Ординатура / Офтальмология / Английские материалы / The Art of Phacoemulsification_Mehta, Alpar_2001

520 THE ART OF PHACOEMULSIFICATION

Fig. 48.21: The final departure

problem. Though it would be nice to have automatic switch-over power systems where the load is taken temporarily on batteries and then automatically shifted to the generated supply, it is a very costly system which is rarely used. Instead small power generators (Honda or Suzuki 5kVA portable generators running off kerosene or diesel) are utilized, adequate to run the theater lamps, general lighting and power the instrument including the phacoemulsifier and support systems. It is important that the wiring should be so organized that all that needs to be done, at a time of a power failure, is to turn over the switch and start the generator. The load on the generator should never exceed 75% of its rated output to prevent overload and tripping. The generators, which are usually run off petrol, kerosene or diesel, all have a few common features. They are all noisy, smelly and temperamental. Hence they need to be placed in a room with good ventilation, and isolated so that the sound and smell does not reach in the theater complex. They should be serviced regularly, and have personnel trained to start and run the units.

PREOPERATIVE CARE AND EVALUATION

Preoperative check-up consists of a routine evaluation done to exclude fever, severe cough, open sores around face. Routine urine checkup to exclude diabetes and a blood pressure check to exclude hypertension. A routine check of the chest should done to exclude any gross cause for exclusion.

PHACOEMULSIFICATION: THE EYE CAMP WAY 521

Since most of the cases are to be done with topical anesthesia, starving is unnecessary. The patients are told to have their meals as per their normal routine. Patients are called in shifts of two hours. Experience has shown that a moderately competent phaco surgeon can do, comfortably, without overextending himself, 6 cases per hour, and can work comfortably a four hour shift, when a mandatory one hour rest period is imposed. With 6 surgeons per shift, it works out to be about 145 cases approximately per four hour shift ( 24 cases per surgeon approx).

Thus for a 8 hour shift per day, about 300 to 325 cases are completed which is the safe average. In practice, once the team settles down and gets into swing it

is a bit faster.

DURING SURGERY

Semiscleral, corneal tunneled incisions are the best since a 5.00 mm phaco PMMA lens is usually implanted. Consistently rapid predictable surgery with minimal surgical steps should be planned for. No suturing required in most cases, though in an occasional use a single infinity stitch may be applied. Normally, hardly 2 to 4% of cases need a single stitch. However the surgeons must be aware that what we are looking for is exceptional results. Even in the event of vitreous break, thanks to the rhexis a PC IOL can still be safety implanted in the sulcus. Fortunately with phaco the risk of late postoperative infection is severely minimized as the eye is for practical purposes sealed following surgery. Hence there is no restriction placed on the patients postoperatively.

Postoperative Advantages

•Rapid rehabilitation, hence sleeping on floor mats under unhygienic conditions obviated.

•Negligible astigmatism induced, hence the spectacles prescribed on the 7th day, are usually stable.

•Chances of late complications like sutures unraveling, accidental wound dehiscence or secondary infection. are very remote

•Preoperative medical requirements—negligible except for eyedrops.

•Resumption of activity virtually immediately, with rural daily chores commenced the very next day.

•Preoperative satisfaction high, hence greater village support for future eye camps, better support from health workers and local medical support teams. Better governmental support translates into logistical and financial assistance.

FINANCIAL IMPLICATIONS OF A PHACO EYE CAMP VS ROUTINE ECCE EYE CAMP

Let us assess the financial implications of an phaco eye camp, its visual results, complications and, most important of all, the financial implications, as compared to a routine ECCE eye camp, held prior at the same venue. It is often considered