Following are the step by step surgical guide to PCIOL implantation in case of poorly dilated pupil with complicated cataract without using pupillary retractors.
1. Paint the patient with betadiene
2. Give peribulbar block with xylocaine and bupivacaine at the lateral 1/3 superiorly and medical 2/3 inferiorly.
3. Superior rectus suture for proper exposure and fixing the eye ball, also known as bridle suture.
4. Prepare the conjunctival flap.
5. Perform wet field cautry so as to clear the field.
6. Give inverted frown shaped incision with 15 no blade.
7. Tunnel is formed by 2.6 crescent blade which is approx 3mm wide and 5.5 mm long.
8. Entry is taken by Keratome.
9. Anterior chamber is reformed by viscoelastic substance.
10. Capsulotomy is done by Cystitome (26 gauze needle with bended tip), then hydrodissection is done by same cystitome after anterior pole of nucleus is prolapsed. After that we inject viscalon for protection of posterior capsule as well as for endothelial protection.
11. Size of tunnel is enlarged by crescent.
12. Nucleus is delivered out by irrigating wire vectis with minimal flow of fluid. Here its important that we will not clean the reminants of cortical matter for the extra protection of posterior capsule.
13. We will insert PMMA IOL (intra ocular lens – non foldable type) in capsular bag.
14. Then wash the cortical matter behind the lens with minimal flow of fluid.
15. Inject air in anterior chamber for polishing the posterior surface of cornea.
16. Finally we will inject dexamethasone with gentamycin in conjunctival flap, after that we will close the eye.
You can watch out the above steps in video form below on youtube.
Credits to this article and surgery goes to
Dr Rajendra Kumar Bundela (M.S Ophthalmology)
Bundela Netra Kendra & Maternity Center, Mahesh Complex, Geetapuri Khand-1, Khargapur, Gomti Nagar, Lucknow-10.
He also sits at Netra Kendra Clinic, Goel Palace, LG-42, Infront of Sahara Shopping Centre, Faizabad Road, Lucknow -16
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