Dr Sudhir Singh, MS
Sr. Consultant & Head
Department of Ophthalmology
JW Global Hospital Research Centre
Mount Abu India 302019
drsudhirsingh@gmail.com
Management of Subluxated Cataract by SICS With CTR and IOL
( Voice Over)
Safe Cataract Surgery in the
Intumescent White Cataracts (With Voice Over)
Cataract And Small Pupil Management
Manual Techniques( With Voice Over)
In this video your are to watch
management of subluxated hyper mature cataract by small
incision cataract surgery (SICS) using capsular tension ring
(CTR)
Subluxated Cataract Management: Ant
Capsulotomy+MSICS+CTR+IOL+Post Capsulotomy
She was an elderly female with hyper mature morganian
cataract with fibrosed and wrinkled anterior capsule with
poor zonular support with subluxation with ns 4 nucleus with
primary posterior capsular. Intraoperative As anterior
capsule fibrosed and wrinkled so capsulotomy was very
difficult but done with 15 degree blade and vannas scissors.
Grade 4 nucleus taken out by vectis. Capsular bag was
supported by CTR and then PMMA IOL implanted. Dense primary
posterior capsular opacification was there, so posterior
capsulotomy done. Vision first post operative day 6/18 PH
6/12.
Viscoelastics HPMC 2 % was used
Irrigation Solution Ringer Lactate was used. Please watch
out video below
MSICS In Nuclear Cataract Grade 5: First
Post Op Day Clear Cornea with 6/9 Unaided Vision
MSICS In Nuclear Cataract Grade 5: First
Post Op Day Clear Cornea with 6/9 Unaided Vision This was a
70 years old gentleman presented with grade 5 nuclear
sclerotic cataract with poor zonular support. Many surgeons
would go for phacoemulsification but it would prone to phaco
ultrasound energy related corneal complications, lens
capsule and zonules related complications including lens
matter drops or zonular dialysis. In other words standard
phaco would be challenging and risky despite of best of the
phaco machines, OVD and surgical skills. In such cases the
role the femto laser assisted cataract surgery (FLACS) is
advocated to minimize ultrasound energy related
complications. The FLACS is unaffordable to most of the
cataract surgeons and patients in the present scenario.
Other par excellence, simple and economical option is manual
small incision cataract surgery (MSICS). We decided to do
MSICS in this case. The capsulorhexis was done and two
relaxing incision were made as nuclear size anticipated
large. The nucleus was tried to rotate in the capsular bag
bit it could not be due to capsulo-cortical matter
adhesions. The cortical matter aspirated by IA canula and
then nucleus is rotated and dialed out in the anterior
chamber. Then nucleus was taken out by vectis. Irrigation
aspiration is done. PMMA IOL implanted. The sclero-corneal
tunnel was sutured with 10-0 nylon suture to control
surgical induced astigmatism. Post operative day 1 vision
was 6/9 unaided with crystal clear cornea. Patient had 6/6
unaided vision on 4th day post operative.
Visco used: HPMC 2 %
Irrigation Solution: Ringers Lactate
Biometry: contact US A Scan
IOL Power Formula: SRK 2
Simple Safe Inexpensive High Quality : Hypermature
Morgagnian Cataract Management
Hyper mature
morgagnian cataracts with hard nuclear with no or
very little cortical support are prone to
phacoemulsification related serious complications like
complications like further posterior extension of capsular
tear, zonulodialysis and nucleus drop. Although some
experience phaco surgeon can complete phacoemulsification by
exercising special precautions and taking calculated risk.
In
my opinion, it’s always better to do manual small incision
cataract surgery to avoid phaco related complications. As
MSICS is an inside out procedure as compared to phaco, which
is an outside to inside procedure. In this video I am going
to demonstrate 6 mm intratunnel phacofracture manual small
incision cataract surgery. Please watch this video below
6 mm Intratunnel Phacofracture MSICS in Jet
Black Hard Nuclear Cataract
Hard nuclear cataracts
along with morbid pupil and capsular support pose problems
to the best of phaco surgeons equipped with high end phaco
machines and expensive OVDs. They are prone to ultrasound
energy related complications; posterior capsule related
complication and nucleus drop related complication. In cases
manual small incision cataract surgery is the savior. We are
going share a case of grade 6 large nuclear cataract, pupil
not getting dilated, capsule was fibrosed and zonular
support was poor. This was managed by 6 mm intratunnel
phacofracture MSICS. HPMC 2% as viscoelastics and Ringer’s
Lactate as irrigation solutions were used.
SICS In Typical Coloboma and Nuclear Cataract
This was a one eyed case of typical iris
coloboma with nuclear cataract grade 4.Manual SiCS was done
.
Capsulorhexis In
Different Situations
Capsulorhexis In Different Situations In
this video I am going to demonstrate Capsulorhexis in
non getting dilated pupil
Capsulorhexis in white intumescent cataract
Capsulorhexis in White morganian Cataract
Capsulorhexis in white morganian cataract with fibrosed
Capsule
CCC in post uveitis non getting dilated 1mm pupil
Intra tunnel Phacofracture SICS in Rock
Hard Nuclear Cataract
Intratunnel Phacofracture SICS In Floppy
Iris and Non Dilating Pupil
Intratunnel Phacofracture MSICS With Trabeculectomy With
Removable Sutures
One eyed 85 years male presented with
left eye nuclear cataract grade 4 with psuedo exfoliation
with floppy iris with advanced glaucomatous cupping. The
right has total glaucomatous optic atrophy.
Vision OD 6/60 OS PL + PR Inaccurate
IOP OD 37.2 mm Hg OS 37.2 mm Hg
Plan 6mm Intratunnel Phacofracture MSICS With Trabeculectomy
With Removable Sutures
Intratunnel Phacofracture MSICS in Intumescent Cataract
This types of the
intumescent cataracts are prone to anterior capsular radial
tear extension (The Argentinian flag sign ).So the three
stage capsulorhexis was done. Three Stage Capsulorhexis
Stage 1: Small Central Capsulorhexis: Cohesive viscoelastics
is preferable for such cases. Initially a curvilinear nick
is given and capsular flap is folded and small capsulorhexis
is made by shearing and tearing forces.
Stage 2: Capsular bag is debulked by aspirating cortical
matter.
Stage 3: Small capsulorhexis Enlargement This is enlarged by
forceps after giving a curvilinear nick in margin of small
capsulorhexis
Nucleus Management: by 6 mm Intratunnel Phacofracture
IOL 6 mm PMMA IOL
Power Calculation : Contact USG A Scan
Keretometry : Goldman manual Keratometer
Post Op Day 1 Vision 6/12 PH 6/6 N12
Argentinian Fag Sign In White Intumescent
Cataract and Management
Despite all precautions
Argentinian Fag Sign encountered. It’s not end of the world.
The capsular tear is converted in a can opener capsulotomy.
If case is planned for phacoemulsification then its better
to convert in MSCIS (Manual Small Incision Cataract
Surgery). Phacoemulsification in extended or non intact
capsulorhexis could be risky affair. Conditions like hyper
mature morgagnian cataracts or hard nuclear cataract with no
or very little cortical support might further increase the
risk of the serious complications. Although some experience
surgeon can complete phacoemulsification by exercising
special precautions. It’s always better to covert to manual
small incision cataract surgery to avoid complications like
further posterior extension of capsular tear, zonulodialysis
and nucleus drop. How to convert to MSICS please watch this
(Link given below) "Most Practical Way To Convert After Not
Intact Capsulorhexis"
https://youtu.be/t-jILM9NUMo
Management of the
Intumescent Cataract with Adherent Leucoma
This
was a 25 year young lady,who had trauma in her left eye
about 15 years back.Clinical features as follows:
Central Adherent Leucoma
White Intumescent Cataract
Vision PL+ PR Accurate
IOP Normal (Digitally)
Right Normal
Plan
Stage 1: MSICS with PC IOL
Stage 2 : Penetrating Keratoplasty
