Magic tool for White Intumescent Cataractالأداة السحرية لعملية المياة البيضاء و زرع العدسة скачать в хорошем качестве

Magic tool for White Intumescent Cataractالأداة السحرية لعملية المياة البيضاء و زرع العدسة

#White Cataract #Cataract #Centurion #Phacoemulsification #Alcon #Healon 5 The Magic tool for the white intumescent cataract To explain the technique of using Healon 5 viscoadptive Ocular Viscoelastic Device (OVD) for performing continuous curvilinear Capsulorrhexis (CCC) in dealing with white intumescent cataract. Removal of a white cataract is one of the most difficult anterior segment procedures to perform. The trickiest white cataract to remove is a intumescent-type cataract. These cataracts have markedly hydrated swollen lenticular material, which then causes an increase in lens thickness and a relatively tense lens capsule. In the extreme circumstance, the cortex can completely liquefy and allow the dense nucleus to sink to the bottom of the capsular bag, forming a morgagnian cataract. The most difficult step of cataract surgery in these hypermature intumescent cataracts is performing a CCC without an extension upon the opening of the capsular bag. Sixty your old female with white intumescent cataract. Vision is PL and normal B-scan ultrasound for posterior segment structures. Staining of the anterior lens capsule with a stain such as trypan blue is very helpful in allowing visualization of the capsule without an adequate red reflex. A high molecular weight or a super cohesive OVD such as Healon5 (Abbott Medical Optics, Santa Ana, Calif). This will help to flatten the dome of the capsule and keep the anterior chamber pressurized without leakage of the OVD out of the anterior chamber during the performance of the capsulotomy. If there is any high pressure it is important to avoid puncturing the capsule with a large forceps, as this may cause an uncontrolled tear with the so-called Argentinian flag sign, in which the white cataract is seen in the centre and the blue stained capsule on both sides with a tear extending to the equator. This can be minimized by using a sharp cystotome to begin the CCC with a very small puncture of the capsule and immediate aspiration of the liquified cortex underneath the anterior capsule to help decompress the intumescent lens. Once decompression has been performed, the capsulotomy can be done safely using an Utrata-type forceps through the stab incision. As there still may be some posterior pressure causing forward bowing of the lens, it is important to perform a relatively small capsulorhexis initially and to replace the highly retentive viscoelastic in the anterior chamber of the IOL to continually flatten the capsule and try to prevent the capsule from extending outward. Once an adequate CCC has been completed, then the phacoemulsification handpiece may be used to remove the liquified cortex and epinuclear material in order to adequately assess the hardness of the lens nucleus. In cases where much of the cataract has been liquified, the nucleus may be relatively soft and easy to remove using a standard vertical chopping technique. When there is a large, relatively brunescent nucleus present, there is often very little cortex or epinucleus present, which usually helps to stabilize the nucleus within the capsular bag. This nucleus may become relatively mobile, and the fact that there is little cortex behind the nucleus leaves little margin for error in terms of the posterior capsule. A high vacuum setting may be used to impale the nucleus, and a vertical chop may be used to break off small pieces of the nucleus, which will then allow them to be brought into the plane of the iris with phacoemulsification. It is essential that the surgeon be aware of the various types and presentations of white cataracts. Anterior capsular dyes such as trypan blue are an excellent adjunct to allow adequate visualization of the capsule in these white cataracts. An intact CCC is critical, and careful attention to technique must be paid in order to prevent splitting or running out of the anterior capsule. Once an adequate capsulotomy is performed, using Healone 5 the difficulty of the remaining surgical procedure depends on the hardness of the lens nucleus. Often, straightforward or routine phacoemulsification is possible on these hypermature cataracts once the lens is decompressed and an adequate capsulotomy is performed.