KOTA, RAJASTHAN , INDIA. CONTACT NO. +9414181161, MAIL US AT [email protected] PHACOEMULSIFICATION, CATARACT SURGERY & CONDUCT SHORT & LONG TERM HANDS ON PHACO NATIONAL/ INTERNATIONAL FELLOWSHIP PROGRAMME.