EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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April 2012 "Inside-out" continued from page 17 Ep ithe ia l remo vall i C Xli king, PR Su face A at on Xlinkn in g , PRK & A SurfrfaceAbllatiion. Remove the Addvanced ov ed Figure 7. Delineation is produced by the fluid traversing inside-out Epithe ium Pr omottes Con istentonssiste n Re ults + Mini Esse n mize total pr + Essentential in re-t + U for Unniifo m epithel + No need f Ressults! e total pr oced ntt Figure 9. A well-demarcated ring within the lens denotes the endpoint of delineation edu e time dure tim ial in re-treatmeent helium rem e ments emo amovall No n need f or subsequent scraping Figure 11. A sketch to demonstrate inside-out delineation Source (all): Abhay R. Vasavada, M.S., F.R.C.S., and Shetal M. Raj, M.S. Su p rior Results upere iorResult s ated (Figure 1). No hydro proce- dure is done, and the surgeon commences phacoemulsification. A central trench is sculpted using the slow motion technique (Figure 2). In nuclear sclerosis less than grade 3 (grading system from grades 1-5): • Ultrasound energy (U/S): 30- 40% • Vacuum: 40 mm Hg • Aspiration flow rate (AFR): 14 cc/min • Bottle height: 50 cm Care should be taken not to mechanically rock the lens. • Dispersive viscoelastic is injected through the side port before re- tracting the probe to avoid for- ward movement of the iris-lens diaphragm (Figure 3). T. 800.46 61.1200 800.461.1200 | www nw..ininnoo vativexcimer .com • A specially designed right-angled cannula mounted on a 5 cc sy- ringe filled with balanced salt so- lution is introduced through the main incision to reach the central Figure 10. A precise demarcation of the central core nucleus from the epinucleus provides a thick epinucleus bowl trench. (Figure 4). The tip of the cannula is placed adjacent to the left wall of the trench at an appro- priate depth (Figure 5). The plane at which the cannula penetrates the wall of the trench (buried) depends on the thickness of the epinucleus cushion we generate and on the density of the nuclear sclerosis. In dense nuclear sclerosis the cannula penetrates easily in the superficial plane generating a thin epinucleus cushion, as against a soft to firm nuclear scle- rosis where a thick mechanical cushion of the epinucleus can be achieved. • Fluid is injected slowly with mini- mal force through the left wall of the trench (Figure 6). • Delineation is produced by the fluid traversing inside-out (Figure 7). • If the ring is incomplete, fluid injection may be repeated in the right wall of the trench with an- other right-angled cannula facing left (Figure 8). • Endpoint: A well-demarcated ring within the lens is evidence of suc- cessful delineation (Figure 9). Advantages of inside-out delineation • Inside-out delineation can pre- cisely demarcate the central core of nucleus (Figure 10), is easy to perform, provides superior con- trol, and reduces stress to the zonules. continued on page 19 pitheliuml in 5 to 7 secondseconds . Figure 8. If the ring is incomplete, fluid injection may be repeated in the right wall of the trench with another right- angled cannula facing left pitheliall al inn Corneal