brief ppt on Blumenthal presented by me @ SN

2. • Aka mini nuc tech…for mini nucleus
outcome

3. • local anesthesia
• fornix-based flap (1mm conj)
• 5.5-mm partial thickness scleral incision
with 1.5-mm backward cuts at each end
was initiated 1.5-mm posterior to the
limbus

4. • The tunnel was fashioned with a crescent
blade; the incision usually extends
approximately 2 to 2.5 mm into the cornea
• Dissection on both sides to create a
funnel-shaped “pocket”.

5. • The blade was then angled to cut
backwards so as to incorporate the
backward cuts into the pocket permits
extraction of most nuclei

6. • Visco-elastic into the anterior chamber
through a paracentesis
• CCC was performed through the
paracentesis using a cystitome.
• Complication : relaxing incisions in small
CCC , because of fluidics can extend
completely – PCR. Avoided by converting
it into beer can opener

7. • MVR is used to make a 1-mm entry into the anterior
chamber in clear cornea through the bed of the tunnel
under the scleral flap at the inferior limbus
• An anterior chamber maintainer connected to a bottle of
irrigating fluid was inserted through an additional
paracentesis

10. • Complication : if ACM is not completely
inside A/C and flow is started it can l/t
DMD , altering visibility and hence surgical
outcome
• Prevented by keeping ACM OFF while
insertion + end of ACM atleast 1mm
beyond Descemet membrane
• Rx : full chamber air bubble at the end of
surgery

11. • The anterior chamber was entered with a
2.8-mm Keratome, the internal incision
was about 8-9 mm

12. • Complications :
1. iris prolapse : since ACM is on , if tunnel
is not self sealing or keratome entry is
not proper
2. Bleeding
• During / at the end of surgery
• Stopped by increasing IOP ( bottle
height)
• Continuous flow - No accumulation – no
debris – no post op inflammation.

13. • Hydrodissection was performed inferiorly to
prolapse the upper pole of the nucleus into the
anterior chamber
• Complication : from side port if hydro done @
3 / 9 o’clock , canula prevents nucleus to pop
out of bag + fluidics from ACM - PCR

14. • the Blumenthal canula was introduced just
under the anterior capsule to the equator
between 10 and 12 o’clock
• the canula moved in the same plane
toward the pupil and then anteriorly thus
manipulating the upper pole of the nucleus
into the anterior chamber

15. PCR + Vit in A/C
• Bimanual vitrectomy

16. • Presence of ACM reduces fluctuation &
turbulence in A/C
• Vitrectome through tunnel – increases
fluctuation – more vitreous loss – difficult
to perform vitrectomy tunnel + enlarges
PCR

17. • Sheet glide was then inserted between the
nucleus and the posterior capsule and the
nucleus was extracted

18. • cortex extraction with a single port-
aspirating canula on a syringe
• A posterior chamber lens (PMMA lens with
optic diameter of 6.5 mm) was placed in
the bag;

19. MANUAL ASPIRATION V/S I/A
• CANULA doesn’t affect fluidics, so even if
very close to PC, rarely it ll be engaged.
• Simcoe’s / automated I/A does

20. FLUIDICS
• FLUCTUATION IN A/C DEPTH
• TURBULENCE OF FLUID
• IOP

21. ADVANTAGES
• PUPIL DILATATION
• FACILITATES RHEXIS
• EXPULSIVE CHOROIDAL H’GE:
REDUCE/ ELIMINATE
• CME REDUCED