Year : 1979 | Volume
: 27 | Issue : 4 | Page : 47--48
Phaco-emulsification and aspiration technique for cataract operation
Sitapur Eye Hospital, Sitapur, India
A K Paul
Sitapur Eye Hospital, Sitapur
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Paul A K. Phaco-emulsification and aspiration technique for cataract operation.Indian J Ophthalmol 1979;27:47-48
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Paul A K. Phaco-emulsification and aspiration technique for cataract operation. Indian J Ophthalmol [serial online] 1979 [cited 2020 Sep 24 ];27:47-48
Available from: http://www.ijo.in/text.asp?1979/27/4/47/32572
This paper describes a method of dissolving, emulsifying and aspirating a mature cataract through a two to three mm incision.
By presenting this paper it is not meant to replace the usual technique of cataract surgery in favour of phaco -emulsification but it is presented as an adjunct which may be interesting and informative. Phaco-emulsification does not imply on extra capsular procedure necessarily. The capsules can be left or removed at the discretion of the surgeon. The desired goal is immediate physical and early visual rehabilitation of the patient which is achieved by a small incision (2mm), one suture and early mobilization. This eliminates the need for hospitalization also.
Besides such complications as corneal astigmatism, iris prolapse, flat chamber, down-growth of epithelium, hyphaema, cystic bleb formation, disturbances of filter bleb and vitreous adherence to wound with updrawn pupil, are seen less frequently (Kelman-1969).
Selection of patient
Fifteen cases of cataract with poor visual prognosis due to associated ocular disease were taken up for this operation. The examination of patient is important in order to select the cases for the type of surgical procedure as we have considered the following things:
(l) Condition of the cornea and endothelium. -Must have clear visibility into A.C. in order to perform safe phaco-emulsification.
-In clear cornea with healthy endothelium evaluation of the results is satisfactory.
(2) Depth of A.C.
-Nice deep A.C.-easy to perform the operation than in shallow anterior chamber.
-Difficulty in shallow A.C.-is getting the nucleus into the A.C.
(3) Size of the dilated pupil-The pupil should be well dilated to perform the phaco-emulsification technique. In undilated pupil one should not attempt to perform the operation.
(4) Type of the nucleus-This has no relation with the results of the technique but ultrasound time varies. In soft cataract it takes less time to dissolve than in hard or medium hard cataract.
Pre-operative preparation of the patient
The pupils were fully dilated with 2% homatropine and 10% phenylephrine. All cases were operated under local anaesthesia. However, these cases were having clear cornea and healthy endothelium and the depth of the anterior chamber was normal. The patients were between 50-60 years of age. There were 9 males and 6 females.
The Kelman Cavitron's apparatus was used in this study which subserves 3 basic functions:
a) Ultrasonic vibrating emulsification, b) irrigation and c) aspiration.
The Zeiss zoom operating microscope was used it all the cases. It was so angled that the microscope allows the surgeon a clear view. A 2mm incision was made at the limbus after a small conjunctival flap had been raised. After the incision had been accurately placed the anterior chamber was filled either with ail or with saline. Now the cystotome was placed on the anterior capsule and tear was performed in the "Christmas tree" fashion and was completed till an adequate removal of the anterior capsule performed. The lens nucleus was subluxated into A.C. The capsule was removed and cut with the De Wecker scissors, without exerting undue traction on the zonule adjacent to the incision. For subluxation of the lens nucleus into the A.C. there are several methods but we followed "See Saw technique". The tip of cystotome was buried into the firm nucleus substance so as to dislocate the nucleus.
As the nucleus is placed in A.C. emulsification part is to be done now. First ultrasonic tip was put in A.C. (Foot switch position : 1), the nucleus was engaged and foot switch position changed to : 2. Emulsification was done by moving to foot position : 3, emulsification and aspiration was done with same ultrasonic tip. After completion of the emulsification of the lens the remaining cortex and capsular matter were removed. The ultrasound tip was withdrawn and 1/A tip was put (irrigation and aspiration only), with this tip, complete removal of the remaining lens cortex was done using foot position :2. A specially designed forceps was then passed into the eye to grasp one tip of anterior capsule at the 4 O'clock position. This was drawn forwards upto the wound until the zonules at the 6 O'clock position were ruptured. The anterior capsule was then grasped at the 8 O'clock position and then withdrawn from the eye. No attempt should be, made to grasp the posterior capsule directly as it is not possible to do so without also grasping the vitreous face. At the time there may be some soft cortical material subjacent to the wound. The emulsification device can again be introduced into the eye but at this point it should be used only as an irrigating-aspirating device. After that a small peripheral iridectomy was done. One absorbable suture was placed in the shelved incision and the conjunctiva was closed with three absorbable sutures. The postoperative treatment of the eye was the same as for any other cataract extraction except that the patient was immediately allowed unrestricted activity. Atropine ointment 1 % was used and the eye was patched for 48 hours only and there after daily dressing with atropine ointment 1% and hydrocortisone drops was carried out for a week or so.
Following complications were noticed in the 15 operated cases. The post-operative follow up of the cases was mainly from first post-operative day to 6th day.[Table 1]
The technique of phaco-emulsification and aspiration of the lens was used in 15 cataract patients. Initial complications, which were seen, were almost absent after 4-6 weeks. The visual result in each case was as would be expected with conventional surgery.
|1||Kelman, D.C., 1969, Amer. J. Ophrhal., 67,464.|