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 easy methods to verify the sufferer, practice the process, and supervisor the main tough cataract surgical procedure advanced instances dealing with either starting and skilled surgeons.
Cataract surgical procedure in advanced situations covers a large choice of issues together with cataract in excessive myopia, floppy iris syndrome, nerve-racking cataract, phacoemulsification with a small student, and IOL clarification and replacement.
Supplemented via greater than 250 colour illustrations, diagrams, a thesaurus, and references, all surgeons, from newbie to professional will wish this precise source by means of their side.
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Extra info for Cataract Surgery in Complicated Cases
If the surgeon wishes to achieve total akinesia of the eyelids, a facial nerve block should be used (Van Lint technique). 5% tetracaine hydrochloride); in addition to topical anesthesia, the surgeon should always do an intracameral injection of preservative-free 1% xylocaine. 62,63 Good exposure of the surgical field can be obtained by asking the patient to look down. Usually, a form of akinetic anesthesia is preferred, as the surgical dissection of the flap is a delicate procedure. These techniques can be applied to the other surgeries described in this chapter.
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. With a temporal main corneal incision, the haptics of the IOL are positioned along the horizontal axis (3 and 9 o’clock positions) and 2 opposite cuts are made in the edge of the capsulorrhexis at the vertical axis (6 and 12 o’clock positions). The cuts should not extend too far peripherally, as they serve simply to prevent contraction of the capsulorrhexis.
Regardless of technique, the following principles are standard: If dilation is not excellent, surgical maneuvers performed blindly behind the iris must be cautiously performed. ● ● ● Low ultrasound energy provides greater protection for the corneal endothelium. It should be remembered that the endothelial cell count may be very low in glaucomatous eyes, particularly with the angle-closure form often associated with a reduced AC depth. Cataract surgery must therefore be very delicate and the surgeon should use dispersive or viscoadaptive VES injected repeatedly into the AC during surgery.