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Chad Bouterse, DO
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Chad Bouterse, DO, presents a bimanual cataract surgery. Two 1.2 mm incisions are created and the capsulorhexis is performed with MST forceps. Utilizing aggressive hydrodelineation, the nucleus is prolapsed in the anterior chamber. Using the MST chopper irrigation tip and high vacuum (450 on the AMO Whitestar), the nucleus is cleaved and aspirated with no phaco energy. This is a 3+ nucleus of moderate to advanced density. One of the 1.2mm incisions is enlarged to ~1.6mm and an Akreos AO lens (Bausch & Lomb) is inserted with wound-assist delivery. Dr. Bouterse has found this technique to be safe and always result in a crystal clear cornea the next day. Additionally, the author noted that he has "not found any lens too dense to use this technique, but soft nuclei are better to be just aspirated in the bag."
Posted: 1/31/2012
Chad Bouterse, DO
Chad Bouterse, DO, presents a bimanual cataract surgery. Two 1.2 mm incisions are created and the capsulorhexis is performed with MST forceps. Utilizing aggressive hydrodelineation, the nucleus is prolapsed in the anterior chamber. Using the MST chopper irrigation tip and high vacuum (450 on the AMO Whitestar), the nucleus is cleaved and aspirated with no phaco energy. This is a 3+ nucleus of moderate to advanced density. One of the 1.2mm incisions is enlarged to ~1.6mm and an Akreos AO lens (Bausch & Lomb) is inserted with wound-assist delivery. Dr. Bouterse has found this technique to be safe and always result in a crystal clear cornea the next day. Additionally, the author noted that he has "not found any lens too dense to use this technique, but soft nuclei are better to be just aspirated in the bag."
Posted: 1/31/2012
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Just Now
Rohan Sawant
13 years ago
endothelial count is a must after all that movement and manipulationuclein in the anterior chamber. Not sure if this would work for denser nuclei. This nucleus was between NS grade 2 and 3.
Chad Bouterse
13 years ago
A must is a little bit of a stretch. If you are talking about direct trauma, you should have resultant edema should be present in the postop period. If you are talking about generalized trauma (like in manipulation of the endo during a DSEK), you are talking cell loss over months to years. Thank you for the suggesttions
Chad Bouterse
13 years ago
Due to the 2D nature of the video, it is difficult to tell that the nucleus fragments never come in contact with the cornea. In an era before good viscoelastics, this would never have been possible. I have never actually checked a cell count after a rountine cataract surgery, but its a thought.
Jeronimo Alvarez
13 years ago
did you check the endotelial count after all those cataract pieces gobble arround the anterior chamber, no ultrasound used but a lot of movement in the anterior chamber also damagaes the endnothelium