Cataract surgery in pictures
The cataract surgery has different steps whose goal is the withdrawal of the clouded lens and replace it with an artificial lens implant.
It is done on an outpatient basis under local anesthesia, in a room equipped with a device of phaco emulsification operation (ex: Stellaris, Bausch and Lomb) and an operating microscope. It is possible to add a system of augmented reality as Callisto (Zeiss), in order to facilitate and increase the accuracy of certain stages. From the footage with a video box connected to the operating microscope, the system injects Visual cues that appear superimposed, as in some guidance and systems help flight (military aviation).
Operating room for the cataract surgery: it has at least an emulsificateur phaco and a microscope. The Callisto (augmented reality) system is linked to the operating microscope for adding useful Visual cues allowing the surgeon to increase the accuracy of the size and positioning of some surgical gestures.
Control of the emulsificateur phaco screen has buttons over a circle round: these modes allow to control the flow irrigation and aspiration, as well as the possible issuance of ultrasound at different stages chained during the cataract surgery.
The transparency of the corneal dome allows the surgeon to directly visualize the crystalline, once the dilated iris (pupillary dilation is performed by instillation of drops before the procedure). The lens is surrounded of the capsular bag, and is thus directly visualizes the anterior portion of the bag (anterior capsule). Brands carried out near the limb can identify the horizontal direction (azimuth 0 ° - 180 °). The orange glow is related to the diffuse reflection from the retina to light of the microscope.
The main incision is made in clear cornea, in the immediate vicinity of the junction of the cornea and lamina using a calibrated Blade (here 2.2 mm). It is possible to achieve more narrow incisions yet (or even 1.8 1.6 mm). The Callisto system include the location of the incision to the previously chosen azimuth augmented reality in the eyepiece of the microscope by the surgeon (here at 135 °).
The lateral incision allows later the micromanipulator, instrument used during phaco emulsification to "fragment" the kernel, and various irrigation cannulas.
The space between the space between the anterior capsule of the crystalline lens and the posterior face of the cornea of a visco-elastic substance; This transparent gel allows you to cover and protect the endothelium (located at the posterior face of the cornea), as well as to maintain the volume of the anterior Chamber during surgery.
This maneuver is performed with a microphone clip: it seeks to access inside the cristallinien bag. The created opening diameter is ideally close to 5.5 mm, in order to cover the edges of the optics of the implant once put it: the realization of its route can be helped augmented reality like here by the projection of the virtual image of the ideal path in the eyepieces of the microscope: this trace to double contour delimits a circular area whose diameter is between 5 and 5.5 mm. The created circular opening gives access inside the capsular bag, which contains the cortex and the nucleus of the lens to remove.
Hydro dissection is to inject a buffered solution (BSS for Balanced Salt Solution) to separate the capsule (the cristallinien bag) the superficial cortex and the nucleus (which will be extracted during the phacoemulsification). This separation facilitates the next stage of phaco emulsification.
The micro manipulator is introduced by the lateral incision to help mobilize and facilitate the maneuvers of fragmentation (cracking) or fragmentation (chop) of the cristallinien kernel. The handpiece has a head hollow vibrating at the frequency of ultra sounds, to emulsify mechanically cristalliniens kernel fragments, and that is covered with a sleeve of irrigation to allow irrigation of liquid by infusion of liquid BSS.
Each fragment or core area is mobilized, emulsified and sucked by the piece at hand. At the end of this step, the cristallinien bag is empty of the nucleus and the deep cortex: a part of the superficial cortex remains largely adherent (epi core or "the masses" cristalliniennes). At this stage, it is important to preserve the integrity of the capsular bag, which will provide support to the artificial lens implant.
The aspiration of the masses washing is done with the cannula for irrigation aspiration: during this stage, it is not necessary to use ultra sounds, as the masses have a consistent enough soft.
This step is to remove the masses and epithelial adherent cells of the inner walls of the capsular bag, in order to ensure the greatest possible transparency of this bag before insertion of the implant.
The capsular bag is unpleated and filled with viscoelastic gel: this step precedes the injection of the implant (intraocular lens) in the capsular bag. It allows to re-form the volume of the bag, and protect the walls during the deployment of the implant.
The implant with the total diameter close to 12 mm (6 mm for optics) is previously placed in an injection syringe, then injected controlled through the main incision in the capsular bag of substance visco elastic manner.
During the injection, the elastic properties of the materials of the implant will allow him to deploy and return to its original shape (that he owned before the introduction in the injector where it undergoes a winding and a compression so that it can be injected through the microincision)
Once the implant is placed in the capsular bag, it is possible to remove the viscoelastic gel: the volume of the implant allows the capsular bag to stay open.
To seal a 2 mm incision, just inject a bit of liquid by infusion (BSS) into its banks. Hydration ensures a swelling of the banks and their coaptation.
The procedure is completed. It lasted about dune ten minutes, without bleeding, and purely local anesthesia. The Visual recovery takes a few hours to a few days. A local treatment about a month should be continued. The first post operative control can take place in the first 24 to 72 hours.