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
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.
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)
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
extensive corneal deformation and
straie, which compromises the view
as well as safety.
Pushing against the incision can
cause wound gape, loss of
viscoelastic and flattening of the
anterior chamber. This should be
avoided.
 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
surgeon’s view and maneuverability in the eye.
 Floating within the phaco incision Floating keeps the instruments away
and using a pivoting technique allow from incision wall.
maximal reach and control during
surgery.
2.3 Implementation of pivoting techniques at
phacoemulsification stage
1. Corneal Incisions
Additional steps such as the creation of a supraincisional
penetrating nonperforating corneal incision (Wong incision)
have decreased the possibility of wound leaks.
Cataract surgery incision, (1.9-2.75 mm), corneal incision, limbal incision, clear
corneal, small incision, sutureless.
2. Continuous Curvilinear Capsulorrhexis
Critical elements of technique for the construction of continuous
curvilinear capsulorrhexis include operating in a deep and stable
chamber, initiating the tear in the center of the capsule, and
regrasping the flap to maintain control of the vector of the tear at
all times.
Hand of the operator holding the
instrument must move toward
the left such that the tip of the
instrument shifts toward the
right and vice versa.
This surgeon shows that a large
20mm movement of the external
instrument handle gives a very
precise 2mm movement of the
internal tip of the forceps, thereby
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 tend to be single piece, made entirely of PMMA,
and, due to their rigid nature, they require a larger incision for
insertion, typically 0.5mm greater than the optic size.
• 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
Terima Kasih