Surgery: Phacoemulsification

00:10
This is a standard phacoemulsification case. So here I am stabilizing the eye with my finger and making a paracentesis using a 1.2 side port blade. Now filling the anterior chamber with a dispersive viscoelastic and then use that same viscoelastic cannula and stabilize the eye as I make my clear corneal, 2.4-millimeter primary incision. Then use capsulorhexis forceps starting in the center, creating a flap, and then grabbing that flap and delicately walking it all the way around to complete the continuous curvilinear capsulorhexis.

00:50
We are aiming for a five millimeter, well centered capsulorhexis. Now this is hydrodissection being done with the Chang cannula. As you can see the fluid wave propagating behind the nucleus, we can then come over nasally into another fluid wave and then use the same Chang cannula to attempt to free the nucleus and attempt some rotation of the nucleus as seen here.

01:31
We can then go on to the phacoemulsification. So, use the second instrument to open up the primary incision to try to avoid any endothelial displacement or damage. I am using some like phaco here just to remove some of the viscoelastic. In this case, I will employ a stop and chop techniques, So I will make a small central groove.

01:58
And then attempt to crack the nucleus into two hemis. We will then use a horizontal chop technique. So, once we do that first horizontal chop, I will remove that small piece of, of nucleus which then gives us space or create space to manipulate the rest of the nucleus. I’m using the second instrument to simply elevate that other quadrant, bring it into the iris plane so that I’m not working near my posterior capsule and then employing the quadrant setting of my phacoemulsification machine to safely remove that quadrant. Now we have rotated the other Hemi nucleus around so it’s easy to grab with the second instrument and the phaco needle. This is where we need to be careful because our capsule is no longer protected by any nucleus. You can see my second instrument is staying posterior to my phaco needle to protect the capsule. We’re then going to do some cortex removal, I’m starting subincisionally, using a circular sweeping motion pulling the cortex towards the center, being careful not to vacuum too strongly underneath the capsule. I am grabbing those pieces of cortex and pulling them towards or stripping them towards the center.

03:21
Once all of the cortex has been removed, we can now fill the anterior chamber with a cohesive viscoelastic. This is just creating space for the intraocular lens to be implanted. Here we have a single piece monofocal acrylic lens, this happens to be made by Alcon, njecting that into the capsule. Now for my cases I use a Trimoxi injection. So, I am injecting a formulation of triamcinolone and moxifloxacin. This is done through the zonules into the anterior vitreous. And this is for control of inflammation and endophthalmitis prophylaxis. We then will take the irrigation aspiration handpiece and remove all of the viscoelastic. Once the viscoelastic has been removed, we’re going to hydrate the paracentesis and the main corneal wound and also reposition the IOL, to ensure that it’s adequately centered. We are going to leave the eye with a physiologic pressure and that completes a standard case of phacoemulsification.