Comparison of various cataract surgical techniques 2
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Transcript of Comparison of various cataract surgical techniques 2
04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda
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Comparison of various cataract surgical techniques
Dr. Anand Sudhalkar, Baroda
04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda
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Why Cataract Surgery
• Medical management: Lengthy, costly, inefficient,
• Surgery: quick, immediately rewarding, most efficient amongst all surgeries, Justified
• Aim: To clear visual axis
04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda
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Couching ( Ancient) No anaesthesia
• Fastest?• Displace the lens:
(Morgagnian) • Clears Visual Axis,
Instant vision• Break the capsule
(needling)• Delayed complications:
Inflammation.
04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda
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Extracap AC wash Topical Cocain (<1950)
Technique• Break Anterior capsule• Deliver the nucleus• Reposit the wound, no
sutures• Strict bedrest, bilat
patching, sandbags.• Let the nature take over
Concerns• High failure rate/
ambulatory vision• Iris prolapse• Phacoanaphylactic reactions• After cataracts
04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda
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Intracap (1960-1982): Retrobulbar
Technique• Removing the lens with intact
capsule : Clear media• Holding anterior capsule:
Forceps, Erisiphake, Cryo • Zonulysis: Chymotripsin• Keeping intact hyaloid phase
• PBI, Suturing• VL, Vit. Vick, Choroidal detach,
RD, CME • Aphakia
The Instrument
Intra forceps, cryo
04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda
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Aphakia
04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda
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Intracap + Ac IOL ( 1982-1984) Retrobulbar
Technique• Introduction to
Microsurgery• 10/0 suturing• Viscoelastic• Concept of anterior
vitrectomy• AC IOL
04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda
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Extracap + PC IOL (1982-1992) Retro/Peribulbar
Technique• Microsurgery• Precise ant. Cap.• Smooth Nucleus delivery • Irrigation aspiration
concept of AC maintenance.
• Thorough cortical cleanup Simcoe canula
• Posterior Chamber IOL
04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda
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Phaco + Rigid IOL (1992 – 2000) Peribulbar
Technique• Small Incision/Less
Astigmatism• Rhexis• Visco• Chamber stability• Precision in nucleus
management• In the bag implantation
04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda
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Phaco + Foldables (2000 onwards) Peribulbar/Topical
04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda
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The pearls
Past Techniques1. Couching
2. ECCE/Needling
3. Intracap
4. ECCE + PC IOL
Present Applications1. Consider correcting
aphakic zone, AC IOL2. Infants, Bilat Cataract3. Hypermat subluxated
cataracts4. Hard Cataracts, Machine
failures, compromised corneas, Shallow AC, Small pupils, Synechias
04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda
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The message
Take each case on its merit and be prepared for modifications
The choice of a technique should be surgeon’sdiscretion and should not be offered as “goods” on display
Thank You