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Farrell "Toby" Tyson, MD
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Farrell "Toby" Tyson, MD, shows lens fragmentation using the miLoop device (IanTech) in an 82-year-old patient with a small pupil and long history of Flomax (tamsulosin) use. A femtosecond laser was used to create arcuate incisions but it was unable to complete lens fragmentation or capsulotomy due to the small pupil. After making the capsulorhexis under the iris, the miLoop is introduced at an angle and segments the lens into quadrants in the bag. The sweeping action of the loop also removes cortex and epinucleus material which eliminates the need for I/A after phaco.
Posted: 5/09/2018
Farrell "Toby" Tyson, MD
Farrell "Toby" Tyson, MD, shows lens fragmentation using the miLoop device (IanTech) in an 82-year-old patient with a small pupil and long history of Flomax (tamsulosin) use. A femtosecond laser was used to create arcuate incisions but it was unable to complete lens fragmentation or capsulotomy due to the small pupil. After making the capsulorhexis under the iris, the miLoop is introduced at an angle and segments the lens into quadrants in the bag. The sweeping action of the loop also removes cortex and epinucleus material which eliminates the need for I/A after phaco.
Posted: 5/09/2018
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Comments
Just Now
Naf Badr
7 years ago
Good surgery
Eduardo Mayorga
7 years ago
I agree with those who commented in that dilating the pupil by mechanical means would give better visibility and make the surgery safer and that would be the best initial course of action option. I also recognize the value of being able to watch an example on how to handle a small pupil without mechanical dilation and keep this option in mind as the second option if for any reason the first one is not available.
Anonymous
7 years ago
I would never want me or my family members to do cowboy cataract surgery like this through a 2-3mm opening. Why? There is no good reason not to use a pupillary expansion device. Obviously cost is not an issue if your spending money on a disposable MiLoop. Maybe you want to flex your muscles and show what a "Master" you really are by taking all this risk for no reason.
Murilo Borges
7 years ago
Why risk a surgery, just not to put an expansion device. Chances to have a complication is way up.
Toby Tyson
7 years ago
The whole idea behind showing this case is that you can do a controlled and safe procedure with limited visibility through the use of the MiLoop. First the patient was given intracameral lidocaine with no effect. Performing the majority of the procedure under viscoelastic allows for a straight forward and safe dissection of the nucleus without worry of the iris getting damaged by either streching with a ring or getting sucked into the phaco. The MiLoop when deployed tracks between the epinucleus and the bag. Its not going to break the bag with depolyment. It also cuts the nucleus all the way thru. Small pupils act as a template and actually keep the capsularrhexis from extending out. There have been several devices that have been developed that mimic that technique. Now I will say that this is a case that I performed after doing over six hundred MiLoop cases. So yes this is not for the first timer but as one get very comfortable with device it becomes very reliable especially in difficult cases. The Malyugin Ring is a great device too but not without its technical difficulties for the starting surgeon.
Anonymous
7 years ago
Nice case but the money you save by not using the M-ring is spent on the miLoop. In addition, a small amount of intracameral epinephrine would likely eliminate the need for either the ring or the miLoop.
ari weitzner
7 years ago
amazing skill, but i would imagine not put putting in a malyugin and doing a blind rhexis is bad advice for 99.9% of us.