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Anaesthesia
Local anaesth General anaesth A) Local anaesthesia: 1) Retrobulbar block: to block oculomotor nerve before it reaches the recti muscles Agents used: bupivacaine 0.5% plus lidocaine 2% plus hyaluronidase 150u Site : just above the inf orbital rim bet temporal limbus and lateral canthus
Hydrodissection/ hydrodelineation:
hydrodissection of the lamellar planes To separate the nucleus from the surrounding cortex. Fluid flows around the equator of the lens, peripheral to the cortex, into the posterior aspect of the lens capsule. it continues forward and reaches the dense adhesions between the capsule and the cortex at the equator.
Hydrodelineation is performed by injection of the fluid into the substance of the nucleus. tract is made midway between the center of the anterior surface of the nucleus and the equator. The cannula is advanced toward the central plane of the nucleus until the nucleus starts to move.
Fluid flows along the path of least resistance, which is the junction between the soft epinucleus and the hard endonuclear mass; this results in the formation of a golden ring or dark circle at that junction. This completes the circumferential division of the nucleus. In about 70% of cases, the cortex is evacuated with the epinuclear removal.
Phacoemulsification:
Nucleus is removed by various techniques All of them are based on sculpting (central crating or grooving), fracturing the nucleus into several segments while rotating it within the bag, and then emulsifying each fragment. start the emulsification at a lower power than is anticipated for the specific nucleus Nucleofracture and emulsification are usually done with high irrigation (high bottle), 50% emulsification power, and moderate aspiration. The power may be increased to 75% for hard nucleus.
Techniques A. Carousel B. Chip-and-flip (Fine) C. Phacofracture 1. Divide-and-conquer (Gimbel) 2. Four-quadrant pregrooved (Shepherd) 3. Nonstop chop (Nagahara) 4. Stop-and-chop (Koch) 5. Double chop (Kammann)
The cracked nucleus is emulsified. Location A. Anterior chamber B. Iris plane C. Posterior chamber Cortex is removed PCIOL lens is implanted, foldable or nonfoldable Sutures are applied