Phaco nightmare

Dr.Wael El Gendy
accidental injury of the post capsule pass unnoticed leading to dropped nucleus later on.

Category:

Education

Tags:

• Ozil
• Brown
• cataract
• Wael
• El
• Gendy
• dropped
• nucleus
• rupture
• capsule
• phaco
• complications
• management.
• medicine
• vitrectomy.
• 白内障手術

[professor9850]

In case phaco will be done in such hard cataract I do not advised to use phaco chop or stop and chop technique since this will result in more stress on the zonules and increase the risk of posterior capsule rupture

[dwgendy]

@professor9850 thank you for your comments, they are invaluable and totally appreciated

[jadeally1]

hi Dr Gendy

thanks for a nicely shot video..where ample of things to learn. actually one thing led to other

i will like to make couple of points here.

1. since it was a hard nucleus, a stop n chop would have been tried. i really mean a very deep groove.

2. trying nucleus chasing with wire vectis might save our head next day but its really a bad way doing that as it offer hell lot of vitreous traction. its better to leave it like that and ask VR surgeon to take over for PPV.

thanks Dr Gendy

[dwgendy]

@jadeally1:

Thank you very much for the contribution, I really appreciate the comments& points are well taken.

The only thing that made decide to go after the nucleus was seeing it floating freely which indicates how fluid the vidreous was, leading me to believing that there would be minimal vireous traction. I was getting ready to seal my wound, but it just jumped up to resurface again, I think it was a situational discision that I wouldn't do at any other case.

Thank you again

[AdamZUTube]

Quick thinking, well saved, will there not be quite a lot of epi-nuclear and cortex material in the vitreous in this case leading to floaters? I appreciate that the anterior-vitrectomy section was shortened, was there significant loss? I suppose what I'm asking is - have you managed to avoid total victrectomy in this patient despite a dropped nucleus?

[dwgendy]

No total vit was needed, she alseady had very lquified vitreous (that why the nucleus resurfaced) I did plenty of anterior vitrectomy though the machine was broken (as far as I remember) and she didn't complain of floaters after ward, as I said, I just saw her a week or so ago, she is very happy with 6/18 vision unaided and will be doing the other eye soon. (hopefully complication free this time).

[DRIPSINGH]

I think , using PHACO in this case was not a wise decision , elective manual SICS would have been a better choice and avoided the stitches as well .

I would like to add that , the way the nucleus was delivered out was a little risky but done cleanly .

Tissue respect is very important in any surgery ...

[professor9850]

Try to but viscoelastic under the lens , close phaco wound and do a regular scleral tunnel ECCE , this will decrease markedly the astigmatism

[professor9850]

I agree with suggestion that ECCE wither large or small incision is better in such hard cataract , because even if no complication happened a lot of ultrasound will be used that effect on the endothelial cell

[migtomsar2008]

I have a new criteria for not doing phaco....and this type of cataract is one of them....there seems to be more complications in doing phaco with them than is worth the "small incision"....what I do is MSics...

[arzucomez]

Really nighmare!

[mrsharadeye]

i would like to add some suggestions

1-bigger rhexis

2tumble and chop technique

could have saved this case

i will upload this technique for your opinion