Blumenthal small incision cataract extraction

Blumenthal small incision cataract extraction is an improvement of modern extracapsular cataract extraction. The fundamental difference between the former and the latter is that the former uses the anterior chamber maintainer, maintains the anterior chamber perfusion, and uses the water pressure to lower the lens nucleus. The pouch is taken out and pulled out of the tunnel small incision by means of the lens slide. Treating diseases: cataracts Indication Blumenthal-type small incision cataract extraction is suitable for almost all types of cataracts. Preoperative preparation 1. Comprehensive evaluation of systemic and local lesions and necessary treatment. 2. Topical application of antibiotics was started 3 days before surgery. The conjunctival sac and lacrimal duct were washed with 0.25% chloramphenicol or gentamicin on the day of surgery. 3. Anesthesia after routine or after ball. Surgical procedure 1. Anterior chamber maintainer: The anterior chamber maintainer is a metal catheter with a spiral at the end, which can be fixed to the limbus by rotation. Because of the large inner diameter, it can maintain a large perfusion flow even if the incision leaks during the operation. Will not have much impact on the front room. As one of the special means of this operation, the main functions of the anterior chamber maintainer are: 1 to maintain the intraocular pressure in the whole process of surgery, and to have a large tolerance to the loss of intraocular pressure caused by fluid loss; 2 to maintain adequate anterior chamber Depth, providing a satisfactory operating space; 3 leakage of perfusate through the incision, can eliminate some residual components; 4 anterior chamber positive pressure makes the posterior capsule bulge backward, reducing the chance of rupture of the posterior capsule; 5 can be applied by perfusion pressure The lens nucleus is dislocated and floated; 6 the capsulorhexis can be completed without the use of a viscoelastic agent. The specific method for placing the anterior chamber maintainer is as follows: in the outer lower limbus, the puncture knife is used to puncture the oblique direction of the cornea, the slit width is 1.5 mm, and the length is about 2.0 mm. The direction of the incision may be slightly perpendicular to the limbus so that the direction of the implanted maintainer is tangent to the cornea. The retainer is inserted into the incision in a rotational manner to allow the opening to enter the anterior chamber. Since the size of the incision matches the outer diameter of the retainer, the retainer can be in watertight contact with the incision without suture fixation. Connect the perfusion tube, adjust the perfusion bottle to about 45-60cm from the surgical plane, and keep the intraocular pressure at 35mmHg. 2. Capsule, water separation, nuclear floating: In the outer/inner upper corneal margin, an auxiliary puncture incision for operation is performed, and the perforating needle with perfusate is inserted into the incision to make a circular capsulorhexis. A single-tube aspiration needle with a suction hole of 0.4 mm is used to absorb the softer cortex of the front to form a "crater-like" depression to expose the front surface of the core. A flat needle with a BSS is placed along the bottom of the crater and accurately inserted into the cortical layer of the nucleus for water separation, and the core is released by water separation. Immediately after the injection of the flat needle through the water to form a crack, carefully inserted into the back of the core, and with a light stroke and pick up action, the complete core is taken into the anterior chamber. 3. Scleral tunnel incision: The manufacturing method is similar to that of the conventional phacoemulsification tunnel incision, except that the inner incision is made sufficiently large to form a trapezoid with a short inner length and a short outer length. In order to increase the potential expansion of the outer incision, the outer incision can also be made into an inverted "V" shape. 4. Pulling the core: Insert the small slide into the lens core through the tunnel incision to form a state in which the lens core is lifted. Lightly press the inner mouth with a small slide. Under the perfusion pressure, the lens nucleus will be pressed against the funnel-shaped inner opening of the tunnel incision. As the skateboard is slowly pulled out and the sclera is gently pressed at 12 o'clock, the lens nucleus will be pulled out under the combined action of perfusion pressure and sliding friction. 5. Clear the cortex and implant the intraocular lens: the cortex is removed according to the conventional method. Generally, there is no major difficulty. The suction tube suction outlet diameter can be selected to be slightly larger, such as 0.4mm or even 0.5mm, and it can be operated by the auxiliary incision. Reduce the chance of anterior chamber collapse.

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