nucleus drop - sn
DESCRIPTION
its a brief ppt on nucleus drop presented @ SN , Chennai by meTRANSCRIPT
NUCLEUS
DROP
Mechanism
• large posterior capsular tear• more rarely, following zonular
dialysis
Superficial tunnel
Tunnel rupture during phaco
A/C collapse(unstable)
Quadrant removal/ I-A
Chance of PC capture by phaco
Small CCC
Relaxing incisions (blumenthal tech)
Hydrodissection
Continuous irrigation
Relaxing extends posteriorly PCR
Prevention : beer can opener
from side port if hydrodissection done @ 3 / 9 o’clock , canula prevents nucleus to pop out of bag + fluidics from ACM – PCRPrevention : Hydro , from side port, @ 6 o’clock
Novice phaco surgeon
Cant control foot pedal well
Irrigation OFF while making trench / quad removal
PC captured in phaco probe
• Inadvertent hydrodissection in the presence of a posterior polar cataract.
• Sub incisional co axial I/A or blind I/A beneath pupil with full vaccum – capture PC.
• Inadvertent IOL insertion – injures PC by haptic / dialer
Risk factors
result in loss of the capsulorhexis or later capsular tears• corneal scarring, • Small pupil, • dense nucleus• previous vitrectomy
MANAGEMENT
• At this point, the situation is still entirely salvageable.
• The key point is that appropriate management of the case by a vitreoretinal surgeon is likely to result in a good visual outcome.
• However, inappropriate and/or inexperienced intervention may result in serious complication, which will compromise the outcome.
• The cataract surgeon should therefore resist the temptation to ‘chase’ nuclear fragments or perform procedures outside his/her expertise.
• An anterior vitrectomy, preferably with separate irrigation cannula or anterior chamber maintainer, should be performed to clear the wound from vitreous strands.
• Where there is an intact capsulorrhexis a 3 piece foldable lens can be placed in the ciliary sulcus and capture of the optic by the capsulorrhexis may be used to stabilise the lens
Early Intervention by VRS if :
• the large amount of lens matter present
• Anterior retinal tears• Early RD• IOP cannot be controlled by medical
means• marked inflammatory response
Delayed Intervention
resolution of corneal oedema & acute postoperative inflammation.
allow the retained lens material to soften
aid its removal
• Higher incidence of long term complications such as uveitis, glaucoma and corneal oedema with delayed surgery, particularly where surgery is delayed by more than four weeks.
• The aim should be to operate in the first 2 weeks.
• Nuclear pieces of size less than 25% of the whole nucleus may not cause significant inflammation and may eventually be reabsorbed if left
• Three-port pars plana vitrectomy• Induce pvd - vitreous should be
removed from around the lens fragments to minimise retinal traction.
• If the lens matter is soft it can be removed with the vitreous cutter. Otherwise ultrasonic fragmentation, using a phacofragmatome