Phacoemulsification

Suturing of the plate and creation of the scleral flap are best performed before any incisions are made into the eye. This is because a formed globe helps perform these procedures safely. Once these have been done, phacoemulsification can then be proceeded with.

Since we are planning a sulcus placement of the tube in the posterior chamber, a cataract extraction with an in-the-bag posterior chamber intraocular lens is planned. In an eye that is pseudophakic, this step is omitted. And the next step of insertion of the tube into the posterior chamber is directly proceeded with.

A phaco is now started in the conventional manner. A side port is created, followed by a main port. The main port is initially kept small in order to do a capsulorhexis in a controlled setting and with a formed anterior chamber.

The capsulorhexis needle is bent, though this could also be done with a rhexis forceps. Here I am using a 26 gauge cystitome. A rhexis flap is created in the usual way, and a rhexis sized about 5.5 millimeters is created. These are all performed exactly as done for a conventional phacoemulsification.

This is followed by hydrodissection and hydrodelineation. In this case, I have prolapsed a superior pole of the nucleus out of the bag and then proceed to emulsify it. Epinucleus and cortex are then removed using the IA probe. This is performed as is conventionally done in a phacoemulsification. Viscoelastic is then instilled into the anterior chamber in preparation for IOL implantation.

You can see that there is bleeding into the anterior chamber from the neovascularization of the iris, or the NVI that is now clearly seen and becomes even more visible under the endoilluminator light. This is a light probe that is present in vitrectomy machines. The viscoelastic tamponades the bleeding and we go ahead and inject the intraocular lens into the bag. The main port is then sutured in preparation for the next step.