04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda

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Comparison of various cataract surgical techniques

Dr. Anand Sudhalkar, Baroda

04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda

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Why Cataract Surgery

• Medical management: Lengthy, costly, inefficient,

• Surgery: quick, immediately rewarding, most efficient amongst all surgeries, Justified

• Aim: To clear visual axis

04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda

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Couching ( Ancient) No anaesthesia

• Fastest?• Displace the lens:

(Morgagnian) • Clears Visual Axis,

Instant vision• Break the capsule

(needling)• Delayed complications:

Inflammation.

04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda

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Extracap AC wash Topical Cocain (<1950)

Technique• Break Anterior capsule• Deliver the nucleus• Reposit the wound, no

sutures• Strict bedrest, bilat

patching, sandbags.• Let the nature take over

Concerns• High failure rate/

ambulatory vision• Iris prolapse• Phacoanaphylactic reactions• After cataracts

04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda

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Intracap (1960-1982): Retrobulbar

Technique• Removing the lens with intact

capsule : Clear media• Holding anterior capsule:

Forceps, Erisiphake, Cryo • Zonulysis: Chymotripsin• Keeping intact hyaloid phase

• PBI, Suturing• VL, Vit. Vick, Choroidal detach,

RD, CME • Aphakia

The Instrument

Intra forceps, cryo

04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda

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Aphakia

04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda

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Intracap + Ac IOL ( 1982-1984) Retrobulbar

Technique• Introduction to

Microsurgery• 10/0 suturing• Viscoelastic• Concept of anterior

vitrectomy• AC IOL

04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda

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Extracap + PC IOL (1982-1992) Retro/Peribulbar

Technique• Microsurgery• Precise ant. Cap.• Smooth Nucleus delivery • Irrigation aspiration

concept of AC maintenance.

• Thorough cortical cleanup Simcoe canula

• Posterior Chamber IOL

04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda

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Phaco + Rigid IOL (1992 – 2000) Peribulbar

Technique• Small Incision/Less

Astigmatism• Rhexis• Visco• Chamber stability• Precision in nucleus

management• In the bag implantation

04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda

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Phaco + Foldables (2000 onwards) Peribulbar/Topical

04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda

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The pearls

Past Techniques1. Couching

2. ECCE/Needling

3. Intracap

4. ECCE + PC IOL

Present Applications1. Consider correcting

aphakic zone, AC IOL2. Infants, Bilat Cataract3. Hypermat subluxated

cataracts4. Hard Cataracts, Machine

failures, compromised corneas, Shallow AC, Small pupils, Synechias

04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda

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The message

Take each case on its merit and be prepared for modifications

The choice of a technique should be surgeon’sdiscretion and should not be offered as “goods” on display

Thank You