NOTED SURGEON SHARES TIPS GARNERED FROM 30 YEARS OF EXPERIENCE

A METHODICAL approach provides the smoothest path to successful cataract surgery, said Richard Packard FRCS, UK, who presented his most common tips for trainee cataract surgeons at the Young OphthalmologistsProgramme of the 20th ESCRS Winter Meeting in Athens yesterday.

Dr Packard noted that he tells his students to regard their position as being at 12 o’clock on the eye’s meridians, when performing a capsulorhexis.

Creation of the rhexis begins with drawing a ‘C’ on the capsule with a cystotome, then grasping and pulling at each clock hour in a sequential manner to reduce the risk of a capsular tear. The flap created in this way will be twice the size of the original ‘C’, he noted.

He noted that, when performing a hydrodissection, it is important to ensure that the hydrodissection cannula goes in peripherally. After injecting fluid, the surgeon should push the nucleus back and across while holding thesyringe like a pencil, to turn the nucleus with a smooth injection of fluid.

During nuclear cracking, the instruments should be placed at the bottom of the sculpted trench. When bisecting the nucleus, the surgeon should push back and then sideways, giving time for the crack to propagate.

He added that dropping the bottle height to 45cm each time the eye is entered can prevent sudden anterior chamber deepening, and he recommended asking the patient to look at the surgeon, to assist in wound-assisted intraocular lens insertion.