Typical Cataract Surgery (Part 4 of 4)

Hello again. This is Dr. David Richardson, "The Cataract Coach" Welcome to the 4th and final installment of a "Typical Cataract Surgery" In the last segment I had just placed viscoelastic into the anterior chamber and now we are about ready to place the intraocular lens into the eye. This here is the lens insertion device. I place this against the incision. I actually use what's called "wound assist" in which I use the incision to "assist" my delivery of the lens into the eye This allows me to use a smaller incision size. I use a 2.2mm incision. Incision sizes range from 1.8mm all the way up to 3.2mm We really don't see much larger than 3.2mm now. Years ago an incision could be as large is 11-13mm. That may not seem like a lot, but when you talk about the eye, that's pretty big Now I'm rotating the lens. It's been inserted into the capsular bag and I'm rotating it so if it's in good position. You can see that the optic. goes out almost all the way to the dilated iris and the capsular edge is actually over the optic edge. It's difficult to see, but there is a little reflection you can see. That's actually going to help the lens stay in position as the capsular bag heals in position around the IOL. So at this point I'm going to remove the viscoelastic material because it's no longer needed and it's done it's job of protecting the corneal endothelium and allowed me to safely insert the lens into the eye. I'm now going to remove it. This here on the of left You can see the "coaxial" irrigation and aspiration handpiece You just saw some of the irrigation that's going on right now. I'm aspirating, or removing, the viscoelastic material. from the inside of the eye. Right now I'm in front of the lens. You can see the patient moved a little bit and that's relatively common with somebody suddenly has clear vision because the lens is now in the eye they want to look around so I generally just inform the patient that "we're almost done." and I just need them to keep looking straight ahead for a little bit. Now right there saw I actually took the handpiece and placed the tip behind the lens to remove the viscoelastic that's behind the IOL. Not everybody does this step because you're placing the tip near the capsular bag. My concern is that if the viscoelastic is not removed from behind the lens and it's trapped, you can get a pressure spike which puts the optic nerve at risk. As with most things in medicine it's a matter of weighing the risks versus benefits. In my hands I think the benefit of removing the viscoelastic from behind the lens is worth it. Now what I'm doing is I'm hydrating the incision I'm basically using pressurized saline solution to close off the little paracentesis, or side incisions, that were made with the one millimeter diamond blade earlier. I've injected some special saline solution into the eye itself making sure that the lens is well centered and in a good position. We're pretty much done with the surgery. Now what I'm going to do before I'm completely done is I'm going to inject an antibiotic solution into the corneal stroma. This is actually injecting it into the cornea itself The solution whitens the cornea It's not pretty but this is going to go away in the next twenty four hours. What this does is it helps close the incision. Right now I'm just checking the pressure digitally The solution is going to close the incision and give this patient some protection from infection. The first 24-48 hours are absolutely critical. Here I'm actually testing the incision with what we call a "Wekcel" sponge. And the incision is tight, watertight The incision looks good. Checking the pressure here. Pressure looks good. And we are done! www.David-Richardson-MD.com