Radial Tear
This is an interesting case in which our junior resident went radial with the capsulorhexis, leading ultimately to a posterior tear and vitreous loss. The video demonstrates how to perform an anterior vitrectomy and placement of a sulcus IOL.
The capsule went radial with a funny motion of the capsule forceps possibly from catching them on the speculum. The Vanna scissors where used to take the rhexis the other way and intially everything seemed to go alright. The nucleus was sculpted out a bit like a bowl to decompress the lens prior to hydrodissection/dileneation. The phaco was done with "slow motion" as described by Bob Osher with low vacuum and low flow rate. Then near the conclusion of the cortical removal it was clear that the anterior radial tear had extended inferiorly resulting in vitreous loss.
The automated vitrector was used to remove residual cortical material and vitreous. In this section of the video the sound from the OR is played so you can tell when the vit cutter is on and when it is off. First the vit sut rate is high and the vitreous is removed from the anterior chamber. Then the cut rate is slowed down to remove lens material. The cutter is turned off to acquire peripheral cortical material and then turned on when removing the material in the center of the chamber when vitreous may be present.
A 3-piece acrylic IOL lens was placed in the sulcus and has remained stable for the past 6 months since the surgery.
Reference:
Osher RH Slow motion phacoemulsification approach, J Cataract Refract Surg. 1993 Sep;19(5):667. comment on: J Cataract Refract Surg. 1993 Mar;19(2):223-31.
unnarrated. Length approx. 7 min.
