10 Secrets of successful Phacoemulsification Cataract surgery and Intraocular lens Implantation скачать в хорошем качестве

10 Secrets of successful Phacoemulsification Cataract surgery and Intraocular lens Implantation

1-Planning of your clear corneal incisions site (typically a bi or tri-planar wound to promote self-seal) On steep meridian to reduce postoperative astigmatism. Begin with 2 paracentesis at 6 and 12 clock hours if the incision is temporal. If patient is Myope and deep AC, use short tunnel to avoid corneal corrugations. If patient is hypermetrope and shallow AC, use long tunnel to avoid iris prolapse. 2-Trypan blue stain is a valuable tool in doing capsulorhexis which is the creation of an opening in the anterior capsule to gain access to the cortex and nucleus. Most of the capsule is left intact to provide a pouch for insertion of the IOL. 3-Injection of Cohesive OVD to maintain AC depth and start injecting opposite the incision. 4-Cystotome on OVD cannula to avoid going in and out frequently. Start in the centre under the microscope light reflection First, an angular tab is made in the capsule from the centre under the microscope light reflection then sub-incisionally anti-clockwise. This tab is then pulled in a curvilinear motion to create a circular opening. This is the most important surgical step since mistakes can make the removal of the natural lens and IOL insertion very difficult. 5-Hydrodissection to dissociate the cortex from the overlying capsule by injecting a balanced salt solution (BSS) between the cortex and capsule. The surgeon needs to depress the lens to slightly down to ensure the wave of fluid is completed anteriorly. 6-Divide and Conquer approach of phacoemulsification of the nucleus. It is first divided into two main pieces. A probe uses ultrasonic energy to break up the lens nucleus. A vacuum attached to the same probe removes the nucleus fragments that are generated. Several other approaches may be used including approach whereby the techniques use a chopper as a second instrument to fragment the nucleus into multiple pieces which are then emulsified by the phaco-hand piece. 7-Posterior capsule is not forgiving but cornea can forgive you. 8-Bimanual Irrigation aspiration of the cortex is aspirated and pulled away from the capsule. Hydroirrigation of any cortical remnants. Care must be taken to avoid tearing the posterior capsule and allowing vitreous loss into the anterior chamber. 9-If any capsular opacity, remember YAG laser posterior capsulotomy is cheaper than vitreous loss. Any vitreous loss can make very high chance of the future complications. 10-The capsular bag is filled with a cohesive OVD (this is a less viscous OVD than was used to fill the anterior chamber), creating a space in which to inject the lens. Placement of the IOL. The lens itself has the optic and two haptics (arms). The lens is inserted into the capsular bag through a tube and uncurls automatically. The haptics extend outward into the periphery of the capsular bag to maintain the optic within the center of the capsular bag. If the optic is right side up, the haptics form the shape of a number “2” or “Z”, and an optic placed upside down will look like an “s.” Removal of OVD from the capsular bag and anterior chamber. Hydration of the corneal incision with BSS, which causes local corneal epithelial cells to expand and compress each other and allows for wound closure without sutures. Assessment for leakage by drying the wound area with a weck-cell tip and gently pressing down on the sclera watch iris movement. Application of intracameral antibiotic injection 0.1 ml solution contains 1 mg of cefuroxime during surgery always used and reduce the incidence of endophthalmitis.