Phacoemulsification Principles And Techniques Pdf
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- A rapid technique for en masse soft cataract phacoemulsification
- Phacoemulsification: Principles and Techniques
- Phacodynamics and Phacoemulsification
A rapid technique for en masse soft cataract phacoemulsification
Phacoemulsification is a modern cataract surgery method in which the eye 's internal lens is emulsified with an ultrasonic handpiece and aspirated from the eye. Aspirated fluids are replaced with irrigation of balanced salt solution to maintain the anterior chamber. The term originated from phaco- Greek phako- , comb. Proper anesthesia is essential for ocular surgery. Topical anesthesia is most commonly employed, typically by the instillation of a local anesthetic such as tetracaine or lidocaine.
A facial nerve block using lidocaine and bupivacaine may occasionally be performed to reduce lid squeezing. General anesthesia is recommended for children, traumatic eye injuries with cataract, for very apprehensive or uncooperative patients and animals.
Cardiovascular monitoring is preferable in local anesthesia and is mandatory in the setting of general anesthesia. Proper sterile precautions are taken to prepare the area for surgery, including use of antiseptics like povidone-iodine. Sterile drapes, gowns and gloves are employed. A plastic sheet with a receptacle helps collect the fluids during phacoemulsification.
An eye speculum is inserted to keep the eyelids open. Before the phacoemulsification can be performed, one or more incisions are made in the eye to allow the introduction of surgical instruments. The surgeon then removes the anterior face of the capsule that contains the lens inside the eye. Phacoemulsification surgery involves the use of a machine with microprocessor-controlled fluid dynamics.
These can be based on peristaltic or a venturi type of pump. The phaco probe is an ultrasonic handpiece with a titanium or steel needle. The tip of the needle vibrates at ultrasonic frequency to sculpt and emulsify the cataract while the pump aspirates particles through the tip. In some techniques, a second fine steel instrument called a "chopper" is used from a side port to help with chopping the nucleus into smaller pieces.
The cataract is usually broken into two or four pieces and each piece is emulsified and aspirated out with suction. The nucleus emulsification makes it easier to aspirate the particles. After removing all hard central lens nucleus with phacoemulsification, the softer outer lens cortex is removed with suction only.
An irrigation-aspiration probe or a bimanual system is used to aspirate out the remaining peripheral cortical matter, while leaving the posterior capsule intact. As with other cataract extraction procedures, an intraocular lens implant IOL , is placed into the remaining lens capsule. For implanting a foldable IOL, the incision does not have to be enlarged.
It is then inserted and placed in the posterior chamber in the capsular bag in-the-bag implantation. Sometimes, a ciliary sulcus implantation may be required because of posterior capsular tears or because of zonular dialysis. Charles Kelman and Anton Banko introduced phacoemulsification in Use of ultrasound in phacoemulsification can cause effects such as corneal edema, and macular edema after surgery.
However, in some cases, use of ultrasound energy does not generate macular edema. The cause of macular edema in phacoemulsification is intraocular pressure fluctuation during surgery.
Intraocular fluctuation can create micro bubbles and generate micro emboli in macular vessels that can cause micro ischemia in the retinal nerve fiber layer RNFL. A Cochrane Review seeking to determine whether glaucoma surgery combined with cataract surgery via phacoemulsification has any advantages over cataract surgery via phacoemulsification alone, found that eyes that underwent combined glaucoma and phacoemulsification surgery had a significantly lower intraocular pressure A Cochrane Review of 16 trials seeking to compare the effectiveness of laser-assisted cataract surgery with standard ultrasound phacoemulsification found uncertain evidence suggesting benefits of one procedure over the other.
In a Cochrane Review, clinical trials comparing NSAIDs versus corticosteroids in the treatment of postoperative eye inflammation were uncertain, but there was some evidence suggesting patients treated with NSAIDs were less likely to develop cystoid macular edema. This design reduces manufacturing costs, eliminates the risk of infection and provides better surgical outcomes  .
From Wikipedia, the free encyclopedia. Phacoemulsification Phacoemulsification: Cataract surgery, by a temporal approach, using a phacoemulsification probe in right hand and "chopper" in left hand , being done under operating microscope at a United States Navy medical center. Journal of Cataract and Refractive Surgery. Cochrane Database Syst Rev.
Tests and procedures involving the eyes. Blepharoplasty East Asian blepharoplasty Epicanthoplasty Tarsorrhaphy. Dacryocystorhinostomy Punctoplasty. Harada—Ito procedure Strabismus surgery Botulinum toxin therapy of strabismus. Fluorescein angiography Indocyanine green angiography Fundus photography Corneal topography Optical coherence tomography Electrodiagnosis : Electrooculography Electroretinography Electronystagmography.
Plaque radiotherapy. Categories : Ultrasound Eye surgery. Namespaces Article Talk. Views Read Edit View history. Help Learn to edit Community portal Recent changes Upload file. Download as PDF Printable version. Phacoemulsification: Cataract surgery, by a temporal approach, using a phacoemulsification probe in right hand and "chopper" in left hand , being done under operating microscope at a United States Navy medical center.
Phacoemulsification: Principles and Techniques
Phacoemulsification is a modern cataract surgery method in which the eye 's internal lens is emulsified with an ultrasonic handpiece and aspirated from the eye. Aspirated fluids are replaced with irrigation of balanced salt solution to maintain the anterior chamber. The term originated from phaco- Greek phako- , comb. Proper anesthesia is essential for ocular surgery. Topical anesthesia is most commonly employed, typically by the instillation of a local anesthetic such as tetracaine or lidocaine. A facial nerve block using lidocaine and bupivacaine may occasionally be performed to reduce lid squeezing.
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Phacodynamics and Phacoemulsification
The problem with the brunescent cataract is its thicker dimension. When chopping is done with a 1. There was a general shift from horizontal to vertical cutting conceptualized by Vladimir Pfeifer of Slovenia and further developed by David Dillman and Louis Nichamin.
This is even more relevant to bimanual microphaco and is mandatory for the evolution of this technique. Phacodynamics is defined as the study of the funda- mental principles of inflow rates, outflow rates, vacuum, phaco power modulation along with microsurgical maneuvers with different types and grade of cataract. A true understanding of this will help in logical setting of the machine parameters in adaptation to different surgical techniques. Even the most modern machine will not give adequate results as compared to an older machine if the principles of phacodinamics are not well understood.
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However, the procedure is not without risks and complications. Poor visual outcome, retinal detachment, infection, diplopia, and cornea and iris problems may pose considerable challenges. Additional potential problems arise from implanting the intraocular lens IOL. Edited by a renowned master surgeon and educator in the field, and authored by a remarkable cast of cataract experts, this is the definitive text on managing cataract surgery, with practical guidance on recognizing and managing complications, should they arise. Experts demonstrate the right way to perform phacoemulsification and diverse surgical and intraocular lens implantation procedures in order to reduce risk and improve patient outcome.