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| REVIEW ARTICLE |
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| Year : 1989 | Volume
: 37
| Issue : 4 | Page : 164-165 |
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Envelope method of insertion of disc I.O.L
Neol Moniz
CBM Ophthalmic Institute, Little Flower Hospital, Angamally, India
Correspondence Address:
Neol Moniz
CBM Ophthalmic Institute, Little Flower Hospital, Angamally
India
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 2638301 
How to cite this article:
Moniz N. Envelope method of insertion of disc I.O.L. Indian J Ophthalmol 1989;37:164-5 |
The pre-operative preparation and anaesthesia is as for any other IOL implantation technique.
| Stages of surgery | |  |
The incision is located in the corneal capillary region and should be a biplanar incision. The incision is made from 10-2'o clock. The initial incision to 1/2 corneal depth is perpendicular and the latter 1 /2 oblique. After first injecting Phenylephrin and then Healon into the anterior chamber the incision is enlarged with non-curved Castrovejo scissors.
Horizontal linear capsulotomy is made with a 30G straight or bent needle. The needle is connected to a plastic tube the other end of which is connected to a syringe held in the nondominant hand. Small multiple perforations are made in the capsule and connected to each other. The capsulotomy is made from 10 - 2'o clock and at the end radially in a direction parallel to the zonular fibres. The needle is reversed along the track to break any bridges.
Hydration of the cortex initially using the same capsulotomy needle, the anterior and lateral parts of the nucleus are freed by injecting Ringer lactate solution. Separation of the superior part of the nucleus can be done by hydrating the 12'o clock area with a bent Binkhrost cannula.
| Nucleus expression | | |
Nucleus expression is achieved by alternate pressure and counter pressure at 12'o clock and 6'o clock respectively. Pressure at12'o clock dislodges the upper pole and at 6'0 clock helps expel it out.
| Cortical clean up | | |
It is best to use a double cannula system with irrigation and aspiration at the same point. The cannula should have a hole at its tip and not a lateral orifice. A single cannula bent may be needed for the 12'o clock portion. The anterior chamber is entered with a continuous drip force. Infusion is from an infusion bottle and aspiration by a 5 ml syringe. The syringe should be empty at first and should not have any air in it. The cortex is detached from the equatorial zone and then by small lateral movements is detached from the posterior capsule, once the centre is reached pressure may be increased and cortex aspirated into the syringe.A curved single channel Binkhrost Mcyntre cannula is used forthe area from 11 - 1'o clock. The curve of the cannula must be kept parallel to the surface of the capsule. Vaccum cleaning of the capsule is accomplished by light suctioning of the posterior capsule.
| Insertion of the disc implant | | |
Healon R is injected to the AC and to the entry at the capsular bag. The implant is held at its edge near a centering hole and gently slid in without lifting the cornea. Once through, the implant is slowly slid through the horizontal capsulotomy, when it is seen that the implant is reaching the lower pole, the forceps is released. Then the forceps is used to push the superior edge of the implant. The implant can be properly placed under the superior capsular flap with a dialler (Sinskey hook).
| PASSAGE OF THE IMPLANT BEHIND THE SUPERIOR CAPSULAR FLAP | | |
The implant can be passed behind by pushing the implant towards 6'o clock and at the same time. towards the fundus. The superior capsular flaps are seen to slide over the lens when the implant is in place. This can also be done bimannually with a Sinskey hook in the dialling hole and a Rycroft cannula using irrigation is slid under the capsular flap. Moving the cannula tip towards the front slips the superior capsule over the edge of the implant. In case of too low a capsulotomy or loss of mydriasis prevent the implant from going into the bag it is better to make only a small capsulotomy or even keep the lower bag intact to support the implant. The excess lower capsule is opened with a YAG Laser after a few weeks.
After centering the implant Miochol is used to constrict the pupil.
| Anterior capsulotomy | | |
After injecting Healon R, two vertical cuts are made with capsule scissors and then the capsule is torn with capsular forceps in the lower part. If it at this stage the pupil is still not constricted Miochol is again injected. Before closing the section Healon is withdrawn.
| Closure of the section | | |
This is achieved by one interrupted suture at 12'o clock. Suturing is followed by continuous 10'o monofilament suture.
| POST- OPERATIVE CARE | | |
Steroid antibiotic drops are instilled four times a day and after a week thrice a day for one month. Postoperative miotics and mydriatics are not used routinely in post operative cases.
| Acknowledgement | | |
The article is abridged from the book "The envelope technique with insertion of a disc lens by Albert Galand, which was sent to us for abridging and publishing in the Indian Journal of Ophthalmology.
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6], [Figure - 7], [Figure - 8]
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