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PHACOEMULSIFICATIPHACOEMULSIFICATION IN INTUMESCENT ON IN INTUMESCENT MATURE CATARACT: MATURE CATARACT: Managing a run-out Managing a run-out
capsulorhexiscapsulorhexisDR.MANISH MAHENDRADR.MANISH MAHENDRA
KHAIRABAD EYE HOSPITAL & KHAIRABAD EYE HOSPITAL & P.N.MAHENDRA EYE INSTITUTEP.N.MAHENDRA EYE INSTITUTE
KANPURKANPURINDIAINDIA
The Author has no financial The Author has no financial interest in the subject matter interest in the subject matter
of this poster of this poster
INTRODUCTIONINTRODUCTION
White CataractsWhite Cataracts4 Types4 Types
Golden Nuclear Hue & Hard ConsistencyGolden Nuclear Hue & Hard Consistency Swollen Intumescent CataractSwollen Intumescent Cataract
Morgagnian Cataract Morgagnian Cataract
White Cortical Cataract – SpokingWhite Cortical Cataract – Spoking CleftingClefting Cortico-capsular AdhesionsCortico-capsular Adhesions
INTUMESCENT MATURE INTUMESCENT MATURE CATARACTCATARACT
EtiologyEtiology Characteristics Characteristics * Depth Of AC * Depth Of AC << 2.0 mm 2.0 mm * Angle Of AC * Angle Of AC << 40 40
DegreeDegree * Lens Thickness * Lens Thickness >> 5.50 5.50
mmmm * Shape Of Lens : Decrease * Shape Of Lens : Decrease
The Aspect Of Biconvex The Aspect Of Biconvex Lens And It Becomes Lens And It Becomes Spheroidal. Spheroidal.
Imbibe Aqueous Imbibe Aqueous Through Through Semipermeable Lens Semipermeable Lens CapsuleCapsule Lens Swells Lens Swells
1) UNANTICIPATED ELEVATED 1) UNANTICIPATED ELEVATED ENDOCAPSULAR PRESSUREENDOCAPSULAR PRESSURE2) COMPROMISED 2) COMPROMISED VISUALISATION OFVISUALISATION OF THE CAPSULORHEXIS THE CAPSULORHEXIS
TWO TWO DIFFICULTIESDIFFICULTIES
HydroStatic Or Intra Lenticular Pressure
PhacomorpPhacomorphic hic GlaucomaGlaucoma
MATURE CATARACT
MAKING MAKING OF OF “A”“A” FLAGFLAG
InitialInitial Entry Entry (Puncture) Of Ant.Cap(Puncture) Of Ant.Cap
Egress Of Liquified Egress Of Liquified
Cortex Cortex
High IntraLenticular High IntraLenticular
Pressure Pressure
Radial TearRadial Tear ( ARGENTINA FLAG ) ( ARGENTINA FLAG )
METHODMETHOD
If Rhexis is going radial,what to do?If Rhexis is going radial,what to do?
- Immediately Stop Performing The - Immediately Stop Performing The RhexisRhexis
- Fill The AC With High Molecular Weight - Fill The AC With High Molecular Weight
Viscoelastics Viscoelastics
- Make Sure Nothing Is Pressing On The- Make Sure Nothing Is Pressing On The
Globe (Finger,Lid Speculum,Pt Globe (Finger,Lid Speculum,Pt Squeezing Squeezing
Lids) Lids)
METHODMETHODManaging The Torn RhexisManaging The Torn Rhexis
Small cut by Vannas ScissorIn the Periphreal Upper Part of the Torn Rhexis
Use of Utrata Forcep to complete a Superior semi circle of the Modified Rhexis
Nick in the Peripheral Lower Part of the Torn Rhexis
Use of Utrata Forcep to complete the Inferior semi circle
Rhexis Forcep completing the Inferior Modified Rhexis
“Modified Rhexis” Superior and Inferior Semi Circles
METHODMETHODManagementManagement
Phaco Chopping – Most Phaco Chopping – Most AppropriateAppropriate
SupraCapsular SupraCapsular Phacoemulsification Phacoemulsification (Avoid Stressful (Avoid Stressful Cracking)Cracking)
Low Bottle Ht/Low Low Bottle Ht/Low Flow Rate/Low Vacuum Flow Rate/Low Vacuum Phaco Phaco
Fortunately These Fortunately These Cataracts Are Not Too Cataracts Are Not Too Hard To CrackHard To Crack
IOL Implantation In IOL Implantation In The Bag, Taking Care The Bag, Taking Care Not To Enlarge The Not To Enlarge The Existing Tear & Placing Existing Tear & Placing The Haptics The Haptics Perpendicular To It Perpendicular To It
METHODMETHODSteps To Avoid Argentina’s Steps To Avoid Argentina’s
FlagFlag Puncture And Aspirate The Liquified Cortex Puncture And Aspirate The Liquified Cortex
And Decrease The Intralenticular PressureAnd Decrease The Intralenticular Pressure Use Liberal HPMC Or High Mol.Wt. Use Liberal HPMC Or High Mol.Wt.
Viscoelastics (Ofcourse Better)Viscoelastics (Ofcourse Better) Aim For A Small RhexisAim For A Small Rhexis
RESULTRESULT
By applying modified techniques By applying modified techniques
- Modified Capsulorhexis- Modified Capsulorhexis
- Phaco Chop(Avoid Stressful - Phaco Chop(Avoid Stressful Cracking) Cracking)
SupraCapsular PhacoemulsificationSupraCapsular Phacoemulsification
- Lower Phaco Parameters- Lower Phaco Parameters
one can manage these Intumescent Mature one can manage these Intumescent Mature Cataracts with Run-out Capsulorhexis and do Cataracts with Run-out Capsulorhexis and do successful phacoemulsification successful phacoemulsification
CONCLUSIONCONCLUSION
Thorough Pre-Surgical Evaluation Is Thorough Pre-Surgical Evaluation Is A Must In These Types Of Cataracts A Must In These Types Of Cataracts
Careful Surgical Planning Careful Surgical Planning Skillful & Dilligent Surgical Skillful & Dilligent Surgical
Technique Technique
++
GOOD FORTUNEGOOD FORTUNEPrevents Argentinean Flag Formation