Ординатура / Офтальмология / Английские материалы / Manual of Practical Cataract Surgery_Sundararajan_2009

How to Prevent Complications in Planned ECCE ... 61

If analgesia wears off and patient is restless, inject 2% xylocaine ' subconjunctivally at 6 O'clock to relieve pain.

Bend the cystitome with the base of needle holder, otherwise the needle holder will get spoiled.

Fig. 2.36

In Can Opener Method

Fig. 2.37

Start anterior capsulotomy at 9 O'clock position and proceed in anticlockwise method as shown in figure.

Fig. 2.38

For safer removal of capsule make multiple vertical and horizontal incisions make it into multiple smaller bits. Aspirate with infusion with cannula.

1.When the pupil is not round → Iris is caught by the haptic somewhere. So rotate-reverse-sometimes vitreous prolapse can also distort the pupil.

2.When there is froth in anterior chamber with air → There is still some viscomet present.

CHAPTER 3 Posterior Capsular Rupture—Rent 65

Posterior Capsular

Rupture—Rent

After having gone through the journals, attending conferences, I understand that some of our Ophthalmic practitioners are facing some problems in ECCE of IOL surgeries. I am writing this article when most of us are striving hard to practice small incision surgeries and phaco and Microphaco.

This will be Useful for Beginners.

The following are the common complications Iris prolapses, posterior capsular rent and vitreous loss, endothelial damage, endoophthalmitis, zonular dehiscences and etc.

In this section, I am making an attempt in relation to the causation of PC rupture and how to prevent the same.

I am confining myself only to planned ECCE with routine IOL surgeries excluding small incision surgeries.

As we all know, PC rupture is a dreaded complication for the surgeon as his ambition to do a better PC. IOL is simply shattered throwing us in the lurch and to redecide the alternate ways to complete.

The following are the circumstances, where in the PC rent or rupture can occur during.

66 Manual of Practical Cataract Surgery

6.Scleral side flap if big.

7.A/c flat

8.Surgeon should have excellent visual control.

9.Repeating the capsulotomy (digging in the same groove) may produce PC tear.

1. Incision:

Making deep limbal incision with sharp blade in a myopic eye, can produce iridodialyses, zonular tear and disturbance to vitreous as the sclera is thinner than normal.

Posterior Capsular Rupture—Rent 67

Fig. 3.1

2. Ilumination:

Should be good enough, to see every step in surgery, what exactly is going on while working inside the globe. Dim illumination ( in the microscope or focusing lamp ) will lead to un-understanding of the procedure in the surgery.

3. Magnification:

The surgeon should immmediately change to higher magnification (from 0.6 to 1 or 1.6) and do the anterior capsulotomy with an excellent visual control. It is always better to do anterior capsulotomy under higher magnification.

4. Dialation:

Pupil should be fully dialated to see what is happening in each step of surgery. If pupil is small, try to dialate the pupil with adrenaline - BSF Mixture. If undialating pupil as in PX F syndrome, it is better to do keyhole iridectomy and do anterior capsulotomy. Once IOL insertion is over, pigment epithelium of iris may be brought out and sutured with 10.0 suture with closely cut knot left inside. Some prefer to do sphin, cterotomy either at 12 O'clock position only or in two places one at 11 O'clock and 1 O'clock position.

5. Small needle tip:

For this a recollection of the brief anatomy of the anterior segment - LENS.