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.
Reference:
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.)
