Comparison of various cataract surgical techniques 2

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Comparison of various cataract surgical techniques 2

  1. 1. Comparison of various cataract surgical techniques<br />Dr. AnandSudhalkar, Baroda<br />2/19/2010<br />Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda<br />1<br />
  2. 2. Why Cataract Surgery<br />Medical management: Lengthy, costly, inefficient,<br />Surgery: quick, immediately rewarding, most efficient amongst all surgeries, Justified<br />Aim: To clear visual axis<br />2/19/2010<br />Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda<br />2<br />
  3. 3. Couching ( Ancient) No anaesthesia<br />Fastest?<br />Displace the lens: (Morgagnian) <br />Clears Visual Axis, Instant vision<br />Break the capsule (needling)<br />Delayed complications: Inflammation.<br />2/19/2010<br />Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda<br />3<br />
  4. 4. Extracap AC wash Topical Cocain (<1950)<br />Technique<br />Break Anterior capsule<br />Deliver the nucleus<br />Reposit the wound, no sutures<br />Strict bedrest, bilat patching, sandbags.<br />Let the nature take over<br />Concerns<br />High failure rate/ ambulatory vision<br />Iris prolapse<br />Phacoanaphylactic reactions<br />After cataracts<br />2/19/2010<br />Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda<br />4<br />
  5. 5. Intracap (1960-1982): Retrobulbar<br />Technique<br />Removing the lens with intact capsule : Clear media<br />Holding anterior capsule: Forceps, Erisiphake, Cryo<br />Zonulysis: Chymotripsin<br />Keeping intact hyaloid phase <br />PBI, Suturing<br />VL, Vit. Vick, Choroidal detach, RD, CME <br />Aphakia<br />The Instrument <br />2/19/2010<br />Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda<br />5<br />Intra forceps, cryo<br />
  6. 6. Aphakia<br />2/19/2010<br />Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda<br />6<br />
  7. 7. Intracap + Ac IOL ( 1982-1984) Retrobulbar<br />Technique<br />Introduction to Microsurgery<br />10/0 suturing<br />Viscoelastic<br />Concept of anterior vitrectomy<br />AC IOL<br />2/19/2010<br />Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda<br />7<br />
  8. 8. Extracap + PC IOL (1982-1992) Retro/Peribulbar<br />Technique<br />Microsurgery<br />Precise ant. Cap.<br />Smooth Nucleus delivery <br />Irrigation aspiration concept of AC maintenance.<br />Thorough cortical cleanup Simcoe canula<br />Posterior Chamber IOL<br />2/19/2010<br />Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda<br />8<br />
  9. 9. Phaco + Rigid IOL (1992 – 2000) Peribulbar<br />Technique<br />Small Incision/Less Astigmatism<br />Rhexis<br />Visco<br />Chamber stability<br />Precision in nucleus management<br />In the bag implantation<br />2/19/2010<br />Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda<br />9<br />
  10. 10. Phaco + Foldables (2000 onwards) Peribulbar/Topical<br />2/19/2010<br />Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda<br />10<br />
  11. 11. The pearls<br />Past Techniques<br />Couching<br />ECCE/Needling<br />Intracap<br />ECCE + PC IOL<br />Present Applications<br />Consider correcting aphakic zone, AC IOL<br />Infants, Bilat Cataract<br />Hypermatsubluxated cataracts<br />Hard Cataracts, Machine failures, compromised corneas, Shallow AC, Small pupils, Synechias<br />2/19/2010<br />Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda<br />11<br />
  12. 12. The message<br />2/19/2010<br />Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda<br />12<br />Take each case on its merit and<br /> be prepared for modifications<br />The choice of a technique should be surgeon’s<br />discretion and should not be offered as “goods” on display<br />Thank You<br />

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