Cataract Surgery & Phaco

Question 1

What are the 8 steps of Cataract Surgery?

ICHHNCIO (In Caps Hip Hips Now Cause IOL OVD)

Answer 1

Incision 
Capsulorhexis
Hydrodissection
Hydrolineation
Nuclear Disassembly
Cortical Aspiration (cortex removal AI)
IOL Insertion
OVD Removal and Wound Closure

Question 2

1-What are the steps of Incision, what common instruments are used, and how does each step advance the cataract procedure for the surgeon?

ICHHNCIO (In Caps Hip Hips Now Cause IOL OVD)

Answer 2

LRI Limbal Relaxing Incision or
CRI Cornea Relaxing Incsion

1. 1st step is to make clear, corneal incisions which are usually 2 through the cornea using a keratome manually or phaco tips
2. Main or primary incision is used to insert tools or introduce OVD to allow for the paracentesis insicion
3. Lidocaine
4. Through 2nd incision placement of OVD in the anterior
5. Creation of paracentesis or side port (or stab)manually using a blade with a fixation ring
   or Laser LCS Laser will make an incision

Question 3

2-What are the steps of Capsulorhexis, what common instruments are used, and how does each step advance the cataract procedure for the surgeon?

ICHHNCIO (In Caps Hip Hips Now Cause IOL OVD)

Answer 3

If Manual using forcepts to create an opening in the front part of the lens.

1-Cystome tips allow for first pince
2-Utrata forceps flat handle

If it doesn’t spin don’t begin.
A needle thin probe inserted hole is created in capsule to remove nucleaus and cortex of len.

LCS Capsultomy with Catalys is smaller than manual tearing and cuts into the front part of the lens with laser.

Question 4

3-What are the steps of Hydrodissection, what common instruments are used, and how does each step advance the cataract procedure for the surgeon?

ICHHNCIO (In Caps Hip Hips Now Cause IOL OVD)

Answer 4

Syring with Cannula
Cortical cleaving generates a fluid wave encircles the nucleus separating it from the capsule or walls.
1. Separates the cortex and the capsule to make the lens mobile.
2. The capsule needs to remain so it can be used to hold the IOL.
3. Dissection of the capsular bag separates the lens from the cortex.
(If it doesn’t spin, don’t begin.)

The cannula is used to Inject fluid to separate the lens nucleus from cortex during cataract extraction & requires cortical removal by irrigation aspiration as a separate step.

Creates a golden wave – goes all the way around

Question 5

4-What are the steps of Hydrodelineation, what common instruments are used, and how does each step advance the cataract procedure for the surgeon?

ICHHNCIO (In Caps Hip Hips Now Cause IOL OVD)

Answer 5

The surgeon splits the nucleus from the cortex & a golden ring signals a successful separation.

Syringe with Cannula
Hydrodelineation Cannula
Done with cannula to separate the nucleus from the epinucleus.

Question 6

5-What are the steps of NUCLEAR DISSEMBLY, what common instruments are used, and how does each step advance the cataract procedure for the surgeon?

ICHHNCIO (In Caps Hip Hips Now Cause IOL OVD)

Answer 6

Dissembles the nucleaus using ultrasound energy - a vacuum is attached to the ultrasount to probe and suck away freed pieces
Phacoemulsification
1- Phacoemulsification breaks down the nucleus of the lens.
2- The nucleus & cortex are removed using high frequency to turn the lens into liquid & then extract by suction
Divide and conquer is popular to break lens into quarters, then break each quarter into smaller fragments.
1-Chop, 2-Phaco Flip, 3-Stop & Chop, 4-Divide & Conquer, 5-Bowling outside/ in.
3- Softening of the lens; laser pulses segment the crystalline lens and softens cataract. The laser creates complex incisions in the cornea and precise control over length and structure.

Question 7

6-What are the steps of CORTICAL ASPIRATION (cortex removal/IA) what common instruments are used, and how does each step advance the cataract procedure for the surgeon?

ICHHNCIO (In Caps Hip Hips Now Cause IOL OVD)

Answer 7

IA handpiece strippinge the wallpaper, removing cortex
thin layer cortex

POWER, IRRIGATION, ASPIRATION, VACUUM

Insert Cohesive OVD filling the bag before IOL insertion
Hitting the wound

Question 8

7-What are the steps of IOL INSERTION what common instruments are used, and how does each step advance the cataract procedure for the surgeon?

ICHHNCIO (In Caps Hip Hips Now Cause IOL OVD)

Answer 8

Forceps
IOL can be inserted in the lens bag, sulcus
or anterior chamber

If not eyehance or simplicity preloaded, insertion device emerald inserter OVD inserter

Capsular Tension rings designed to stabilize capsular bag

With the aid of visco elastic fluid clear IOL inserted in the capsular bag or in the sucus

Unfolder of delivery system Tecnis simplicity preloaded delivery system screw style inserter
OVO cohesive with insertion

Question 9

8-What are the steps of OVD Removal & Wound Closure what common instruments are used, and how does each step advance the cataract procedure for the surgeon?

ICHHNCIO (In Caps Hip Hips Now Cause IOL OVD)

Answer 9

Manual- all instilled OVD removed from the capsular bag and anterior chamber.

BSS
BCC
Weck cell sponges
• Removes all tools and surgical fluids; Endothelial protection, space-occupying and slow motion/pause button. The cataract incision is closed.
Removal of OVD from capsular bag and anterior chamber.
• Stromboli hydration
A cataract incision is closed through Stromal hydration, sutured closure, and use of a corneal adhesive (hitting the wound with BSS to create edema & hydration) re all wound closure options for clear corneal incisions.