basics of cataract surgery for ophthalmic assistant , 2nd year what is cataract ? instruments used in cataract surgery ? types of cataract surgery ?

1. CATARACT SURGERY
DR. ANITA KUMARI
ANTERIOR SEGMENT FELLOW
SCEH, LAHAN

2. TYPES OF CATARACT SURGERY
I. Intracapsular cataract extraction (ICCE)
II. Extracapsular cataract extraction techniques
- Coventional extracapsular cataract extraction
- Manual small incision cataract surgery
- Phacoemulsification
- Femtosecond laser assisted cataract surgery

3. INSTRUMENTS

5. EXTRACAPSULAR CATARACT EXTRACTION
• ECCE – cataractous lens is removed while posterior capsule is left
intact to allow implantation of intra ocular lens
• In contrasted to ICCE in which whole lens with its capsule removed

6. STEPS OF ECCE
1. Superior rectus (bridle) suture
2. Conjunctival flap (fornix based)
3. Partial thickness groove or gutter- 10-12mm incision made
on the limbal area
4. Entry into anterior chamber with 3.2mm keratome or blade
knife
5. Injection of viscoelastic substance in anterior chamber
6. Anterior capsulotomy
- can opener technique
- linear capsulotomy
- continuous curvilinear capsulorhexis
7. Removal of anterior capsule
8. Completion of corneoscleral section
9. Hydrodissection

7. 10. Removal of nucleus
– pressure & counter pressure technique
- irrigating wire Vectis technique
11. Aspiration of the cortex
12. Implantation of IOL
13. Closure of the incision – 3-5 10-0 nylon suture
14. Removal of viscoelastic substance
15. Conjunctival flap is reposited and secured by wet
field cautery
16. Subconjunctival injection of dexamethasone 0.25
ml and gentamicin 0.5 ml is given
17. Patching of eye

8. STEPS OF SICS
1. Superior rectus (bridle) suture
2. Conjunctival flap and exposure of sclera
3. Haemostasis - wet field cautery
4. Sclerocorneal tunnel incision
i. External scleral incision- A one-third to half thickness external
scleral groove is made about 1.5 to 2 mm behind the limbus. It
varies from 5.5 mm to 7.5 mm in length depending upon the
hardness of nucleus. It may be straight, frown shaped or
chevron in configuration
ii. Sclerocorneal tunnel- made with the help of a crescent knife.
extends 1–1.5 mm into the clear cornea
iii. Internal corneal incision- 3.2 mm angled keratome
5. Side-port entry
6. Anterior capsulotomy

9. 7. Hydrodissection
8. Nuclear management-
• Irrigating wire vectis method
• Blumenthal’s technique,
• Phacosandwitch technique
• Phacofracture technique
• Fishhook technique
9. Aspiration of cortex
10. IOL implantation
11. Removal of viscoelastic material
12. Wound closure

10. STEPS OF PHACOEMULSIFICATION
1. Clear corneal incision (3 mm
2. Continuous curvilinear capsulorrhexis (CCC) of 4–6 mm
3. Hydrodissection
4. Nucleus is emulsified and aspirated by phacoemulsifier-
• Chip and flip technique,
• Divide and conquer technique
• Stop and chop technique
• Direct Phaco chop technique
5. Remaining cortical lens matter is aspirated
6. IOL implantation
7. Next steps i.e., removal of viscoelastic substance and wound closure are
similar to that of SICS

11. CONSUMABLES
• Syringes
• Needles
• Drapes & eye pad
• Dye & ophthalmic viscosurgical devices
• Gloves
• Balanced salt solution
• Intraocular lens
• Liquids for scrubbing

12. MEDICATIONS(eye drops)
• Antibiotics
• Corticosteroids
• Nonsteroidal anti inflammatory drug

18. ADVANTAGE OF SICS

20. Thank you