Wednesday, 20 April 2016

Manual SICS  Using  Intra Tunnel Phacofracture Nucleus Management  Technique 

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Manual Small Incision Cataract Surgery  in White   Cataract With Commentary  By Sudhir Singh
You are going to watch Intra tunnel Phaco Fracture Nucleus Management Technique of Manual Small Incision Cataract Surgery in white cataract.




1. A fornix based Conjunctival Incision is made in superio-temporal quadrant .A light Cautery is applied.A partial thickness groove of 5 mm length is made
2. A paracentesis incision is made and BSS is injected in to the anterior chamber to make eye tight 3.Sclero-corneal tunnel is made with crescent knife.
4.Entry in to the anterior chamber is made with 2.8 mm keratotome.
5.Air is injected into the anterior chamber. Trypan Blue dye is injected under the air bubble to stain lens capsule.HPMC viscoelastic injected in to the anterior chamber and dye and air pushed out. 6.Capsulorhexis is made with 26 gauze needle Capsulotome
7.Internal opening of the corneo-scleral tunnel is enlarged to 6.5 mm with the 5.1 mm and 2.8 mm keratotome.
8.Hydro dissection is done in all quadrants.
 9.The nucleus is rotated within the capsule and prolapsed into anterior chamber by a Sinskey hook.  10.Enough viscoelastic is placed between cornea and superior surface of the nucleus to protect endothelium and between nucleus and iris to keep away iris from nucleus. Small Lewis lens loop is introduced through the tunnel and positioned between the iris and the nucleus. The nucleus is engaged in the lens loop and slowly withdrawn from the anterior chamber while the posterior lip of the tunnel is remaining depressed.
11. Nucleus is engaged in the tunnel, then the Lewis lens loop is pulled posteriorly and upwards. This causes breaking and removal of a part of the nucleus and other part remain engaged in the tunnel.  12.By viscoelastic the engaged part of the nucleus is pushed back into anterior chamber and rotated so its longitudinal axis was coincided with longitudinal axis of the tunnel. Again viscoelastic is placed between the cornea and superior surface of the remaining nucleus and between the nucleus and iris.  The lens loop is introduced through the tunnel and positioned between the iris and the remaining part of the nucleus.  The remaining part of the nucleus is engaged in the lens loop. Lens loop is slowly withdrawn from the anterior chamber along with nucleus fragment ,while the posterior lip of the tunnel is remaining depressed.
13.As iris is floppy and coming out from main section so I deferred irritation aspiration of the remaining cortical matter.
14.Anterior chamber is formed with HPMC Viscoelastics. A single piece PMMA intraocular lens of is implanted into the capsular bag
15.The remaining cortical matter is cleaned up is done with 23 gauze Simcoe Irrigation cannula. 16.Side port and main port are sealed with hydration. Conjunctival flap is reposited back. Subconjunctival injection of the gentamicin and dexamethasone given. Cut ends of the conjunctiva is sealed with cautary

Dr Sudhir Singh,MS
Sr.Consultant & HOD
Phaco Surgeon,Paediatric Ophthalmololist & Strabismologist
JW Global Hospital & Research Centre
Mount Abu,India
resp2020@gmail.com
Visiting Senior Consultant Ophthalmologist
Global Institute Of Ophthalmologist
Abu Road 307510
resp2020@gmail.com
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