By Lucio Buratto MD, Stephen Brint MD, Luigi Caretti MD
Dr. Lucio Buratto; Dr. Stephen Brint; and Dr. Luigi Caretti supply step by step method of facilitate tips on how to examine the sufferer, practice the approach, and supervisor the main difficult cataract surgical procedure complex circumstances dealing with either starting and skilled surgeons.
Cataract surgical procedure in complex situations covers a wide selection of subject matters together with cataract in excessive myopia, floppy iris syndrome, worrying cataract, phacoemulsification with a small student, and IOL rationalization and replacement.
Supplemented by means of greater than 250 colour illustrations, diagrams, a thesaurus, and references, all surgeons, from newbie to specialist will wish this targeted source through their side.
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Extra info for Cataract Surgery in Complicated Cases
Most recommend 5 to 6 retractors for greater stabilization. 33,34 Richard Mackool designed titanium capsule retractors with hooks at the tips; they are long enough to support the peripheral capsular fornix and the capsulorrhexis. 35 In these cases, the retractors act as artificial zonules to stabilize the entire bag during phaco and cortical removal. As opposed to CTRs, the capsule retractors provide excellent support in the anterior-posterior direction without trapping cortex, each retractor creates just one pressure point on the capsular fornix without engaging the cortex.
Particularly with shallow chambers, slower vacuum rise times (achieved by lowering aspiration flow rate) reduce the risk of engaging the iris or capsule with the tip. Bottle height should be low as the higher the bottle, the greater the infusion pressure into the AC. If IOP is greater than the vacuum in the aspiration line, passive vacuum will be generated (not created by the pump) engaging the iris or other structures. Overall, phaco chop satisfies these needs, allowing rapid, safe completion of the surgery.
The Anchor is sutured to the sclera with a single suture of 9-0 or 10-0 polypropylene. It can also be associated with implantation of a CTR. This new device appear to be effective in cases of significant zonular dehiscence. With a subluxated lens, there are several alternatives to the insertion of the CTR or MCTR when the surgeon has been unable to perform a correct continuous curvilinear capsulorrhexis or if CTRs are not available. Instead of enlarging a small-diameter capsulorrhexis, the surgeon can create small relaxing incisions along the edge of the capsulorrhexis once the nucleus and the cortex have been removed and the IOL has been inserted into the bag.
Cataract Surgery in Complicated Cases by Lucio Buratto MD, Stephen Brint MD, Luigi Caretti MD