phacoemulsification in myopic eyes

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Everything one needs to know about phacoemulsification in the myopic eye

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  • 1. PHACOEMULSIFICATION IN MYOPIC EYES Sumeet Agrawal PG 3 UCMS and GTB Hospital Delhi

2. HOW IS IT DIFFERENT FROM A ROUTINE CATARACT SURGERY ? PREOPERATIVE INTRAOPERATIVE POSTOPERATIVE 3. WHEN TO BE CONCERNED ? Degree of myopia High myopia (2%) ( Spherical equivalent -6.00 D or more; Axial length 26.5 mm or more) Pathological myopia (0.5%) ( Spherical equivalent -8.00 D or more; Axial length 32.5 or more) 4. UNILATERAL / BILATERAL Keep the possibility of amblyopia, specially if unilateral Visual acuity before onset of cataract History of spectacle use; History of trauma PATIENT EXPECTATIONS (informed consent) Use of reading glasses Refractive surprises CENTRAL FUNDUS EVALUATION *Macular scar* *Forster Fuchs spot* *Myopic degeneration* *Epiretinal membrane* *CNV* *Posterior staphyloma* Careful INDIRECT OPHTHALMOSCOPY to look for retinal breaks Zonular weakness IOL POWER CALCULATION *Axial length pitfalls* *SRK II / SRK-T / Holladay 2 formula* *Aim for postop residual myopia* 5. INTRAOPERATIVE CONSIDERATIONS Peribulbar / Retrobulbar block : chances of globe perforation ; topical / subtenon anaesthesia Clear corneal incisions with a short tunnel Limbal / scleral incisions heal poorly due to low scleral rigidity Suture if in doubt High elasticity of anterior capsule 6. Deep AC Difficult instrumentation Stretching of iris - > pain (intracameral lignocaine) Reverse pupillary block (Lens-Iris-Diaphragm Retrodisplacement Syndrome (LIDRS)) (Low bottle height with low vacuum) Avoid traction to vitreous base Abrupt collapse of anterior chamber Inject viscoelastic before removing probe 7. Posterior capulorrhexis (to avoid future need for YAG capsulotomy); controversial IOL To implant or not Abbott Medical Optics Sensar AR40M acrylic IOL (as low as 10 D) Alcon AcrySof acrylic IOL (as low as 5 D) Bausch & Lomb Crystalens AO (as low as +4 D) Hoya Surgical Optics iSymm (as low as +6 D) Avoid silicon IOLs 8. POSTOPERATIVE Refraction takes longer to stabilize Check for retinal breaks Closer and more frequent follow ups Operate the other eye earlier if high anisometropia 9. THANK YOU

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