Topic

#Cataract Surgery

19 articles
  1. Articles 1 Apr 2021 18 min read

    Learn from the Masters Tips & Tricks in the Management of Pediatric Cataract 2

    Read Learn from the Masters Tips & Tricks in the Management of Pediatric Cataract 1 After the discussion on the etiology of pediatric cataracts, and about when and how to operate we go further to know about choosing the IOL formulae, IOL material and power of IOL to be implanted in children. Also, an insight into the post-operative rehabilitation with follow up eOphtha: Considering the varied opinions in choosing the IOL formulae for pediatric cataracts , what’s the formulae used in your practice ? Do you use different formulae in microphthalmic eyes? Dr. Bharti Gangwani : I use Holladay 1 for young children and small eyes with AL < 22 mm and SRK/T for older children with AL > 22 mm. No I do not use different formula in microphthalmic eyes though many of these eyes are left aphakic if the eye is really small. Dr Kalpana Narendran : SRK - T formula is used. If Axial length 22 – SRK T. Dr. Sudarshan Khokhar: We use modified SRK 2 or SRK/T formula for IOL power correction for all eyes. We

    Dr. Sowmya R, MS,FMRF, FAICO
  2. Articles 1 Apr 2021 26 min read

    Learn from the Masters: Tips & Tricks in the Management of Pediatric Cataract 1

    Cataracts in children are one of the most common cause of avoidable blindness. The incidence is in the range of 1.8 to 3.6/10,000 per year and the prevalence is about 1.03 per 10,000 children (0.32– 22.9/10,000). Management at the right time and the right way goes a long way in rehabilitating them . To understand the current practices in management of pediatric cataract Dr. Sowmya R. spoke to a few experts across India. Dr. Bharti Gangwani (Bharti Nihalani) is a practicing Pediatric Ophthalmologist, Assistant Professor of Ophthalmology and also the Director of Clinical Research for the department of Ophthalmology at Boston Children’s Hospital, Harvard medical school. She is actively involved in teaching Pediatric Ophthalmology to the residents and fellows. She has about 50 publications in peer and non-peer reviewed journals, books and review articles. She is a co-editor of a renowned book in strabismus management called “Learning strabismus surgery-A case-based approach”. She has focus

    Dr. Sowmya R, MS,FMRF, FAICO
  3. Articles 1 Apr 2021 12 min read

    Ten Tips for Phacoemulsification in Small Pupil

    Phacoemulsification in eyes with preoperative non-dilating pupil or with intraoperative miosis is fraught with complications [1,2]. The following tips will help understand the small pupil and optimize strategy to deliver better outcomes. 1. Every eye is an IFIS candidate; Reduce threshold for using Pupil expansion devices: Since its original association with tamsulosin intake, Intraoperative Floppy Iris Syndrome (IFIS) has been positively correlated with a plethora of risk factors which include: gender, age, hypertension, other a1-adrenergic receptor antagonists, finasteride, angiotensin II receptor inhibitors, benzodiazepines, antipsychotics, hypertension drugs and decreased dilated pupil diameter [1,3,4]. The risk of IFIS exists regardless of alpha antagonist treatment, in eyes with 7.0 mm or smaller pupil [5]. Hence, it would be prudent to consider every eye a potential IFIS candidate. Increased patient expectations, surgeon's desire to consistently deliver good outcomes, use of tor

    Dr. Suven Bhattacharjee
  4. Articles 1 Apr 2021 7 min read

    Ten Pearls for Phacoemulsification in a Hard Cataract

    Phacoemulsification of the very dense cataract presents the surgeon with a series of specific and difficult challenges. How hard is hard and what level of hardness makes it challenging depends largely on the experience of the surgeon. LOCS III classification does not always reveal the real hardness of the cataract, and that aside there is no definition in the literature that classifies the hardness of cataract. A hard cataract is a relative term relative to the surgeon’s experience and confidence! I have over the years put some criteria for myself when I call it a difficult situation. These are dark brown to the black nucleus, no visibility of the posterior slit beam due to the nuclear sclerosis, an older patient, diabetic patient, and preoperative poor vision. Ocular co-morbidities such as pseudo exfoliation, absence of pupillary ruff and calcific spots on the anterior capsule are some of my personal markers which add further to an already challenging surgery Pearl 1: Preoperative con

    Dr. Ashok Rangarajan, MS; DNB; FRCS (Glasgow)
  5. Articles 1 Apr 2021 2 min read

    Ten Pearls of Phacoemulsification in Subluxated Cataracts

    Phacoemulsification in subluxated cataracts is a challenging situation for the phaco surgeon due to lot of variables like management of the subluxation, management of the cataract, vitreous etc. Here are the top ten Pearls for Phaco in subluxated Cataracts. 1 Pre-Op Assessment Careful slit-lamp examination for a) Extent of Subluxation b) The density of the cataract c) Presence or absence of vitreous in Anterior chamber d) Status of the corneal endothelium e) Age of the patient 2 Devices & Instrumentation a) Capsular Tension Ring (CTR) size 10 – 12 mm size 11 – 13 mm b) CIONNI Ring (1 or 2 eyelets) c) CT Segment (Ahmed Segment) d) Capsular Hooks e) Iris Hooks f) Micro Surgical instrumentation like Microrhexis forceps etc. 3 Proper Surgical Planning Zonule loss less than 1 quadrant: Place 3 piece IOL in the axis of the Zonular loss 1 to 2 quadrants: CTR Standard 2 to 3 quadrants: CIONNI 1 or 2 or CT segment (Ahmed) More than 3 quadrants: Above or scleral fixated IOL 4 Surgical Plan Site

    Dr. Mohan Rajan
  6. Articles 1 Apr 2021 2 min read

    Ten Tips to Achieve a Complete Curvilinear Capsulorhexis

    1. See clearly: Focus the microscope in such a way that the anterior capsule is exactly in focus. Low magnification would help in increasing depth perception, even though things don’t appear grossly magnified. Even if the patient moves the eye a little, things don’t go out of focus. 2. Stain if needed: If the red glow is not very clearly seen, and the cut end of the anterior capsular flap may not be easily visible, its best to stain the capsule by trypan blue. This should be done before starting the capsulorhexis. 3. The pressure above should be more than the pressure below. The capsulorhexis flap shall not extend to the periphery if the pressure above it is more than the pressure below it. If superior rectus muscle suture has been taken, loosen it. Loosen a tight speculum. Both increase the pressure on the globe, pushing the vitreous up and putting strain on the posterior capsule. 4. Do CCC slowly: The time spent on it is completely worth it. The success of surgery, especially in phac

    Dr. Parikshit Gogate
  7. Articles 1 Apr 2021 6 min read

    Ten Tips for Youngsters to Increase Proficiency in Phacoemulsification

    Phacoemulsification, like any other surgery, comes with its learning curve. Here are some pearls, from my experience, to help you ‘shorten’ and ‘Flatten the curve’. 1. Believe in yourself: The first step to successfully doing anything in life is to believe in yourself. Believe you can and you are half way there. 2. Observe, Observe, Observe & Learn I am a firm believer of this quote by Marilyn vos Savant, “To acquire knowledge, one must study; but to acquire wisdom, one must observe.” Each skill in life can be improved by observing others. It is the same case for surgeries too. The more you observe a particular type of surgery, the better you get at it. Observe your seniors. Observe their hand movements, observe how they complete a straight-forward case and observe how they tackle complications. Try and observe as many people surgeons as you can, as each and every phacoemulsification procedure teaches you something new. Residents in today’s era are blessed with easy availability of the

    Prof. (Dr.) Mahipal S. Sachdev
  8. Interesting Reads 1 Apr 2021 12 min read

    New normal - Tenets with Cataract Surgery Every Ophthalmologist Should Know during COVID-19 pandemic

    Introduction: Cataract is the second most common cause of preventable blindness worldwide and the most common cause of preventable blindness in India, affecting nearly 65.2 million worldwide [1-5]. To control the number, a high cataract surgery rate (CSR) is required. Sudden lockdown due to the current pandemic led to the cessation of elective cataract surgery [6,7], causing a sharp decline in the required CSR. In India as per the National Programme for Control of Blindness (NPCB) data 2018-19, the desired CSR was 947866 which could not be achieved [7]. As the unlock process has started, resumption of elective cataract surgeries is being initiated with precautionary measures. In this article, we have tried to summarize the current guidelines for elective cataract surgery. Preferred practice for cataract surgery: 1. General measures: The Govt. of India (GOI), Ministry of Health and Family Welfare (MoHFW) have advised certain preventive measures to avoid transmission (mask, hand hygiene,

    Dr. Jatinder Singh Bhalla · Dr. Satender Kumar Singh · +1 other
  9. Students Gallery 1 Apr 2021 16 min read

    Instruments used in Cataract Surgery: Ready Reckoner for the Post Graduates

    Cataract Surgery is the most common surgery performed all over the world. Proper knowledge of surgical instruments used in cataract surgery is essential. This article gives you an overview and description of instruments commonly used in cataract surgery. Simcoe's irrigation- aspiration cannula: Design: Available in two different designs. The original model also called the direct Simcoe where aspiration is through the silicone tube and irrigation through the main hub. The surgeon holds the syringe attached to the silicone tubing which is used to generate suction for aspiration in his/her left hand and the irrigation line is attached to the main central hub. The other model is the Reverse Simcoe where irrigation is through the main hub. The surgeon uses a syringe attached to the main hub to generate suction for aspiration. Cannulas are available in different sizes: 21,22,23 gauge which has an aspiration port size of 0.5,0.35,0.3 mm respectively. These are 15 mm long in size with an angle

    Dr. Rohit Rao

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