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PHACOEMULSIFICATION IN
MYOPIC EYES
Sumeet Agrawal
PG 3
UCMS and GTB Hospital
Delhi
HOW IS IT DIFFERENT FROM A
ROUTINE CATARACT SURGERY ?
PREOPERATIVE
INTRAOPERATIVE
POSTOPERATIVE
WHEN TO BE CONCERNED ?
• Degree of myopia
– High myopia (2%)
• ( Spherical equivalent -6.00 D or more; Axial length 26.5
m...
UNILATERAL / BILATERAL
Keep the possibility of amblyopia, specially if unilateral
Visual acuity before onset of cataract
H...
INTRAOPERATIVE CONSIDERATIONS
• Peribulbar / Retrobulbar block : chances of globe
perforation ; topical / subtenon anaesth...
• Deep AC
– Difficult instrumentation
– Stretching of iris - > pain (intracameral lignocaine)
– Reverse pupillary block (L...
• Posterior capulorrhexis (to avoid future need for
YAG capsulotomy); controversial
• IOL
– To implant or not
– Abbott Med...
POSTOPERATIVE
• Refraction takes longer to stabilize
• Check for retinal breaks
• Closer and more frequent follow ups
• Op...
THANK YOU
Phacoemulsification in myopic eyes
Phacoemulsification in myopic eyes
Phacoemulsification in myopic eyes
Phacoemulsification in myopic eyes
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Phacoemulsification in myopic eyes

Everything one needs to know about phacoemulsification in the myopic eye

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Phacoemulsification in myopic eyes

  1. 1. PHACOEMULSIFICATION IN MYOPIC EYES Sumeet Agrawal PG 3 UCMS and GTB Hospital Delhi
  2. 2. HOW IS IT DIFFERENT FROM A ROUTINE CATARACT SURGERY ? PREOPERATIVE INTRAOPERATIVE POSTOPERATIVE
  3. 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. 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 Fuch’s 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. 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. 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. 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. 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. 9. THANK YOU

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