Cataract

1–10 of 17 articles Page 1 of 2

All Cornea 36 Cataract 17 Glaucoma 14 Retina & Vitreous 72 Neurophthalmology 8 Oculoplasty 15 Uvea & Inflammatory Diseases 24 Miscellaneous 20 Oncology 9 Pediatric Ophthalmology 16

6 min read

Ten Points A Surgeon Should Know About the Phaco-probe

1. Basic structure of phaco probe Phaco Probe has two attachments (For aspiration & Irrigation) and one wire coming out of back end for power supply and sensors. In the front there is the tip attached to the hand piece, which has a silicon sleeve around it with two apertures. The irrigation tubing are wider in diameter than aspiration and both tubings are colour coded Fig 1 Basic Structure of Phaco Probe 2. Fluid Inflow and Outflow pathway: The fluid flows from the irrigation tube to the handpiece and comes out via two apertures in the silicon sleeve cooling the tip. It then traverses in the AC and is aspirated back via phaco tip and comes out via aspiration tube. Irrigation is gravity based in traditional machines and Active in newer generation machines. Aspiration is always active can be via either peristaltic and venturi pump based. Fig 2 Fluid inflow and Outflow via Phaco Probe 3. Phaco Tip design: Phaco tip is made of titanium alloy. The end of the tip has a bevel, which can be of

Dr. Rohit Rao · Dr. Charudutt Kalamkar
11 min read

Top Tips for Toric IOLs for Young Ophthalmologists: Should You Make the Plunge?

The use of TORIC IOL in the modern cataract surgical world has rightfully become a necessary tool for all surgeons. This is because of the demand for customization and the need for great refractive outcomes, rendering all cataract surgeries as “REFRACTIVE CATARACT SURGERIES” today! Patients no longer are happy being dependent on glasses or want to miss the chance of being less dependent on glasses after their cataract surgery! This article quotes a few of the top pointers that may benefit all cataract surgeons, even more, the young ophthalmologists evolve into refractive cataract surgeons with the use of TORIC IOLs. A very necessary next step in the era of constant changes and customizations that have been the last 5-10 years in cataract surgery! So, let's dive in: 1. Start Early, Start Strong (Small) The first pointer is that the “mind games” of expectations with TORIC IOLs is a cloud that you don’t want to set in. So, it is important to start Toric IOL cataract surgeries much EARLY i

Dr. Aditya Sethi
5 min read

Seven Tips for Sideport Construction

Sideport might appear as a small and trivial step in SICS but it has great significance. Improperly constructed side port will give rise to a cascade of events which will complicate the further steps. You can make an ideal side port by employing the following tips. 1. Size Width: A very small side port will pose a lot of problems while instrumentation. It will force multiple attempts to enlarge the side port throughout surgery, which itself poses the risk of injury to intraocular structures. Conversely, a very big side port will lead to wound leak and instable AC intra-operatively. It may end up in needing a suture at the end. So assessment of apt width is imperative. The size of side port is largely dependent on the gauze of simcoe cannula being used. It needs a bit of experience to adequately size the side port and after doing a few cases one will be able to judge how much the blade needs to be inserted and how much extension is required. Fig 1 a. Very Big Sideport and b. Small Sidep

Dr. Rohit Rao · Dr. Bhavin Kumar Patel
4 min read

Ten Pearls of Phacoemulsification with PPC

Posterior Polar Cataract is associated with remnants of Tunica vasculosa lentis. (1) It presents as a white opacity situated on the posterior capsule appearing as a circular plaque with concentric whorls. (2) Surgical management of posterior polar cataracts is a challenge even for skilled surgeons due to high risk of posterior capsular rupture and vitreous loss during surgery. (3) 1. Preoperative Considerations: It has to be identified correctly on slit lamp examination – with its characteristic onion peel or bull’s eye appearance. Patient has to be counselled regarding increased surgical time, higher chances of posterior capsular rupture and even the possibility of posterior segment intervention and delayed visual recovery. (3,4) The fellow eye also needs to be evaluated. Image showing: Characteristic onion peel appearance of Posterior Polar Cataract (Courtesy of Rajan Eye Care Hospital). 2. The Preferred Anaesthesia: Peribulbar anaesthesia is preferred because of longer surgical time

Dr. Madhuvanthi Mohan · Dr. Sashwanthi Mohan · +1 other
5 min read

Ten Pearls for Tunnel Construction in SICS

SICS is the most commonly performed cataract surgery by young budding surgeons. Young postgraduates are introduced to the world of ophthalmological surgery via SICS. Initially, every new surgeon struggles to make good scleral tunnel and capsulorhexis. These TOP TEN pearls will make young surgeons confident to achieve textbook tunnel. 1. Good Visualization: If you can see well, you can do well. Proper exposure of working field is a must. So, focus on to make adequate Conjunctiva and tenon’s dissection, avoid pooling of blood with judicious cautery and don’t let saline or visco to pool. Fig.1 Adequate Scleral exposure for tunnel construction 2. Superior rectus bridle suture: Mind the rectus It is probably one of the most important step in SICS. It is the first step any beginner surgeon learns, but it has not been given the due credit. It is a hidden player in tunnel construction. Furthermore, it provides the globe with sufficient traction and support to construct the tunnel seamlessly. 3

Dr. Rohit Rao · Dr. Patel Bhavin
11 min read

Ten Pearls for the Management of Posterior Capsular Rupture

Posterior capsular rupture (PCR) is an important complication of cataract surgery whose timely recognition and appropriate management can ensure a good visual outcome. Here are ten pearls for its prevention and management. Pearl 1: Understand the risk/predisposing factors It is imperative to assess the preoperative and intra-operative risk to prevent the development of a PCR. Elderly, anxious, and uncooperative patients are at a higher risk of developing posterior capsular rupture. Extraocular factors include a deep socket, narrow palpebral fissures, exaggerated bell’s phenomenon, hazy cornea, and intraocular factors are poor mydriasis, shallow or excessively deep anterior chamber, pseudoexfoliation, and type of cataract (like posterior polar, traumatic, post-intravitreal injections, intumescent or hard cataract), previous vitrectomy or oil-filled eyes. Surgical factors like inexperience of the surgeon, leaking incisions, small capsulorhexis, radial tears in rhexis, fluid imbalance in

Dr. Arup Chakrabarti · Dr. Nirupama Kasturi
13 min read

Techniques of nuclear delivery in Manual small incision cataract surgery

Manual small incision cataract surgery (MSICS) is now practiced in both developed and developing countries. It involves the extraction of a complete or divided nucleus from the capsular bag through the capsular opening and then through the sclero-corneal tunnel. A number of techniques of nuclear delivery have evolved over the time. These techniques have their own merits and demerits. However they give similar results in the hands of experienced surgeons. The methods are broadly classified as follows: Anterior chamber maintainer technique Microvectis technique Phacofracture technique Phacosandwich technique Fish hook technique Ruit's technique We shall now discuss the difference in steps involved in the various techniques. 1. Anterior Chamber Maintainer technique ( Blumenthal`s technique): Fixing the AC Maintainer (Anterior Chamber Maintainer) After the tunnel has been dissected with a crescent knife, two side ports are made with 19 or 20 G MVR knife, one for capsulotomy and the other f

Dr. Ruchi Goel · Dr. KPS Malik
13 min read

Anterior Vitrectomy Made Easy For Cataract Surgeon

One of the most dreaded complications of cataract surgery is a posterior capsular tear (PCR). Its rate ranges from 1.3% to 9.6% (from skilled surgeons to trainees)1-5. Early recognition of the PCR and skilled management is necessary for good surgical outcomes and to avoid any devastating sequelae. Hence, anterior vitrectomy is an important skill that every cataract surgeon should master. There are some risk factors that may predispose to PCR like a true posterior polar cataract, dense and mature cataracts, old age (zonular weakness, small pupil, and denser cataract), uncooperative/ anxious patients, poor visualization due to corneal disease, pre-existing ocular trauma leading to capsular rupture/ zonular damage, etc.6,7 A thorough preparation beforehand may avoid confusion and lead to a well-managed surgery. The OT staff should be well aware of the kit to be used for anterior vitrectomy and the settings to be used for the same. Early identification of the posterior capsular tear The ea

Dr. Vishal Agrawal · Dr. Ketan Rathod · +1 other
13 min read

Management of Subluxated cataract

Zonular compromise complicates every step of cataract surgery and poses a serious challenge in terms of safety and visual outcome. When the lens is displaced from its normal position, it is considered subluxated if it remains in the pupillary area and luxated or dislocated if it is completely displaced from the pupil. Ectopia lentis is the term used to describe congenital dislocations.1 Lens displacements may be traumatic, heritable, and spontaneous.( Table 1) Table 1: Causes of Lens Dislocation Causes Features Traumatic Responsible for >50% lens displacements Heritable Associated systemic anomalies Marfans’s syndrome: Triad of skeletal, cardiovascular & ocular anomalies. Autosomal dominant. Generalized thinness and elongation of limbs, sternal deformities, kyphoscoliosis, joint hyperextensibility, low ratio between upper and lower segment, arachnodactyly, cardiopathy, aortic dilatation, dissecting aneurysm, mitral regurgitation. Ectopia lentis: B/L superotemporally, usually partial, r

Dr. Ruchi Goel · Dr. KPS Malik
8 min read

Ten Pearls for Multifocal IOL

1. Science behind Multifocal Intraocular Lens (MFIOL) Multifocal intraocular lenses are IOLs which can separate incoming light into two or more foci, thus resulting in multiple coexisting retinal images. At any given point, only one of the images (distance, intermediate or near) is the sharpest, and hence selected by the brain for visualisation. This concept is known as simultaneous vision. The visual system in any mammal is not known to be multifocal, hence the implantation of these IOLs initiate a process of neuroadaptation in the recipient’s brain, and its best effect is seen only after some days to weeks. The splitting of light to form multiple images leads to loss of contrast for each image. However, despite these limitations, MFIOLs continue to be one of the best technologies to provide spectacle independence for all distances after cataract surgery. 2. Types of MFIOL MFIOL can be classified in two ways: Based on focality or the number of foci or images created by the lens: Tradi

Dr. Partha Biswas · Dr. Sneha Batra