Two Stage Rhexis in Hypermature Cataract

In Hypermature Cataract with raised intralenticular pressure, Rhexis can be performed in a controlled way in two stages.After initial small rhexis liquid & fluffy cortex is evacuated decompressing the lens then after injecting visco rhexis is is enlarged.

Category:

Science & Technology

Tags:

• Capsulorhexis
• Hypermature
• Cataract

[rpchalla]

You can never have a perfect small CCCwith phaco tip. Phaco tip essentially cuts but never tears, that too irregularly. We know that CCC performed by tearing around manually is 1000 times stronger than one made by even Fugo blade.Imagine it's strength when punched out with phaco tip. While decompressing the lens you have to rub BSS into the bag if the punched out rhexis is weak it can easily tear to the periphery.

[ernesto987]

Simpler technique (Uday Devgan Technique): with the phaco tip, make a small round hole in the anterior capsule, just to decompress the hypermature cataract. Then make a larger CCC as usual. With your technique, you can still have the argentinian flag sign.

[rpchalla]

You can never have a perfect small CCCwith phaco tip. Phaco tip essentially cuts but never tears, that too irregularly. We know that CCC performed by tearing around manually is 1000 times stronger than one made by even Fugo blade.Imagine it's strength when punched out with phaco tip. While decompressing the lens you have to rub BSS into the bag if the punched out rhexis is weak it can easily tear to the periphery.

[rpchalla]

I have used simple HPMC injected through a 1mm side port before making main Incision.

[9EyE9]

Dear Dr. every surgeon has its prefernce and techniques by which he is comfortable as you are with yours but with due respect I wanna suggest you some thing.

1- over fill the AC with viscoelastics

2- lift the falp only means, with cystotome

central pucture raidal extention and lift the flap and stop

3- again over fill the AC with viscoelatic and compele your CCC.

Regards

[ernesto987]

Thanks for the reply Dr. Challa. I didn´t know that the manual CCC is much stronger than the one made with the phaco tip. I have no doubt that yours is a great technique, but I had once the argentinian flag sign with the very first cystitome puncture in a real hypermature cataract.Dr. Devgan´s mini-ccc with phaco tip is just a quick way to decompress the capsular bag. After that you can proceed with the same 2nd step you skillfully perform. What viscomaterial was used in this case?