"Little" Capsulorhexis Rescue Technique скачать в хорошем качестве

"Little" Capsulorhexis Rescue Technique

One of the most valuable, if not most valuable, techniques that I learned in residency is the capsulorhexis rescue technique developed by Brian Little (Little capsulorhexis tear-out rescue Brian C. Little, FRCOphth, Jennifer H. Smith, MD, Mark Packer, MD J Cataract Refract Surg 2006; 32:1420--1422). I credit Preston Blomquist, MD for teaching this to me and I'll be eternally grateful since it's gotten me out of several tight spots on complicated cataract cases. This technique is very handy for white intumescent cataracts and in nanophthalmic eyes with shallow chambers. In this video I'll show two cases, the first of a diabetic white cataract where the vision went from 20/30 to LP over a couple months. After staining the capsule with Trypan Blue and filling the AC with Healon 5, a 27g needle is used to centrally puncture the capsule and aspirate out some liquid coritcal material to decompress the capsule. A cystitome is used to start a small central flap and the Jones-Inamura style forceps from Crestpoint Management is used to compete the capsulotomy using the rescue technique. I find that it's best to use the technique at the first sign of problems before the problem gets out of hand. I often see people employ it when the tear is getting close to the iris. In my opinion, it's best to use the rescue technique before it gets that far since there are no real downsides to using it. One key point is to do this very gently since one possible problem is redirecting so fast that you complete a small rhexis since it completes over a very small area. This can occur if you pull too hard. If it does occur you can cut a new edge using intraocular scissors and finish with a complete rhexis. The second case was an intumescent cataract where the initial tear hit an area of fibrosis and while gently leading the tear through the fibrosis, the tear instantly radialized. Since the forces were gentle, it didn't go under the iris and the edge is still visible. The rest of the capsulotomy was completed going the other direction. The resuce technique is able to convert the radial tear into a continuous capsulotomy, although not completely circular. There is a 4+ NSC remaining so having a complete capsulotomy, even if not circular, is critical.