Create the ideal capsulorhexis every time скачать в хорошем качестве

Create the ideal capsulorhexis every time

Here are some tips and tricks for constructing the perfect capsulorhexis…. My aim is for 5.5mm diameter so there will be overlap 360 degrees on a 6mm diameter IOL when implanted in the bag. I first taught myself capsulorhexis, by watching other surgeon’s videos and going to observe them in person at their Operating Suite. I started the rhexis by piercing the capsule in the centre of the pupil with a bent 25G needle on a syringe. I would then make a “U” shaped tear inferiorly with the needle tip. Fortunately, we now have pre-made cystotomes for this step and no longer need to make our own. I would then grasp the edge of the flap with the capsulorhexis forceps and make my rhexis. I practiced between cases on whole tomatoes and grapes. The skin of the tomato or grape makes a good surrogate for the lens capsule. My anaesthetist would ask me, “How do you get the rhexis so perfectly round?” I learnt to create the perfect circle ⭕️ by following around in line with the pupil margin of the iris. For a standard dilated pupil this would be approximately 1.5mm in from the iris margin all round. I used frequent re-grasping to keep a short lead on the capsular tag. I needed to regrasp the capsule each time, close to edge of the rhexis for better control. Watch my video here demonstrating the importance of frequent regrasping,    • Capsulorhexis  Dense  Dr Diane Webster   This rhexis is unedited and created in 12 seconds. I first became confident with creating the rhexis anticlockwise and then practised creating it easily either anticlockwise or clockwise to improver versatility. If the rhexis ever started to proceed out tangentially then I would apply more viscoelastic directly on top of the edge of the tear to direct a vector of force posteriorly to the optic nerve head. It is then easy to redirect the tear radially and keep the perfect circle. Another important tip is to always be slightly lifting the flap not slightly depressing the flap as you tear it. During the many hours I have spent supervising trainees in cataract surgery, this seems to be a common error (slightly depressing the edge of the flap while tearing) that slows their improvement in making the capsulorhexis easily. Once I was confident with starting the rhexis with the 25G needle or cystotome, I then progressed to starting and completing the rhexis with the rhexis forceps. I would pierce the centre of the capsule (in the centre of the pupil) with one tip of the forceps, then immediately grasp the edge of the tiny circle I had created. I then start tearing the rhexis out to within 1.5 mm of the pupil edge and then follow the pupil edge around leaving the same width between the edge of the rhexis and the pupil margin. This creates a lovely circular capsulorhexis. Never miss a free weekly update from me. https://stan.store/drdianelesleywebst... Learn the heuristics of Cataract Surgery the new way with the Cataract Surgery System https://stan.store/drdianelesleywebst... #cataractsurgerysystem #cataractsurgerymentor #cataractsurgery #drdianelesleywebster