Small, Tiny, Itsy Bitsy Pupil: Put a Ring on It? скачать в хорошем качестве

Small, Tiny, Itsy Bitsy Pupil: Put a Ring on It?

My routine cataract technique for very small pupils without using rings or hooks. Why do this when I can using a ring or hooks? Well, because I prefer to streamline my technique to cover a wide array of lens densities, pupil sizes, weak zonules, etc. Streamlining enables more efficiency and in my hands better safety. One can argue that it is risky not to put a ring on it. I would argue that this is risky only if you perform techniques which would increase the risk in this setting. For example, sculpting surgeons require a good red reflex to determine the depth for sculpting. Chop surgeons must impale the lens and hold with high vacuum in order to immobilize before chopping the lens. Small pupils have really poor red reflex and thus sculpting would be riskier. Traditional chopping requires high vacuum which can be risky if the pupil is small or if you get close to the posterior capsule. One can argue that a ring is so easy and should be used for all pupils. I would counter that rings can cause pupil trauma, iris atrophy, pupil distortion, capsule tears, ring dislocations, hyphema, etc. In other words, rings are not always benign. This technique does not depend on a big pupil. It does not depend on a red reflex. It does not depend on U/S, aspiration or vacuum. Hooks are less likely to cause some of the complications of a ring but still require time and can traumatize and distort the pupil. For these reasons, mechanical fracturing through double chop, cross chop, hooking lens fragments with the chopper, these all work to help disassemble and remove the lens in a very controlled and safe manner within the safety of the pupillary safe zone. The phaco handpiece is kept in the middle and the chopper brings lens fragments to the phaco tip. Fracturing is performed without U/S or vacuum enabling very safe and exquisite control of lens fragments without risk to the iris or posterior capsule. These cases are as smooth as any routine surgery. No additional instrumentation, manipulation, or time required. One caveat. In order to employ this approach, one must master chopping techniques and become very comfortable placing the chopper out to the equator, one must master footpedal modulation, one must master how to pull fragments into the middle using the chopper, and one must learn how to sandwich the lens using only mechanical forces.