Cataract surgery

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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

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

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

12. ADVANTAGE OF SICS

13. Thank you