Prevention of Argentinian flag sign with phaco rhexis for dense white cataract with miLoop скачать в хорошем качестве

Prevention of Argentinian flag sign with phaco rhexis for dense white cataract with miLoop

One of our chief residents Caroline Wilson did a great job with this white cataract to prevent the Argentinian flag sign and to remove a dense lens with the miLoop. This mature lens was under pressure and is at risk for a rapid tear to the periphery or the Argentinian flag sign during capsulorhexis. There are several strategies to prevent the Argentinian flag sign: 1) make an initial small tear and then use a canula to remove lens fluid. 2) use a 27 gauge needle to simultaneously remove lens fluid and start the tear. 3) use the phaco needle to start the tear and remove lens fluid. In any of these strategies rocking the dense nucleus to release posterior lens fluid is useful. After making the initial tear, placement of OVD to flatten the anterior capsule makes it less likely that the rhexis tear will go out radial. In our case Dr Wilson uses the phaco needle with low vacuum (and flow) settings (similar to sculpting). The needle was used to bore through the capsule into the lens making a round fairly stable hole in the capsule and releasing fluid. Then a canula was used to rock the nucleus and release posterior fluid. OVD was placed to flatten the anterior capsule several times during the rhexis as Dr Wilson "spiraled" out the tear to the desired diameter. The nucleus was dense and so the miLoop was used to break the lens mechanically into 4 pieces. Liberal use of OVD to displace lens fluid and to widen the space between the lens and the anterior capsule aids in this technique. The 4 nuclear pieces were then removed with the phaco needle using high vacuum settings with longitudinal ultrasound with pulses at 80 per second using a duty cycle of 35% on to increase attractiveness of the tip and to lessen heat generation. Thank you for any comments. tom o