Surgical management of a dropped nucleus with PFCL - Author: Yurdacan Demir MD скачать в хорошем качестве

Surgical management of a dropped nucleus with PFCL - Author: Yurdacan Demir MD

In this video we will discuss a technique to approach a dropped nucleus using PFCL to bring it to the anterior chamber to remove it with phacoemulsification. The first step is to remove the vitreous core and all membranes in the pupil and anterior chamber. You can perform this steps with the microscope light (without wide-angle system). If necessary, you can turn off the microscope light and use the Chandelier or endoillumination for better visualization of the posterior lens capsule and to avoid damaging the residual capsule support. Posterior hyaloid detachment maneuver is more difficult in the presence of large nucleus in the posterior pole but adequate vitreous removal is critical to prevent iatrogenic breaks. So, surgeon injects PFCL to fill the vitreous cavity and until bring the nucleus to the pupillary plane. Sometimes the fragment keeps behind the iris and so, you can use a scleral depressor to help place it in the correct position. It´s important to use valved system, or place a plugs in the the trocars to avoid leakage, PFCL loss or nucleus swirling. Use phaco hand piece to remove the nucleus. If possible, try do not break the nucleus in several pieces to avoid that they dropped again to the vitreous cavity. You can both use a viscoelastic behind the nucleus and use the endoillumination probe via pars plana to support and maintain the fragments into the anterior chamber. It´s important to review vitreous bases to remove all fragments and to treat an eventual retinal break. If the anterior support is intact, you can place a 3-pieces IOL in the cilliary sulcus. Author: Yurdacan Demir MD - Bursa 🇹🇷 Edition: Filipe Lucatto MD 🇧🇷 Juliana Prazeres MD 🇧🇷 [email protected]