3D Surgery: Phacoemulsification and Canaloplasty

Summary

Dr. White Coleman performs a cataract surgery on a patient with coexisting glaucoma, demonstrating techniques such as paracentesis, air filling, and staining the capsule with Tripan Blue. He uses a keratome to create a precise capsulorhexis and employs the MY Loop to safely dissect a mature cataract. The video also covers divide and conquer techniques, quadrant removal, and the use of the Centurion machine. Additionally, Coleman discusses the importance of protecting the posterior capsule during lens removal and concludes with intraoperative goniostopy using the Ingenuity device, showcasing a comprehensive approach to managing complex cataract cases.

Takeaways

• 👨‍⚕️ Dr. White Coleman performs a cataract surgery on a patient with coexisting glaucoma.
• 👁️ A paracentesis is made about half a millimeter anterior to the limbus to access the anterior chamber.
• 💉 Air is used to fill the anterior chamber before staining the capsule with trypan blue.
• 🔪 A keratome is used to puncture the capsule, initiating a controlled capsulorhexis.
• 🔗 The MYR loop is used to hyper-dissect the mature cataract with low pressure and volume to avoid posterior capsule rupture.
• ✂️ The cataract is divided and conquered by breaking it into quadrants using the MYR loop or Fugo blade.
• 🛠️ The Connor and Fugo tip are used to further divide the nucleus into even smaller pieces for efficient removal.
• 👁️‍🗨️ The posterior capsule is carefully protected during the procedure to prevent rupture.
• 💧 Provisc is used to hydrate and check for remaining fragments in the eye after the cataract is removed.
• 🛑 Intraoperative goniostopy is performed using the Ingenuity gonia prism for superior visualization of the chamber angle.
• 🔧 The Omni device is used for goniotomy and canaloplasty, with care to avoid diving posteriorly into the supercoidal space.

Q & A

What is the main procedure described in the script?

The main procedure described in the script is cataract surgery, specifically for a mature cataract in a patient with coexisting glaucoma.

Why is paracentesis performed in the surgery?

Paracentesis is performed to create an opening about half a millimeter anterior to the limbus, which allows for the injection of substances like air or viscoelastic into the anterior chamber of the eye.

What is the purpose of using air to fill the anterior chamber?

Filling the anterior chamber with air helps to maintain the shape of the chamber and provides a clear view for the surgeon during the procedure, especially when staining the capsule with trypan blue.

Why is trypan blue used in the surgery?

Trypan blue is used to stain the capsule, which enhances visibility and allows the surgeon to perform a precise capsulorhexis, the step where the anterior capsule of the lens is opened.

What is the significance of puncturing the capsule with a keratome?

Puncturing the capsule with a keratome creates a definite point to begin the capsulorhexis, which is crucial for controlling the size and shape of the opening in dense cataracts.

Why is it important to control the size of the capsulorhexis in dense cataracts?

In dense cataracts, controlling the size of the capsulorhexis is important to prevent the capsule from tearing and to facilitate the subsequent steps of the surgery, such as nucleus removal.

What is the role of the MY Loop in the surgery?

The MY Loop is used to cut and divide the dense cataract nucleus into smaller pieces, making it easier to remove from the eye. It also helps to protect the posterior capsule during the process.

Why is it recommended to use low pressure and low volume when hyper dissecting a mature cataract?

Using low pressure and low volume during hyper dissection of a mature cataract prevents the creation of high pressure, which could lead to the rupture of the posterior capsule before the nucleus is removed.

What technique is used to break the lens into quadrants?

The technique used to break the lens into quadrants involves using the MY Loop to create a clean slice of the dense cataract and then further breaking it into smaller pieces using the Connor and Facio tip.

How does the surgeon protect the posterior capsule during the removal of the nucleus?

The surgeon protects the posterior capsule by using a second instrument, such as the Connor, to hold the capsule back while performing phacoemulsification, ensuring that the capsule does not come into contact with the phaco tip.

What is the purpose of injecting Provisc during the surgery?

Provisc is injected to maintain the space in the anterior chamber and to ensure that there are no remaining fragments after the nucleus removal, which helps in maintaining the integrity of the posterior capsule.

What is the significance of the Ingenuity gonioscopic lens in the surgery?

The Ingenuity gonioscopic lens is used for intraoperative goniostopy, providing unparalleled visualization of the angle of the anterior chamber, which is crucial for performing goniotomy and canaloplasty.

How is the Omni device used in the procedure?

The Omni device is used for goniotomy and canaloplasty. It is inserted into Schlemm's canal and rotated to perform a 180-degree goniotomy, which helps to improve the outflow of aqueous humor in cases with coexisting glaucoma.