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Cataract Surgery
Difficult Cases: Small Pupil
Surgeon: Dr Joobin Khadamy
Vali-E-Asr Hospital, Birjand
Birjand University of Medical Science
BIUMS- 2017
Dr. Joobin Khadamy 2
1. Anesthesia: Topical Anesthesia
2. Prep & Drape : Betadine 10%
3. Eyelid Speculum insertion
4. Washing Ocular Surface and Fornixes
Dr. Joobin Khadamy
Dr. Joobin Khadamy
Stab at 15° knife at 7 & 11 clock
• Tips: use cotton tip applicator to fix eye, it
could be placed the counter side or even just
posterior to insertion side
– Note 1: the cutting edge of knife should be opposite
to surgeon side.
– Note 2: the tip of knife should head toward center
of eye and follow its radius.
– Note 3: follow a plane parallel to iris plane.
Dr. Joobin Khadamy
Dr. Joobin Khadamy
Small Pupil Managment
Intracameral
injections
Ocular
viscoelastic
devices (OVD)
Mechanical
devices
Dr. Joobin Khadamy
Dr. Joobin Khadamy
Epinephrine
• 1:4000
Trypan blue
•Use before OVD
•Irrigate the dye: Epinephrine
•Atropin: Not certified
OVD
• Highly cohesive
Dr. Joobin Khadamy
Dr. Joobin Khadamy
Iris Retractors
• Four short and narrow incisions
– At limbus
– Clock 2, 4, 8 & 10
• Notice: thereafter first retractor placement,
insert the second adjacent to previous one;
not at counter site.
Dr. Joobin Khadamy
Dr. Joobin Khadamy
Capsulorhexis
•Bented cystome
•Large rhexis
Dr. Joobin Khadamy
Dr. Joobin Khadamy
Hydrodisection
•Nucleus rotation
Phaco
emulsification
• Chop technique
• Intracapsular
fragmentation
I&A
• Cortical material
removal
Dr. Joobin Khadamy
Dr. Joobin Khadamy
OVD
•Forming capsular bag
IOL
• Implantation in bag
I&A
• OVD removal
Dr. Joobin Khadamy
Dr. Joobin Khadamy
Forming
A/C
Stromal
hydration
Retractor
removal
Dr. Joobin Khadamy
Dr. Joobin Khadamy
Thanks
• Mr. M Ahmadi
• Mr. Kiani
• Mrs. Masoumi
• Mr. Sabzali
• Mr. Nabayee
• …….
Dr. Joobin Khadamy

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Cataract Surgery: Small Pupil by Dr Joobin Khadamy