Vitreous in the Anterior Chamber at the start of the phaco cataract surgery. What to do? скачать в хорошем качестве

Vitreous in the Anterior Chamber at the start of the phaco cataract surgery. What to do?

I had just started what I thought would be a routine cataract phaco case when I noticed there was vitreous already in the anterior chamber. I injected Vision Blue (Trypan Blue) to stain the capsule and also to stain the vitreous and make the invisible visible. When I started the capsulorhexis. It formed a distorted shape rather than a circular shape. There was a zonular dehiscence of 2 to 3 clock hours (between 3 and 5 o’clock). I was able to tamponade the vitreous with the cohesive viscoelastic. I inserted one capsule hook through a 1.5mm paracentesis made at 4 o’clock to support the capsular bag. Further vitreous prolapse occurred so prior to nuclear removal I cleared any vitreous from the anterior chamber with a bimanual vitrectomy. Watch this video on an anterior vitrectomy    • punctured posterior capsule and anterior v...   I performed hydro delineation rather than hydrodissection to protect the capsular bag. I phacoed the nucleus in the iris plane just out of the capsular bag to put no stress on the zonules. I used a vertical chop technique   / urn:li:activity:7419900322900373504   Cortical removal was performed circumferentially rather than radially and started where the zonules were strongest. I removed the cortex at the site of the dehiscence last. Immediately all cortex was removed I inserted a Capsular Tension Ring (CTR). Then I was able to insert a monofocal IOL into the capsular bag. I removed the Capsular hook and remaining viscoelastic. I injected triamcinolone into the AC to see if any remaining vitreous. There was a little, so a further anterior vitrectomy was performed. Intracameral cefazolin 1mg was administered. The corneal incision was self-sealing and did not require sutures. Never miss a free weekly update about cataract surgery from me. https://stan.store/drdianelesleywebst... Learn the heuristics of Cataract Surgery the new way with a Cataract Surgery System https://stan.store/drdianelesleywebst... #cataractsurgerysystem #cataractsurgerymentor #cataractsurgery #drdianelesleywebster