ASSISTANT:
ANESTHESIOLOGIST:
OPERATION: Phacoemulsification with placement of posterior
lens implant, * eye.
PREOPERATIVE DIAGNOSIS:
POSTOPERATIVE DIAGNOSIS:
INDICATIONS:
FINDINGS:
Cataract, * eye.
Cataract, * eye.
Very poor vision due to cataract, * eye.
See under procedure.
PROCEDURE: The patient was injected in a separate holding
room just lateral to the orbit with approximately 5-6 cc of
a 50:50 mixture of 0.75% Marcaine and 2% Xylocaine with
Wydase, subcutaneously. A 3-4 cc retrobulbar injection was
then performed with good results. The pressure balloon was
then placed on the closed lids and was allowed to remain in
place for about 20 minutes prior to the surgery.
The patient, in the meantime, was transferred to the
operating room where the balloon was removed and the eye
was prepped and draped in the usual manner. A lid speculum
was placed and the operative microscope was swung into
position. Traction sutures of 4-0 silk were placed under
the superior rectus and the limbus at 6 o'clock. A
superior fornix-based conjunctival flap was then elevated
and cleaned to the corneoscleral junction. A 3.2-mm
keratome incision was started about 4 mm from the limbus;
the keratome was advanced in the outer one-third of the
sclera into clear cornea and was then tilted down to enter
the anterior chamber. A puncture wound was then made at the
limbus with a sharp blade at about the 2:30 o’clock
position for use of a manipulation instrument later in the
procedure. After filling the anterior chamber with Healon,
a bent irrigating needle was placed into the anterior
chamber and a circular continuous tear anterior capsulotomy
was then performed. When this was finished,
hydrodissection was then performed through the same
superior puncture incision on four quadrants under the
anterior capsule. This may have been repeated several
times.
The phacoemulsification tip was then placed into the
anterior chamber through this keratome incision. The lens
nucleus was split in pieces and each piece was emulsified.
Usually, the material could be removed within the capsular
bag, occasionally; the lens material needed to be brought
into the pupillary plane for removal. All remaining visible
lens cortical material was then removed with the I/A unit.
The posterior capsule was then carefully polished under
high magnification and low suction so as to remove as much
adherent lens material as possible. The anterior chamber
was filled with viscoelastic. The implant was brought out,
inspected, found to be satisfactory, and was flushed with
balanced salt solution. The implant was placed in the
inserter which was placed through the superior incision.
The implant was positioned within the capsule. The lens
implant was centered appropriately and a light blocker was
placed on the cornea.
The Healon was removed with the I/A unit. Pilocarpine 2%
was then flooded over the light blocker. The pupil began
to come down nicely anterior to the implant. No suture was
used unless a wound leak was noted. The anterior chamber
was filled with balanced salt solution and the wound was
inspected for approximation and leak; it was found to be
satisfactory. The pupil was mid-dilated and round except
in pupilloplasty cases; the pupil was anterior to the
implant.
The wound was again inspected for approximation and leak
and it was found to be satisfactory. The wound was flooded
with balanced salt solution and the conjunctival flap was
folded over the incision. Traction sutures were then
removed.
The speculum and drape were removed and the lids were
cleaned. Polysporin ointment was placed in the
conjunctival sac and a light pressure dressing consisting
of a pad and shield was applied.
The patient was taken to the holding room in satisfactory
condition. There was no specimen to pathology.