2015年10月28日 星期三

How to Conquer Rock Hard Cataract?很硬的白內障怎麼開

rock hard cataract (很硬)是很多人視為棘手的白內障,分享一下我的個人經驗。

1. 儘量散開瞳孔,必要時使用iris retractor
2. 染色,trypan blue or ICG

3. 撕囊前要儘量打飽OVD,撕囊時儘量多分幾次
4. 不打水,不轉lens,假設是zonular weakness
5. 確實的phaco鑿溝,使用divide and conquer分開第一道
6. 用chop mode好好吸住右邊那一半,左手chopper劈開1/6的大小,吸起來吃掉。
7. Viscodissection分開nucleus and capsule及保護capsule
8. chop掉剩下的2/6
9. 重複補OVD作viscodissection及chop直到吃完
10. 小心wound burn 及 lost chips
11. 直到拿掉撐眼器前都不能鬆懈

Rock hard cataract is challenging to cataract surgeons.
I would like to share my experience and tips.

1. Achieve maximum pupil dilation. Use iris retractor if necessary.
2. Stain the anterior capsule
3. Delicate CCC, stop for a few more times
4. Hydrodissection-free, lens rotation-free
5. Divide and conquer for first crack (deep enough)
6. Chop for the right 1/6 fragment.
7. Viscodissection to relieve nucleus from capsule.
8. Chop for the rest right 2/6
9. Repeat OVD injection for viscodissection and a posterior capsule buffer zone
10. Be careful of wound burn and lost chips
11. Alway be attention until removal of eye speculum.


Hydrodissection-free phacoemulsification surgery: Mechanical cortical cleaving dissection (J Cataract Refract Surg 2014; 40:1327–1331 Q 2014 ASCRS and ESCRS)

In situ nuclear disassembly: Efficient phacoemulsification without nuclear rotation using lateral sweep sculpting and in situ cracking techniques
(J Cataract Refract Surg 2009; 35:1487–1491 Q 2009 ASCRS and ESCRS)

Phacoemulsification of the rock hard cataract
(D. Michael Colvard, M.D.)

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