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Inside Eyetube.net | Oct 2009

Focus on Surgical Technique

Several new educational videos highlight surgical techniques for the anterior segment.

Steven H. Dewey, MD, shares his tips for surgeons who are interested in transitioning from divide and conquer to phaco chop (Figure 1) (www.eyetube.net/videos/default.asp?fihume). As Dr. Dewey demonstrates a dual-handed technique for bisecting the nucleus, he provides detailed descriptions of his preferred tools and step-by-step instructions for every stage of the procedure.

Gary Hirschfield, MD, has contributed two new videos to the Web site. In the first, he demonstrates an alternate technique for inserting the Akreos IOL (Bausch & Lomb, Rochester, NY) into the capsular bag (Figure 2) (www.eyetube.net/videos/default.asp?dogilo).

Next, Dr. Hirschfield describes a challenging case in which the misdirection of fluid during hydrodissection caused the iris to prolapse into the surgical incision (Figure 3) (www.eyetube.net/videos/default.asp?tirank). In addition to sharing the complication and his method of replacing the iris in the eye, Dr. Hirschfield discusses alternative surgical options for resolving this challenging case.

A video submitted by Tal Raviv, MD, demonstrates the flip supracap technique of cataract removal (Figure 4) (www.eyetube.net/videos/default.asp?hoofod). This approach allows surgeons to perform phacoemulsification outside the boundaries of the capsule. According to Dr. Raviv, the flip supracap technique is suitable for eyes with loose zonules or soft nuclei.

Jeffrey Whitman, MD, shares his technique for removing residual cortical cells from the fornix of the capsular bag with the Whitman-Shepherd Capsule Polisher (Bausch & Lomb Storz, Rochester, NY) (Figure 5) (www.eyetube.net/videos/default.asp?zuleda). This polishing maneuver may be particularly beneficial prior to the implantation of the Crystalens and Crystalens HD IOLs (both from Bausch & Lomb), because minimizing residual cortical cells theoretically reduces the risk of capsular opacity and contraction.

Knowing how to resolve surgical challenges can turn a complicated case into a success. In addition to expanding their surgical repertoire, trying the innovative techniques featured on Eyetube.net may prepare readers to manage future intraoperative complications.

Section editor William B. Trattler, MD, is the director of cornea at the Center for Excellence in Eye Care in Miami and the chief medical editor of Eyetube.net. He acknowledged no financial interest in the products or companies mentioned herein. Dr. Trattler may be reached at (305) 598-2020; wtrattler@earthlink.net.

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