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Optimising the outcomes in rock hard cataracts

Vasavada A
Ahmedabad/Indien

Phacoemulsification of Rock Hard Cataract poses a special
challenge and tests the skill and experience of a phaco surgeon.
The incidence of intraoperative difficulties and complications are
high, owing, to the excessive use of ultrasonic energy dissipation.
The risk of damage to the corneal endothelium, the trabecular
meshwork, the posterior capsule and the incision are very high.
Thus to minimize the intraoperative difficulties in emuslification
of the rock hard cataracts certain strategies and techniques have
been evolved and modified. The importance of the site of incision,
size of initial rhexis, type of hydrodissection and rotation has
been revealed. The technique of "chop in situ and lateral separa-
tion" and "stop, chop, chop and stuff" along with the "step down
principle" are highlighted, which aid in achieving safe endocaps-
ular emulsification. The ergonomics of the kelman tips, microtips
and mackool system support the surgeon's skill and techniques.
Utilizing NeoSoniX helps to reduce the total U/S power consump-
tion. Also newer viscoelastics protect the endothelium. Thus a
harmonious combination of the appropriate technique and the
ergonomics of modern machines and viscoelastics aid to the sur-
geon's skill and optimize the outcome in rock hard cataract emul-
sification.


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