This article is more than 5 years old. Information may no longer be current.
Technique prevents nucleus drop through capsular tear
Viscoelastic is injected through the pars plana with a hypodermic needle to create a raft under the nucleus.
Click Here to Manage Email Alerts
MILAN — When dealing with a hard cataract, complications resulting from a posterior capsule break can be prevented using a simple technique described at the Satelcataract meeting here.
“Instead of using instruments to support the nucleus,” said Richard Packard, FRCOphth, of Princess Christian’s Hospital, Windsor, England, “I inject viscoelastic through the pars plana, between the hyaloid and the posterior capsule, with a hypodermic needle. This way you can stabilize the break, push the vitreous face back and create a kind of a raft supporting the nucleus, so that there is no risk of it dropping back into the vitreous. Emulsification can then be safely carried out.”
Mr. Packard recommends the use of Viscoat (chondroitin sulfate, sodium hyaluronate, Alcon) for this technique. “Viscoat doesn’t need to be removed. Thanks to its lower molecular weight, it can be safely left in the vitreous cavity,” he said.
Bimanual technique
To minimize stress, Mr. Packard uses a bimanual technique to crack the nucleus. Once the nucleus is divided into two heminuclei, one half is lifted out of the bag and chopped. More viscoelastic can be injected for further support at this stage.
“While doing this, the second half of the nucleus is still held safely in the bag by the Viscoat. When its turn comes to be lifted up and out of the bag to be emulsified, the viscoelastic may tend to come out with it. In this case, a glide can be inserted through the cataract incision to protect the break and give further support to what is left of the nucleus. Emulsification can then be safely finished off on top of it. I normally use a 6-mm glide and cut it in half so that I can retain a small incision,” Mr. Packard said.
The cortex is then gently aspirated, using a dry aspiration technique. This is a particularly delicate stage, as the vitreous tends to ooze out of the break. If this happens, a bimanual vitrectomy is required. Finally, a foldable lens is inserted.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
For Your Information:
- Richard Packard, FRCOphth, can be reached at Princess Christian’s Hospital, 12 Clarence Road, Windsor, Berkshire SL4 5AG, England; +(44) 1753-829204; fax: +(44) 1753-831185; e-mail: eyequack@vossnet.co.uk; or at the Arnott Eye Centre, 22A Harley Street, London WIN 2BP, England; +(44) 207-580-1074; fax: +(44) 207-255-1524; e-mail: arnotteyecentre@compuserve.com. Mr. Packard has no direct financial interest in the products mentioned in this article, nor is he a paid consultant for any companies mentioned.