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The document discusses techniques for overcoming difficult cataract surgery cases involving loose zonules, hard nuclei, small pupils, and lens-induced glaucoma. It recommends gentle manipulation for loose zonules and triangular cracking. For lens-induced glaucoma, phacoemulsification has benefits over extracapsular extraction in reducing risks. Hard nuclei with small pupils require effective pupil management and nuclear disassembly techniques like 3-D divide and chop. With a strong understanding of principles and sufficient skill, surgeons can successfully treat even extreme cases beyond normal borders.
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1. Cataracts are opacities or cloudiness in the lens of the eye that impair vision. They are most commonly age-related but can be caused by eye injuries, medical conditions like diabetes, or exposure to radiation.
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Phaco chopping
1
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- Symptoms include decreased vision, glare from lights, and frequent changes to prescriptions. Cataract surgery is usually done to replace the cloudy lens with an artificial lens implant.
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1. Cataracts are opacities or cloudiness in the lens of the eye that impair vision. They are most commonly age-related but can be caused by eye injuries, medical conditions like diabetes, or exposure to radiation.
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Phaco step 4 : Phaco
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Chopping the nucleus into small pieces
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The document discusses the lens and cataract. It defines the lens as a transparent structure behind the iris that focuses light on the retina. Cataract is defined as any opacity within the lens. The most common cause of cataract is aging, but it can also be caused by trauma, inflammation, diabetes, and other systemic factors. Surgical removal of the cataract involves phacoemulsification, extracapsular extraction, or intracapsular extraction techniques. Post-operative care includes antibiotic and steroid eye drops. Complications include vitreous loss, iris prolapse, and endophthalmitis.
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- A cataract is a clouding of the lens in the eye that can cause vision loss. It is often related to aging but may be caused by other factors like smoking.
- Symptoms include decreased vision, glare from lights, and frequent changes to prescriptions. Cataract surgery is usually done to replace the cloudy lens with an artificial lens implant.
- There are different types of intraocular lenses that provide varying levels of vision correction and independence from glasses after surgery. Conventional lenses correct one distance while newer lenses aim to provide multifocal vision.
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Yag capsulotomy
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Combined cataract and glaucoma surgery can provide benefits of reduced costs, stress, and risks compared to staged surgeries. However, it also carries risks like increased inflammation and complications affecting the success of both procedures. The choice depends on factors like glaucoma severity and damage, medications, prior surgeries, and surgeon expertise. Successful outcomes require minimizing these risks through techniques like two-site surgeries and addressing challenges like poor dilation.
CATARACT-SURGERY.pdf
Cataract surgery involves removing the cloudy natural lens and replacing it with an artificial lens. The standard and most common method is phacoemulsification, which uses ultrasonic vibrations to emulsify and remove the lens. Other older methods include extracapsular extraction, which removes the lens through a larger incision, and intracapsular extraction, which removes the entire lens and capsule. Femtosecond laser-assisted cataract surgery uses a laser for some steps but outcomes are not clearly better than traditional surgery. The most common complication is posterior capsular opacification but it can be treated with a laser capsulotomy.
PCR management presentation of pcrPPT.pptx
This document discusses management of posterior capsule tears that occur during cataract surgery. It notes that posterior capsule tears can complicate the postoperative course by increasing the risk of complications like cystoid macular edema. For small central tears less than 3mm, conversion to continuous curvilinear capsulorhexis may be attempted. Larger tears require anterior vitrectomy and intraocular lens implantation in the ciliary sulcus. Vitreoretinal surgery may be needed for posteriorly dislocated lens fragments or associated retinal detachment. The key steps involve pars plana vitrectomy, removal of all lens matter, intraocular lens management, and treatment of complications.
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This document discusses posterior capsule tears that can occur during cataract surgery. It covers the predisposing factors, mechanisms, identification, and management strategies for posterior capsule tears with or without vitreous loss. Key points include identifying tears early, stabilizing the anterior chamber with viscoelastic, deciding whether to continue phacoemulsification or convert to extracapsular extraction based on the situation, performing anterior vitrectomy when needed with caution to minimize further vitreous disturbance, and properly placing an IOL. The goal is to remove all lens material and prevent further complications while minimizing additional surgery like vitrectomy.
Mgmt of pcr
This document discusses posterior capsule tears that can occur during cataract surgery. It covers the predisposing factors, mechanisms, identification, and management strategies for posterior capsule tears with or without vitreous loss. Key points include identifying tears early, stabilizing the anterior chamber with viscoelastic, deciding whether to continue phacoemulsification or convert to extracapsular extraction based on the situation, performing anterior vitrectomy when needed with caution to minimize further vitreous disturbance, and properly placing an IOL. The goal is to remove all lens material and prevent further complications while minimizing additional surgery.
Cataract (opthalmology)
Cataracts are a clouding of the lens of the eye that can cause gradual vision loss. They are usually caused by aging but can be caused by other factors like diabetes, smoking, or UV exposure. Cataracts are diagnosed based on a decrease in the red reflex seen during eye exams. They can be treated surgically through phacoemulsification to remove the clouded lens and replace it with an intraocular lens, improving vision. Age-related macular degeneration (AMD) is a disease of the macula that causes central vision loss. Dry AMD involves drusen buildup while wet AMD has abnormal blood vessel growth. Treatments include vitamins for dry AMD and anti-VEGF injections or photod
Keratoprsthesis
This document provides information about artificial cornea or keratoprosthesis surgery. It discusses the history and indications for the procedure, describes common designs for artificial corneas including biointegrated and non-biointegrated options, and outlines some of the major keratoprosthesis designs including the Boston KPro, AlphaCor KPro, and modified osteo-odonto keratoprosthesis. It also covers the preoperative evaluation, surgical procedure, postoperative management, prognosis, and complications for keratoprosthesis surgery.
Posterior Capsular Opacification.pptx
This document discusses posterior capsular opacification (PCO), a common complication of cataract surgery where opacity develops behind the lens implant. PCO occurs when a film of tissue forms behind the intraocular lens, decreasing vision clarity. Younger individuals and those with conditions like diabetes are at higher risk. Symptoms include blurred vision, glare, and reduced ability to focus. Treatment involves an outpatient YAG laser capsulotomy procedure to create an opening in the opaque capsule and restore vision.
Femtosecond Laser Cataract Surgery – Is This The Future?
Current and latest results of Femtosecond cataract surgery, procedure overview, patient experience, advantages and disadvantages
traumatic lens subluxation what to know
The document discusses lens trauma including subluxation and dislocation. The pathophysiology is described as a compressional force on the eye causing the zonular fibers that anchor the lens to stretch or damage. This can lead to subluxation or complete dislocation of the lens. Clinical findings may include decreased vision, diplopia, myopia, astigmatism, and a tremulous iris. Surgical management depends on the degree of zonular damage and may include lens extraction and intraocular lens implantation. Capsular tension rings can be used to provide circular expansion of the capsular bag and improve stability and centration during surgery.
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border
- 1. Phaco Beyond ThePhaco Beyond The BorderBorder Loose ZonuleLoose Zonule Hard NucleusHard Nucleus Small PupilSmall Pupil To overcome difficulties in extreme cases, we have to clearly understand basic principle of surgical steps especially the nuclear division.
- 2. Loose ZonuleLoose Zonule Triangular Cracking TechniqueTriangular Cracking Technique In loose zonule cases every manipulations inside the eye must be gentle and balance. Appropriate phaco techniques can be used safely in hands of skillful surgeon. ECCE has limitation since more zonules may be broken during nuclear expression.
- 3. Phacomorphic & PhacolyticPhacomorphic & Phacolytic GlaucomaGlaucoma VitreousVitreous In case of lens induced glaucoma, appropriate phacoemulsification technique has benefits over extracapsular cataract extraction. Chance of having suprachoroidal hemorrhage is reduced because of small, self sealing incision.
- 4. Hard Nucleus & Small PupilHard Nucleus & Small Pupil 3-D Cracking Technique3-D Cracking Technique ( 3-D Divide & Chop )( 3-D Divide & Chop ) Hard nucleus with small pupil is the situation that we do not want to face with. Appropriate pupil management and the most effective nuclear disassembly technique are needed.
- 5. Loose ZonuleLoose Zonule Hard NucleusHard Nucleus Small PupilSmall Pupil Phaco Beyond ThePhaco Beyond The BorderBorder Once we understand basic principle well and have enough skill, we are ready for difficult cases.
- 6. End of TopicEnd of Topic Click here to go back to main menuClick here to go back to main menu
- 7. End of TopicEnd of Topic Click here to go back to main menuClick here to go back to main menu
Editor's Notes
- To overcome difficulties in extreme cases, we have to clearly understand basic principle of surgical steps especially the nuclear division.
- In loose zonule cases every manipulations inside the eye must be gentle and balance. Appropriate phaco techniques can be used safely in hands of skillful surgeon. ECCE has limitation since more zonules may be broken during nuclear expression.
- In case of lens induced glaucoma, appropriate phacoemulsification technique has benefits over extracapsular cataract extraction. Chance of having suprachoroidal hemorrhage is reduced because of small, self sealing incision.
- Hard nucleus with small pupil is the situation that we do not want to face with. Appropriate pupil management and the most effective nuclear disassembly technique are needed.
- Once we understand basic principle well and have enough skill, we are ready for difficult cases.