(1)
Newcastle Eye Centre Royal Victoria Infirmary, Newcastle upon Tyne, UK
Electronic Supplementary Material
The online version of this chapter (doi:10.1007/978-3-319-59924-3_9) contains supplementary material, which is available to authorized users.
When novice surgeons perform nucleus disassembly, the lens fragments are often of an irregular size and shape. It is more technically demanding to remove larger sized fragments, as it requires additional bimanual manipulation and the surgeon must exert better phaco probe control. This chapter will introduce a technique of breaking down large fragments (or even medium sized fragments) into smaller pieces. This is a fundamental skill and it is recommended that novice surgeons gain experience in performing it before taking on whole lens removal.
9.1 Skills to Be Gained
- 1.
Use of the second instrument to debulk fragment.
- 2.
Ability to maintain phaco tip hold on a fragment, whilst the second instrument is used to debulk that fragment.
- 3.
Ability to vary phaco foot pedal control between irrigation only, aspiration and phacoemulsification settings.
The module requires the Trainer to disassemble the whole lens into suitable sized fragments, ensuring that some of which are sized such that debulking is required.
9.2 Debulking of Lens Fragment: Step by Step Instruction
9.2.1 Step 1
The lens fragment is pulled into safe zone (Fig. 9.1). The second instrument (chopper or equivalent) is kept out of the way so that it does not hinder fragment movement or inadvertently knock the fragment off the phaco tip.
Fig. 9.1
Fragment debulking—step 1. (a) Fragment captured and (b) pulled into safe zone
9.2.2 Step 2
As the fragment enters safe zone, ensure the phaco retains its hold on the fragment by maintaining aspiration. The second instrument tip is positioned behind the fragment base as the fragment is pulled forward (Fig. 9.2).
Fig. 9.2
Fragment debulking—step 2. (a, b) Second instrument positioned behind fragment base
9.2.3 Step 3
The second instrument is pulled through the fragment towards phaco tip but slightly to the left hand side. This ensures the tip remains buried in the undisturbed nucleus (Fig. 9.3). The hold on the fragment is maintained with aspiration as needed.
