Pesudo-Exfoliation Cataract Surgery Technique including Pupil Stretching скачать в хорошем качестве

Pesudo-Exfoliation Cataract Surgery Technique including Pupil Stretching

Pseudoexfoliation is associated with glaucoma, iris abnormalities and zonular weakness, all of which can cause difficulty during phacoemulsification. Proper preparation and early intervention can make surgery easier for the surgeon and safer for the patient. Pseudoexfoliative material can be dispersed throughout the anterior segment on the anterior lens capsule in a target manner as shown above, over the zonules and ciliary processes, on the iris and in the angle of the eye (referred to as Sampaolesi’s line on gonioscopy). Any iridodonesis or phacodonesis that is noted at the slit lamp is an indication of severe zonular weakness.  For this case, we are going to use a technique of bringing the nucleus out of the capsular bag and tilting it into the iris plane so that the iris sphincter is holding it in place. This requires a capsulorrhexis of at least 5 mm in diameter, but our current pupil size is just 4 mm. Injecting viscoelastic at the pupil margin can help to push the iris and expand the pupil, a technique called viscomydriasis. We can then make the capsulorrhexis right at the pupil margin or, even better, just underneath it. Most experienced surgeons, having done thousands of procedures already, can make the capsulorrhexis larger than the pupil without directly visualizing it. Balanced salt solution is used to hydrodissect the nucleus out of the capsular bag and then tilt it into the iris plane. The iris sphincter will now hold the nucleus in place while the surgeon uses a phaco chop technique to emulsify and aspirate it. This technique brings the nucleus out of the capsular bag in order to minimize stress on the zonules. And even in cases in which there is zonular laxity, this supracapsular technique can be safer than intracapsular techniques such as divide-and-conquer.