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Healon5 Visco-sandwich Technique for Phacoemulsification in Morgagnian Cataract Surgery. Masaki Sato, MD Tetsuro Oshika, MD Department of Ophthalmology University of Tsukuba Japan.
Masaki Sato, MD Tetsuro Oshika, MD
Department of Ophthalmology
University of Tsukuba
The authors have no commercial or proprietary interest in any of the companies, products, or methods described in this presentation.
Figure 1. The outline of Healon5 visco-shell (visco-sandwich) technique.
A) Healon5 injection into the anterior chamber.B) Additional Healon5 injection between the nucleus and the posterior capsule. C) In the visco-shell made of Healon5, PEA under lowered fluidics is meticulously performed. D) Theoretically, the visco-shell is expected to retain its original form at the copletion of PEA.
Healon5 injection between the lens nucleus and the posterior capsule
to lift the entire nucleus and expand the capsular bag.
The nucleus is slightly subluxated out of the bag.
vacuum 180 mm Hg, AFR 20 cc/min, phaco power 70%,
ultrasound pulse rate 10 pulses/sec, and bottle height 80 cm.
Figure 2.Preoperative (a), intraoperative (b-h), and postoperative (i) anterior segment photographs of a typical morgagnian cataract patient.
b) At supine position, the lens nucleus sinks into the liquefied cortex. c) Outflow of the liquefied cortex at the very beginning of a capsulorhexis (Arrows). d) Note that the intracapsular color changes from white to brown in an instant. Asterisks Spilled cortex. e) Healon5 visco-shell (visco-sandwich) technique. f) The slightly subluxated nucleus. g) PEA in the middle of the visco-shell. The intracameral stability is extremely good. h) An IOL intracapsular fixation as usual. i) No any postoperative complications POD 1.
(In all eyes)
Q : Difference in stage of Healon5 jnjection
Injection under the second piece after half the nucleus is emulsified.
Injection under the whole nucleus prior to PEA.
Wrapping the whole nucleus in the “visco-shell” made of Healon5.
A : Nuclear size : Morgagnian cataract <<Post-vitrectomized cataract
In case of a usual vitrectomized eye, it is not appropriate that Healon5 would be injected under the whole nucleus prior to PEA, because acute IOP elevation might cause complications such as posterior capsule dehiscence followed by nucleus drop into the vitreous cavity. In case of an eye with a large CCC and complete hydrodelineation, however, Healon5 might be injected at the early stage of PEA even if a vitrectomized eye.
Typical or Atypical
Atypical morgagnian cataract with spontaneous posterior capsular rupture (only a few cases reported).
j) A dislocated embryonic nucleus oscillates simultaneously with eye movement. k) Posterior capsule adhered severely to anterior capsule. l) Nucleus floating in the Berger's space. m) Nucleus removal with so-called the visco-extraction technique.
Discussion 2 ( How to use Healon5)
Using visco-shell (visco-sandwich) technique with a viscoadaptive OVD such as Healon5, it is considered that phacoemulsification with the appropriate setting of parameters can be performed safely irrespective of the surgeon's experience.
Retention : DisCoVisc >> Healon5
Removal : DisCoVisc >> Healon5
DisCoVisc may be able to be used instead of Healon5
in performing visco-shell (visco-sandwich) technique.