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REFERAT

PHACOEMULSIFICATION

Pembimbing:
dr. Agah Gadjali, SpM
dr. Gartati Ismail, SpM
dr. Henry A. W, SpM
dr. Hermansyah, SpM
dr. Mustafa K. Shahab, SpM

Disusun oleh:
Anum Sasmita (1102012025)
Dewa Ayu Bulan Nabila (1102012059)
Miftahul Choir (1102010165)
KEPANITER AAN KLINIK ILMU PENYAKIT MATA
FAKULTAS KEDOKTERAN UNIVERSITAS YARSI
RUMAH SAKIT BH AYANGKARA TK. I RADEN SAID SUKANTO
PERIODE 1 6 O K T O B Subtitle
ER 17 NOVEMBER 2017
2.1 Fundamentals of phacoemulsification
2.2 Pivoting and floating technique
PIVOTING

Technique in phaco surgery to move any instruments using the


small incision as the pivot

Goals:
low degree of surgically induced trauma
rapid recovery of excellent vision
pivoting technique allows:
a wide range of movement while the instrument is inserted
through a smaller incision.
increased precision, because a large movement outside the pivot
can produce a small movement inside the eye.
Correct technique

Hand of the instrument should move to the right if you would


like the tip of the instrument to move to the left.

By pivoting within the incision, the anterior chamber depth is


maintained and corneal distortion is avoided.
Incorrect technique

push against the incision walls


trying to move the instrument handle in the same direction as the
instrument tip.
Pushing on the incision can cause Pushing against the incision can
extensive corneal deformation and cause wound gape, loss of
straie, which compromises the view viscoelastic and flattening of the
as well as safety. anterior chamber. This should be
avoided.
The pivoting technique must be used in all dimensions: left-right
movement (x axis), forward-backward movement (y axis) and
anterior-posterior positioning (z axis)
FLOATING

Technique in phaco surgery to keep the instruments away from the


small incision wall

Goals:
Keep the eye in primary position.
Any forceful pushing of the instruments within the eye will cause
the eye to move away from the force vector which limit the
surgeons view and maneuverability in the eye.
Floating keeps the instruments away from incision wall.
2.3 Implementation of pivoting techniques at
phacoemulsification stage
1. Corneal Incisions

A progressive reduction in incision size and related morbidity has


marked the recent history of cataract surgery via phacoemulsification.
The surgeon uses the pivot technique within small incisions to avoid
collapse or distortion of the anterior chamber.
Cataract surgery incision, (1.9-2.75 mm), corneal incision, limbal incision,,
small incision, sutureless.
2. Continuous Curvilinear Capsulorrhexis

CCC has improved stability and centration of intraocular


lenses, which helped to reduce posterior capsular
opacification.
Critical elements of technique for the construction of
continuous curvilinear capsulorrhexis include operating in a
deep and stable chamber.
This surgeon shows that a large Hand of the operator holding the
20mm movement of the external instrument must move toward the
instrument handle gives a very left such that the tip of the
precise 2mm movement of the instrument shifts toward the right
internal tip of the forceps, thereby and vice versa.
increasing precision.
3. Hydrodissection dan Hydrodelineation

Hydrodissection
Hydrodissection is performed between the capsule and the
cataract cortex in order to free the adhesions of the cataract from
the capsular bag and allow it to rotate fully.
Hydrodelineation
Hydrodelineation is employed by some surgeons to separate the
endonucleus from the epinucleus. The epinuclear shell can act to
protect the posterior capsule during phacoemulsification of the
endonucleus
4. Nuclear Rotation

Nuclear rotation with a second instrument ensures that the


nucleus is completely mobile and reduces the possibility of
transferring stress to the posterior capsule and zonules during
nuclear disassembly.
5. Phacoemulsification

Phacoemulsification may be performed in various locations within


the eye. Posterior chamber phacoemulsification is currently the
most common location where phacoemulsification is performed by
surgeons
6. IOL Insertion

Rigid IOLs
These IOLs made entirely of Polymethyl methacrylate
(PMMA) and, due to their rigid nature, they require a larger
incision (6.5mm)
Foldable IOLs
This allows an IOL with an optic size of 6.0mm to be inserted
through an incision of about 3.0-3.5mm, which can be made
safely in the cornea.
Injectable IOLs
This allows the IOL to be completely shielded from contacting
the ocular surface during insertion, and it allows for smaller
incisions of less than 3.0mm, and sometimes even less than
2.0mm
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