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Small incision cataract surgery: tips for avoiding surgical complications.

Gurung R, Hennig A - Community Eye Health (2008)

View Article: PubMed Central - HTML - PubMed

Affiliation: Deputy Medical Director, Tilganga Eye Centre, Kathmandu, Nepal. Email: reetagurung@gmail.com.

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Small incision cataract surgery (SICS) is one of the cataract surgical techniques commonly used in developing countries... With SICS, as with all cataract surgery techniques, it is mandatory to perform a thorough preoperative assessment of the patient (see article on page 12)... If there is doubt about the self-sealing effect, the surgeon may apply one or two sutures at the end of surgery... If correctly tied, these will, at the same time, reduce any induced astigmatism... Only a correct sclerocorneal tunnel incision, at least 1 to 2 mm into the clear cornea, leads to a self-sealing wound... Scleral cauterisation before tunnel. construction reduces the risk of pre- and postoperative hyphaema... If the crescent knife is not visible during the incision, this indicates that you are working too deeply inside the sclera; you may perforate towards the anterior chamber's angle (a ‘premature entry’)... During SICS, different techniques can be used to remove the nucleus: either hydroexpression alone (using an anterior chamber maintainer), hydroexpression plus extraction (using an irrigating vectis or Simcoe cannula), or extraction alone (using a ‘fishhook’ needle)... Instruments for nucleus removal, such as the irrigating vectis, Simcoe cannula, or fishhook, should be kept away from the cornea and should not push the nucleus against the cornea during nucleus delivery.These instruments should push slightly posteriorly, which will help to open the incision for easier nucleus delivery (Figures 9 & 10)... Most of the lens cortex can be removed with a Simcoe cannula through the tunnel (Figure 11)... A sub-incisional cortex can be safely aspirated through a side port at 130–180˚ from the incision site... Wrinkles indicate that the posterior capsule is caught in the aspiration port of the Simcoe cannula... This requires immediate backflushing to avoid posterior capsular rupture... To reduce the risk of a postoperative increase in intraocular pressure, thorough removal of viscoelastics is required.

No MeSH data available.


Checking the tunnel size
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Figure 9: Checking the tunnel size

Mentions: Difficulties with nucleus delivery are mostly due to the inner tunnel opening being too small. This should be checked before nucleus removal, e.g. with the visco cannula (Figure 7). If there is any doubt about the correct tunnel size, it is better to further enlarge the tunnel before removing the nucleus. However, the surgeon should avoid cutting into the anterior chamber's angle while enlarging the inner tunnel opening, as this carries an increased risk of hyphaema.


Small incision cataract surgery: tips for avoiding surgical complications.

Gurung R, Hennig A - Community Eye Health (2008)

Checking the tunnel size
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2377379&req=5

Figure 9: Checking the tunnel size
Mentions: Difficulties with nucleus delivery are mostly due to the inner tunnel opening being too small. This should be checked before nucleus removal, e.g. with the visco cannula (Figure 7). If there is any doubt about the correct tunnel size, it is better to further enlarge the tunnel before removing the nucleus. However, the surgeon should avoid cutting into the anterior chamber's angle while enlarging the inner tunnel opening, as this carries an increased risk of hyphaema.

View Article: PubMed Central - HTML - PubMed

Affiliation: Deputy Medical Director, Tilganga Eye Centre, Kathmandu, Nepal. Email: reetagurung@gmail.com.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Small incision cataract surgery (SICS) is one of the cataract surgical techniques commonly used in developing countries... With SICS, as with all cataract surgery techniques, it is mandatory to perform a thorough preoperative assessment of the patient (see article on page 12)... If there is doubt about the self-sealing effect, the surgeon may apply one or two sutures at the end of surgery... If correctly tied, these will, at the same time, reduce any induced astigmatism... Only a correct sclerocorneal tunnel incision, at least 1 to 2 mm into the clear cornea, leads to a self-sealing wound... Scleral cauterisation before tunnel. construction reduces the risk of pre- and postoperative hyphaema... If the crescent knife is not visible during the incision, this indicates that you are working too deeply inside the sclera; you may perforate towards the anterior chamber's angle (a ‘premature entry’)... During SICS, different techniques can be used to remove the nucleus: either hydroexpression alone (using an anterior chamber maintainer), hydroexpression plus extraction (using an irrigating vectis or Simcoe cannula), or extraction alone (using a ‘fishhook’ needle)... Instruments for nucleus removal, such as the irrigating vectis, Simcoe cannula, or fishhook, should be kept away from the cornea and should not push the nucleus against the cornea during nucleus delivery.These instruments should push slightly posteriorly, which will help to open the incision for easier nucleus delivery (Figures 9 & 10)... Most of the lens cortex can be removed with a Simcoe cannula through the tunnel (Figure 11)... A sub-incisional cortex can be safely aspirated through a side port at 130–180˚ from the incision site... Wrinkles indicate that the posterior capsule is caught in the aspiration port of the Simcoe cannula... This requires immediate backflushing to avoid posterior capsular rupture... To reduce the risk of a postoperative increase in intraocular pressure, thorough removal of viscoelastics is required.

No MeSH data available.