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Combined Cataract and Glaucoma Surgery
Published in Neil T. Choplin, Carlo E. Traverso, Atlas of Glaucoma, 2014
Arvind Neelakantan, Mary Fran Smith, Maher M. Fanous, Mark B. Sherwood
Glaucoma patients, especially those with pseudoexfoliation syndrome, are often at risk of weak zonules, and extra care must thus be taken to avoid complications, such as vitreous loss or loss of lens material posteriorly into the vitreous cavity. To avoid zonular stress, careful and thorough hydrodis-section and hydrodelineation must be performed to free the nucleus from all its cortical attachments, allowing free rotation within the bag. The surgeon should avoid undue pushing of the nucleus with the tip of the phacoemulsification hand piece during sculpting, which could cause zonular disruption. A chopping or supra-capsular technique as opposed to a traditional divide and conquer technique might reduce intraoperative zonular stress. Figures 19.8 through 19.11 illustrate some of these points.
Comparative Analysis of One-Handed and Two-Handed Coaxial Phacoemulsification with 2.4-mm Clear Corneal Incision
Published in Current Eye Research, 2019
Panpan Li, Jian Wu, Yu Guan, Zhirong Lu, Ying Xue, Min Ji, Huaijin Guan
A 2.4-mm single-plane CCI was created in the135-degree position under the guidance of Verion (Alcon, America) with a diamond keratome. Continuous curvilinear capsulorhexis (CCC) was performed with capsular forceps under protection of an OVD. After CCC, hydrodissection and hydrodelineation were performed to loosen and rotate the nucleus and to make the nucleus fully free from the wrapped cortex. First, a deep “bowl” is sculpted in the central nuclear area. After sculpting, a full-thickness groove is made beginning centrally and progressing peripherally so that a half-lens-diameter groove is obtained. The nucleus is then rotated approximately 90 degrees. Again, a full-thickness groove is made starting centrally at the first groove junction, and another half-diameter groove is created. This first “cut-out” quadrant is fully loosened from its position and totally emulsified. The basic process of cut, rotate, cut, remove, rotate, cut, remove is repeated. Residual cortex and OVD removal and posterior capsule polishing were performed using irrigation/aspiration (I/A), and a foldable monofocal IOL (PY-60AD, HAOYA, Japan) was implanted in the capsular bag with an injector. At the end of the surgery, the clear corneal wound was hydrated with a BSS without sutures.
Isolated Capsulorhexis Flap Technique in Femtosecond Laser-Assisted Cataract Surgery to Protect the Corneal Endothelial Cells
Published in Journal of Investigative Surgery, 2019
Shaowei Li, Xu Chen, Jun Zhao, Man Xu, Zhouxing Yu
After opening the main incision, the needle of the OVD (DisVisco, Alcon) injector was carefully introduced into the anterior chamber, then capsulorhexis section from the anterior lens capsule was separated completely. The OVD was injected slowly under the capsulorhexis flap to lift it up carefully until the flap attached to the corneal inner layer (Figure a). OVD filled the anterior chamber with the intraocular pressure to around 30 mm Hg.Figure 1 After hydrodissection and hydrodelineation, the nucleus was emulsified with the torsional mode (Figure b). The parameter was set to a vacuum of 300 mm Hg and aspiration of 22cc/min (Centurion, Alcon). During the procedure, the phaco tip was kept under the plane of the iris. After the phaco stage, the cortex was removed using an aspirated handpiece (Figure c), the intraocular lens was implanted into the capsular. The intraocular lens was implanted into the capsule, the OVD was replaced by a balanced salt solution. The isolated capsulorhexis flap was removed at the end of procedure (Figure d). At the end of surgery, corneal incision was sealed by the stromal hydration.
Risk factors for complications during phacoemulsification cataract surgery
Published in Expert Review of Ophthalmology, 2020
Manpreet Kaur, Nithya Bhai, Jeewan S. Titiyal
Cortical cleaving hydrodissection enables nuclear rotation, facilitates clean-up of the cortical matter and simplifies phacoemulsification. Hydrodelineation reduces the volume of the central portion of nucleus removed by phacoemulsification by up to 50%. The epinucleus acts as a protective cushion and prevents forward movement of the posterior capsule and subsequent rupture[56].