Surgical Technique



Surgical Technique phaco aspiration of congenital cataract combined with the persistent hyperplastic primary vitreous using femtolaser anterior and posterior capsulotomy in childrenThe patient interface’s vacuum ring was centered relative to the limbus. After that, the interface was fixed to the eye by vacuum. The interface was then filled with 3 ml balanced saline solution (BSS). The next step was connecting the patient interface to the laser handpiece at the end of an articulated arm on the operating unit of the femtosecond laser. The laser settings for anterior capsulotomy are set on the laser interface as follows: capsulotomy diameter 4.0 mm, laser power 80 %, resection height 0.7 mm, velocity 50 mm/sec. The resections positions are the determined by the built-in optical coherence tomography (OCT) and adjust on the screen. After the resection (capsulotomy) is complete the patient interface is disconnected automatically from the patient`s eye. Paracentesis are performed with a 1.2 mm disposable knife at 9 and 3 hours, a solution of phenylephrine (10%) is introduced into the anterior chamber and the anterior chamber is filled with a viscoelastic (DisCoVisc OVD, Alcon, USA). The floating edge of the anterior capsule is fixed with capsulorhexis tweezers and removed from the anterior chamber through the paracenthesis. The hydrordissection is performed according to a standard technique.Phaco aspiration by standard bimanual technique is performed, afterwards the capsule bag and the anterior chamber are filled with the viscoelastic (DisCoVisc OVD, Alcon, USA) and the incisions hydrated with the BSS. The posterior laser capsulotomy-membranotomy is performed in the second step. The target diameter of the posterior capsulotomy was determined by the size of the retrolental membrane coarse fibrosis at the area of the hyaloid artery fixation. The femtolaser’s sterile patient interface was vacuum-docked a second time to the eye to perform the posterior capsulotomy-membranotomy. The localization of the lens posterior capsule, adjacent to a vascular retrolental membrane, was determined by the built-in optical coherence tomography (OCT). Parameters of the posterior capsulotomy (such as diameter, localization relative to the central axis and locations of the anterior hyaloid artery attachment), as well as the laser power parameters, were set using the touch screen display of the device. In this case: capsulotomy diameter 3.0 mm, laser power 100 %, resection height increased to 1 mm, velocity decreased to 35 mm/sec. The exact positions of the capsulotomy cuts were checked and adapted on the OCT image based cut configuration display of the laser system. After completion of the positioning of the cut, a continuous circular capsule opening with the required diameter was formed by the femtosecond laser. As soon as the laser resection was finished, the vacuum fixation was automatically released and the patient interface with the articulated arm of the operating unit was disconnected from the eye.A femtosecond laser opening of the posterior capsule is performed resulting in a continuous circular opening of a given diameter. The carved disc of the posterior capsule is fixed with a capsulorhexis forceps, separated and removed with forceps through the paracentesis. Then a carved fragment of the fibrous membrane with a hyaloid artery attached to it is fixed with a clamping forceps. Then, the hyaloid artery, which was attached to a fragment of the fibrous membrane that was cut out by the femtosecond laser, was coagulated by means of a so-called “underwater” thermo-coagulator integrated in ?Centurion Vision System? (Alcon, USA) at 3 mm distance from the membrane. After that, this hyaloid artery was cut by vitreal scissors at the point of coagulation and fibrous tissue was evacuated through the corneal incision. Within the formed posterior capsulotomy, anterior 25G-vitrectomy was performed, using the Infiniti Vision System (Alcon, USA) device. Further a sclera-corneal incision is created and the IOL (Acrysof IQ,Alcon) is injected. The viscoelastic is removed by bimanual irrigation-aspiration. The surgery is completed by sealing the incisions. ................
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