Routine Catarct Surgery 2018

Hi, this is Dr. Youssef
from Cornwall, Ontario,

presenting to you how we do
the cataract surgery in 2018

and the few modifications we made
over 2017.

So we start the surgery
by putting EndoCoat on the cornea,

which is a dispersive viscoelastic.

This gives you a clear cornea
throughout the surgery

without having the nurse to put

a balanced salt solution
on the cornea.

This is the incision;
it's 2.75 millimeters,

two millimeter deep
in the temporal part of the cornea.

You have to make sure
that the construction

of the wound to be self-sealing;
don't suture wounds.

This is the injection
of 1% preservative-free Xylocaine

with seven drops
of 10% phenol,

and we inject about 0.2 mL's.

And this is the EndoCoat again,
protecting the back

of the cornea
and forming the chamber

to give you space to work.

And this is the paracentesis,
which end up to be

0.8 millimeters in size.

It's about 80 degrees to the left
of the main incision.

This is a very important, simple step.

We put a mark on the cornea
to make sure

that the capsulorhexis opening
is well centralized,

and it's a proper size
to cover the optic of the lens,

so that you don't get any--

much less PCO
and perfect concentration.

So we start the capsulorhexis,

and we try to follow the direction

of the mark we made in cornea.

Of course, the Femto-Second Laser,
for now,

we use for that step,
and it gives you

a perfect 4.9 millimeter size,
very well centralized,

because it scans the capsule
and it gives you

a perfect location,
so use the Femto-Second for that.

This is a hydrodysection
and hydrolineation;

"hydrosection"
is splitting the cortical material

from the capsule, and "hydrodelineation"
is to delineate the cap,

the nucleus,
to allow us to remove these--

each one of them,
in a separate step.

This is the fake emulsification step.

We use the Signature Pro,

the Whitestar,

and we remove the nucleus
in dividing

and use a chopping technique,

so each quadrant
is removed by itself

using the fake emulsification,

and it works well for that purpose.

Now this is the epinucleus,
and this very important step to--

at this stage, that you have nothing
holding the capsule back,

so we have to make sure
that the chopper

is there to protect the capsule

and avoid accidental
capturing and ripping the capsule.

See, this step-- What I did,
I opened a small opening

in the cortical material
to allow the J-cannula

to go between the cortical material
and the capsule,

and to result in a perfectly-done...

J-cannula cortical cleanup.

So you can see this--
J-cannula is pushing, actually,

the cortical material out
through the wound,

and it's resulting in a clean,

well-polished posterior capsule,
without having to go

with your I/A
and risking capturing the capsule

and resulting in PC tear,
which is a major complication

of saccadic surgery.

So we make sure
that the smallest parts are cleaned,

and it cleans up the areas
that you don't even see,

because the BSS will rotate
into the capsular bag

and remove all the cortical material
that's hiding.

Now we're inflating the capsular bag
using Healon,

which is a cohesive, visoelastic material

to allow it to easily remove it
after the lens implantation

without increasing the pressure.

Now, this is the lens; this
is the TECNIS from Johnson & Johnson.

It's a one-piece lens;

it has the optical,
which is about 6.5 millimeters,

and the two haptics,
which are the two legs

that would hold lens in place.

It goes in folded,
and it's unfolded inside,

so the openings are small
to allow us

to do the surgery
without putting sutures.

We don't use the PMMA,
the hard lenses, anymore.

Standard lens
is a soft lens in Ontario.

So we're removing all the viscoelastics

from the anterior chamber
using the lens as a shield.

So the lens has to stay
in place

protecting the capsule
from the cortical material,

and if I need to clean up
behind the lens,

I should use irrigation,
rather than aspiration, to remove it.

I don't go, again,
behind the lens

using the irrigation aspiration,
because it risks the capsule.

On hydrating, you won't,
using the moxifloxacin,

which is diluted VIGAMOX.

You empty the tenth--

the 3 mL VIGAMOX from Alcon;

add 7 millimeters of--
milliliters of DSS,

and you result in 10 mL
of diluted 150 microgram

per 0.1 mL,

and you use that
to hydrate the wound.

This is the the dropless injection.

So it's a mix
of moxifloxacin and triamcinolone

and injected
into the subconjunctival space

and make sure that you avoid
the subconjunctival of the blood vessels.

To sum up, this is a sped-up video
of the same thing.

So I'll use the viscoelastic
on the cornea, intracameral...

Xylocaine and Phenyl-.

I don't put it on the infusion anymore.

We use the capsule as a guide
to guide the capsulorhexis.

Always protect the capsule
throughout the surgery,

through the phaco--
through the irrigation aspiration,

using the lens and using the J-cannula
to protect the capsule.

J-cannula is a perfect way
to remove--

to result
in a cortical cleanup that's perfect

without risking the capsule rupture;

use the IOL to protect it.

I don't use any aspiration
behind the lens,

and we use the dropless injections
so we don't have to

put drops after the surgery
except for lubricating drops

if it gets wider in shape.

Thank you for watching.