EVO ICL EXPLANTATION : TUCK AND PULL TECHNIQUE скачать в хорошем качестве

EVO ICL EXPLANTATION : TUCK AND PULL TECHNIQUE

https://journals.lww.com/ijo/Fulltext... This case is hyperopic ICL implantation with extremely high vault. Implantation was one month ago. In step 1: creation of sideports easly with lasik spatula. In step 2; Injection of OVD behind the ICL to widen the space between ICL and the crystalline lens Step 3: After separating ICL from the natural lens, OVD is injected into the AC to protect all the AC structures Step4: Up to one year, the original main incision can be used, as 2.8 mm is enough. It is easily found with a blunt LASIK spatula or a Sinskey hook Step 5: The nearest ICL haptic is elevated with the additional injection of OVD under the ICL Step 6: Tucking of the ICL haptic and pulling through the main incision is the most important step. The haptic is hooked and tucked using a chopper with long blunted tip, pulled through the main incision. Step 7: The haptic that is held through the main incision by the chopper in one hand is grasped by a suture forceps in the other hand . Then, the haptic is taken out by two suture forceps in both hands successively with "hand-to-hand" maneuver, Tuck-and-pull Surgical Technique Full mydriasis pre- or intraoperatively is necessary as it facilitates the rescue of the lens from posterior chamber and diminishes the touch and damage to the iris and the zonulae. The technique is as follows: 1. One side port is enough to explant PCPIOL [Fig. 1a]. Right-handed surgeons need a side port on the right side. If a PCPIOL reimplantation or cataract surgery is planned at the same session, two side ports are preferred. 2. Injection of OVD behind the PCPIOL is done to widen the space between PCPIOL and the crystalline lens, thus protecting it throughout the procedure [Fig. 1b]. If applied initially into AC, PCPIOL will move backward toward the crystalline lens, not allowing safe manipulation. If reimplantation is planned, cohesive OVD should be used because it can be washed easily. If crystalline lens extraction is planned, dispersive OVD is preferred to protect the corneal endothelium. 3. After separating PCPIOL from the natural lens, OVD is injected into the AC to protect all the AC structures [Fig. 1c]. 4. Up to 1 year, the original main incision is used, as 2.8 mm is enough. It is easily found with a blunt LASIK (laser in situ keratomileusis) spatula or a Sinskey hook [Fig. 1d]. Enlargement up to 3.0 mm is suggested during the training period. Late postoperatively, a new main corneal incision should be created, avoiding the place of the first incision. 5. The nearest PCPIOL haptic is elevated with the additional injection of OVD under the PCPIOL [Fig. 1e]. 6. Tucking of the PCPIOL haptic and pulling through the main incision are the most important steps [Fig. 1f]. The haptic is hooked and tucked using a chopper with a long blunted tip, pulled through the main incision, and held out [Fig. 1g]. 7. The haptic that is held through the main incision by the chopper in one hand is grasped by a suture forceps (preferably curved) in the other hand [Fig. 1h]. Then, the haptic is taken out by two suture forceps in both hands successively with a “hand-to-hand” maneuver, keeping them parallel to the incision plane. The hand motion should be very slow in order not to tear the lens. This gives the lens time to slowly fold through the incision on the way out. If the reimplantation of the same PCPIOL is planned, the integrity of the PCPIOL must be checked.