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(REVISI) The Preparation of Phacoemulsification - Faraby Martha MD
(REVISI) The Preparation of Phacoemulsification - Faraby Martha MD
THE PREPARATION OF
PHACOEMULSIFICATION
(REGULAR CASE/DIFFICULT CASE
Faraby Martha, MD
Department of Ophthalmology
Cornea, Cataract, and Refractive Surgery Division
RSCM Kirana- Universitas Indonesia
RSCM KIRANA Jln. Kimia No.8, Jakarta Pusat, 10320 - Twitter/Instagram @rscmkirana - E-mail mata.rscmkirana@gmail.com
• No Financial Interests
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OVERVIEW
• Phaco • Safety Checks • Know your • Prepare to
training • Comfortable machine convert
• Case Position • The Instruments
selection • Draping and • The medications
Sterility
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Phaco Training
Case
Closeselection
supervision
Structured training
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Phaco Structured Training
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Objective Structured Assessment of Cataract Surgical Skill (OSACSS)
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(p>0.05)
P h a c o Tr a i n i n g (p>0.05)
1 0 0 F i r s t (p<0.05)
S u rg e r i e s 79 (65-90)
80 (45-86)
S e n i o r
R e s i d e n t 69.42±12.7
R S C M K i r a n a Phacoemulsification score
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What technique should I
Choose??
Beginner Divide Stop and Phaco
Surgeon and Chop Chop
Conquer
ORCI LUCTUS ET ULTRICES
POSUERE CUBILIA CURAE;
DONEC
CDE
Medium + + ++
Cat
Vestibulum ante ipsum primis in faucibus orci luctus et
ultrices posuere cubilia Curae; Donec velit neque, auctor
sit amet aliquam vel, ullamcorper sit amet ligula. Nulla
quis lorem ut libero malesuada feugiat. Vestibulum ac
CDE Hard
Cat + ++
diam sit amet quam vehicula
Technically
Easy +++ +++
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Case Selection
Soft Cataract
Posterior capsule Rupture
Brown “ Hard Nucleus” Cataract
Pre-operative checks
Patient verification
Preventing wrong eye surgery
Preventing insertion of the wrong intra ocular lens
Maintaining sterility
Accidentally become unsterile
Need to change gloves, microscope handles, or surgical instruments
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Comfortable Position
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“protect your neck, protect your back”
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Draping and Sterility
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Draping and Sterility
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Phaco Machines
AFR
Va c u m
US Power
Tinggi Botol/
IOP
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Grip
(vacuum)
Power
(US)
Speed Space
(AFR ) (BH)
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Mode Mesin Parameter Peristaltik Venturi
Phaco 1 (Sculpting) Tinggi Botol 80 cmH2O 80 cmH2O
US Power 70% (Linier-Cont) 70% (Linier)
Vakum 60 mmHg 50 mmHg
AFR 30 ml/min -
Phaco 2 (Chopping) Tinggi Botol 100 cmH2O 100 cmH2O
US Power 60% (Burst) 60% (Burst)
My Beginner Setting
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Zonulysis, High
Miopia
< 4 Clock
Hours/ 120
Capsular Support Devices CAPSULAR TENSION
RING (MODIFIED)
CAPSULAR TENSION “CIONNI RING”
RING
• Increasing the capsular bag
placement of an IOL
CAPSULAR
RETENSION HOOK
CAPSULAR TENSION
SEGMENT
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Zonulysis, High Miopia
a) Pupillary membrane
Dissection
b) Lysis of posterior synechia
c) Viscodilation Osher Y-hook
d) Pupil stretch
e) Minisphincterotomies
f) Iris hooks, pupil ring
expanders
Atonic pupil !!!
Kuglen Iris Hook
J Cataract Refract Surg 2013; 39:1904–1915
Fine IH. Cataract surgery: third Ed. Elsevier. USA.2010.
Bimanual stretch maneuver
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Micro Scissors
Utrata Forceps
Malyugin Ring
Iris Hooks
Seibel Chopper
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Horizontal
Chopper
Seibel BS. Phacodynamics. USA: SLACK incorporated. 2005 Chang Microfinger Chopper Olson Chopper
Chang FD. USA: SLACK incorporated. 2004
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Hard/ soft Cat
Akahoshi sustainer
Akahoshi PreChopper
Sinskey Hook
Seibel BS. Phacodynamics. USA: SLACK incorporated. 2005
Chang FD. USA: SLACK incorporated. 2004
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PCR, NO capsule support
I n t h e B a g I O L + I n t h e S u l c u s I O L
O p t i c c a p t u r e I m p l a n t a t i o n
1 2 3
A n g l e I r i s
T S F / I S F
S u p p o r t e d C l a w
I O L I O L
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The Medications (Intracameral)
Mydriatics
Nonpreserved epinephrine (1:1000) dilute with BSS 1:9----1 ml
Anesthetics
Intracameral isotonic nonpreserved lidocaine 1% (Xylocain 2% dilute 1:1) ------0.5 ml
Staining Agent
Tryphan blue---0.2 ml
Miotics
Parasympathomimetics :Carbachol 0.01%---0.2 ml
Prophylactic antibiotics TASS !
Irrigating solution VS Intracameral antibiotics !!
Gentamicin (Irrigating solution) ---0.3ml/500 ml
Moxifloxacin 0.5% (Intracameral) Vigamox®--- 0.05 ml
Levofloxacin 0.5% (Intracameral) Cravit® ---0.05 ml
Arshinoff SA, Opalinski YA, Podbielski DW. The pharmacotherapy of cataract surgery. In: Yanoff M, Duker JS. Ophthalmology. 5 ed. Elsevier. USA:2019.
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Ingredient Human Aqueous BSS
Irrigating Solution Humor
Sodium 162.9 155.7
Potassium 2.2- 3.9 10.1
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Prepare to convert
6 Weeks:
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Thank You
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