Topic

#Cataract Surgery

19 articles
  1. Articles 6 Dec 2021 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
  2. Articles 20 Jul 2021 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
  3. Articles 8 Apr 2021 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
  4. Students Gallery 2 Apr 2021 4 min read

    Tips To Achieve Ideal Rhexis

    Capsulorhexis was pioneered and popularized by Howard Gimbel. Capsulorhexis is probably the most challenging to learn in cataract surgery, in other words, once a good rhexis is done half the battle is won. All the Post- Graduates and beginners struggle to do rhexis. This article has compiled small tips and tricks to do rhexis better. Ideally, rhexis should be continuous and curvilinear i.e Circular, Central & of Correct size (5.5-6 mm). Circular: for proper IOL centering and stabilization in the bag Continous: to prevent rhexis extension Correct size: for IOL centering and to ensure anterior capsule overlapping IOL optic 360 degrees. It can be done with the help of a double bent 26 G/27 G needle or rhexis forceps. Let's break the table and use the advantages of a needle Needle Utrata Forceps Advantages Cheap Disposable Universally available Customized Small diameter, lightweight Can be done through side port so less chance of AC shallowing Precise control Disadvantages Less precise con

    Dr. Rohit Rao · Dr. Charudutt Kalamkar
  5. Articles 2 Apr 2021 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
  6. Interesting Reads 1 Apr 2021 8 min read

    Ten Tips for the Beginners for Performing Pediatric Cataract Surgery

    Congenital cataract has a worldwide prevalence of 4.24 per 10,000 people, with the largest prevalence found in Asia (1). It is one of the most important causes of treatable causes of childhood blindness (2). 1.Timing of cataract surgery In order to prevent stimulus deprivation amblyopia, children with dense visually significant bilateral congenital cataracts, surgery should be done at around 6–8 weeks of age (3) and in children with a unilateral visually significant cataract it should be done at the age group of 4-6 weeks (4) due to increased rates of postoperative glaucoma in the first four weeks of life (5). 2.Biometry In small children, axial length can be measured using an immersion/contact A-scan or B-scan ultrasonography. While using contact A-scan values, the value with maximum anterior chamber depth should be chosen to offset the inadvertent indentation of the cornea with the A-scan probe (6). Keratometry values can be obtained using an auto-keratometer. Readings should prefera

    Dr. Parul Chawla Gupta · Prof. Jagat Ram
  7. Students Gallery 1 Apr 2021 6 min read

    Ten Pearls for Mastering Small Incision Cataract Surgery

    Small incision cataract surgery (SICS) is a prevalent technique in all the high volume centres of India as it is faster, gives excellent visual outcome and is much cheaper than phacoemulsification. Tip no. 1. Do a thorough pre-operative assessment and try selecting ideal cases It is mandatory to perform a proper pre-operative assessment of the patient. Helps in preparing the surgeon to anticipate complications and plan the operation accordingly. Tip No.2. Try to achieve adequate size, shape & couture of the incision Scleral Incision We usually make a frown incision 6mm long and 2mm away from limbus with the help of a 15 number blade. Beginners however may start with a straight incision before transitioning to frown. The incision should be made within the astigmatic neutral funnel. To remain astigmatically neutral, incisions closer to the limbus need to be smaller and longer incisions may be constructed further from the limbus. The incision should be placed on the steep meridian accordi

    Prof. Kamaljeet Singh · Dr. Pranav Saluja
  8. Students Gallery 1 Apr 2021 3 min read

    Ten Mistakes One Should Avoid in Small Incision Cataract Surgery

    Mastering Small Incision Cataract Surgery (SICS) lays a solid foundation for achieving sutureless cataract surgery in the majority of the cases. This article aims to bring forth some commonly committed errors in SICS. Nuclear grade: Though a surgeon is not expected to choose a patient, but a beginner should avoid extremes of nuclear grade. A grade 3 nucleus with a 6mm external incision and >6mm capsulorrhexis, are the most comfortable to manage initially. Only topical anesthesia! Anesthesia is meant to make the patient comfortable and the choice depends on the patient’s cooperation, condition of the eye, and the surgeon’s expertise. Attempting topical anesthesia in an uncooperative patient, non-dilating pupil or a novice surgeon can result in disaster. Use of blunt knives The creation of a triplanar incision requires sharp knives. Blunt knives result in ragged wounds and premature entry due to the application of excessive pressure. A poorly constructed wound opens the door to the occur

    Dr. Ruchi Goel
  9. Articles 1 Apr 2021 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
  10. Articles 1 Apr 2021 9 min read

    Ten Pearls for Phacoemulsification in a Soft Cataract

    Soft cataracts are usually seen in pediatric or young adult patients. We encounter them more frequently nowadays due to the increasing patient awareness and evolving lifestyle requirements which bring the patients earlier to the clinic. Another important reason behind the increasing number of soft cataracts in our surgical practice is the fact that the number of pars plana vitrectomies is increasing and we tend to perform combined cataract surgery with pars plana vitrectomy in patients with early cataract. Soft cataract phaco can be quite challenging especially in situations where the pupil starts coming down in the face of an uncooperative patient and positive posterior pressure during surgery. It is no surprise that soft cataract has been termed as “Neither Here-Nor-There” cataract! We will be offering 10 pearls on how to successfully manage such cases with good outcomes. Pearl 1: Need for precise IOL calculations: Most soft cataracts encountered in younger visually active patients c

    Dr. Arup Chakrabarti · Dr. Nirupama Kasturi

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