Simulated Surgery: Phacoemulsification: Hydrodissection and Sculpting of the Nucleus

The SOS Basic Gel Cataract eye is used to demonstrate how to perform hydrodissection of the nucleus and then to sculpt the nucleus using a modified “divide and conquer” technique. These model eyes enable trainees to transfer some of the skills they have developed on the EyeSi simulator into a more tactile setting. Although these eyes have no posterior capsule trainees learn to avoid damaging the anterior capsule whilst sculpting the nucleus and they also get a feel for how deep they need to groove the nucleus before attempting to crack it.

In addition to Cybersight, you can find videos featuring teaching techniques for all types of ocular surgery, using any form of simulation, in the Simulation Gallery.


>> In this clip, we’re showing how the simulated ocular surgery basic phaco eyes can be used to practice sculpting of the nucleus in hydrodissection. Here we can see hydrodissection being carried out. And quite frequently, you can see a little wave of fluid at the periphery of the capsulorrhexis, but you don’t see fluid passing round the back of the lens, as you would in a human eye. Again, our trainees have practiced their hydrodissection and hydrodelineation skills on the IC. And this just lets them reenact those maneuvers in a more lifelike scenario. When it comes to phacoemulsification, the principles they’ve learned on the IC of creating a nice steep-sided groove, maintaining the eye in the primary position, without pushing the lens, letting the phaco probe do the work, are all enforced with this mode of training. This is a soft gel eye. And you can see, as the probe passes through it, we’re getting a nice steep-walled trench. Sometimes you have to use slightly higher vacuums than you would use in your normal sculpt mode to remove the nuclear material. And as you get deeper, although there’s no posterior capsule, you can see that lightning of the reflex, which lets the trainee know when they’ve got to the correct depth. Again, just going down the back slope to create a nice uniform rectangular profile of the initial groove. Here you can see the second instrument being introduced via the side port. And this is going to be used to rotate the nucleus. With the soft gel eyes, the lens material is relatively soft, and so the second instrument just slides into the lens material a little bit more than it would in a human eye. This is less of a problem with the white, harder basic phaco eyes. So again, the same principles of creating a nice divide and conquer-type formation, before rotating the lens around. Here’s another eye. Different colored iris. Same consistency of lens. Again, just practicing the sculpting technique, getting a nice groove, getting into a rhythm, with efficient use of the phaco probe, letting the probe cut through the lens, rather than pushing through the lens. And keeping the probe — depth of the groove, rather — one and a half probe widths. Just using my finger there, just to clear the view. Again, second instrument being introduced. This time a mushroom manipulator. I’m using it to rotate the lens. You can see how it’s relatively soft. But it still rotates, and it gets the trainees to practice in a different environment what they’ve learned on the IC. Using that two-handed technique to manipulate the lens without putting excessive pressure on the lens’s zonules. And just rotating, again, to complete the final bit of sculpting, before the nucleus is cracked. And finally, just completing the fourth groove, again, avoiding the anterior edge of the rhexis, before dividing the nucleus into quadrants.

Last Updated: October 31, 2022

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