Surgical Pearl: Capsulorhexis
By Andrew Doan, MD, PhD
The capsulorhexis is the most important step in cataract surgery. A nicely performed continuous curvilinear capsulorhexis provides strength during phacoemulsification and lens manipulation as well as a nice shelf to place an intraocular lens in the sulcus if necessary.
Most residents I staff have trouble with this step because use of forceps to perform the capsulorhexis results in significant distortion of the wound leading to loss of the viscoelastic device. When viscoelastic is lost, the anterior chamber depth lessens, the anterior lens bulges forward, and the capsulorhexis tear migrates radially. If the tear goes into the lens zonules, then there is increased risk of radialization leading to vitreous loss.
If you're having trouble with maintaining the anterior chamber because the viscoelastic device is lost through the wound, then stop, reassess, and inject more viscoelastic device into the anterior chamber.
Alternatively, try using the cystitome to perform the entire capsulorhexis. Because this instrument is smaller in diameter than forceps, there is less loss of viscoelastic through the wound. Performing a capsulorhexis using the cystitome is best done with a cohesive viscoelastic device, such as Healon.
Watch the video showing the use of the cystitome:
The capsulorhexis is the most important step in cataract surgery. A nicely performed continuous curvilinear capsulorhexis provides strength during phacoemulsification and lens manipulation as well as a nice shelf to place an intraocular lens in the sulcus if necessary.
Most residents I staff have trouble with this step because use of forceps to perform the capsulorhexis results in significant distortion of the wound leading to loss of the viscoelastic device. When viscoelastic is lost, the anterior chamber depth lessens, the anterior lens bulges forward, and the capsulorhexis tear migrates radially. If the tear goes into the lens zonules, then there is increased risk of radialization leading to vitreous loss.
If you're having trouble with maintaining the anterior chamber because the viscoelastic device is lost through the wound, then stop, reassess, and inject more viscoelastic device into the anterior chamber.
Alternatively, try using the cystitome to perform the entire capsulorhexis. Because this instrument is smaller in diameter than forceps, there is less loss of viscoelastic through the wound. Performing a capsulorhexis using the cystitome is best done with a cohesive viscoelastic device, such as Healon.
Watch the video showing the use of the cystitome:
posted by MedRounds Publications at 9:03 PM
0 Comments:
Post a Comment
Links to this post:
Create a Link
<< Home