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IntraCameral Medications during Cataract Surgery

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Putting medication directly into the anterior segment of the eye can be very effective. There are many different medications that we can use during surgery to assist in the procedure or help with post-operative healing.

It’s cataract coach comm we’re doing a routine cat or a case here it’ll be fake oh chop and i want to show you in this case what we do in terms of medications in the eye at the end of the case in this case we’re gonna put an anti-inflammatory inside the eye a meiotic agent as well as some intra cameral antibiotics and we’ll talk about all three of those so here

We’re filling the hour they’re dispersive viscoelastic time to make our main fake-o incision here it comes a fixation ring to hold the eye diamond carat ohm used to make a single plane temple incision just like that appropriate tunnel length that looks great and will do about a five millimeter caps for exes in this case the patient needs extra anti-inflammatory

Activity and so we’re gonna inject at the very end preservative-free triamcinolone in the anterior chamber not in the vitreous not sub tenon’s but actually in the anterior chamber it’ll have a good anti-inflammatory and flam attractivity for a few days until it’s washed out as you know the antechamber turns over about once every 90 minutes or people say a good

Guideline is about 1% turnover per minute somewhere in that timeframe we’ll also put a mitotic agent in the eye and that’s gonna be dilute carbajal that’ll help bring down the pupil also may help a little bit with pressure control and then finally we’re gonna put some intra camera’ll preservative-free moxifloxacin now there been studies that have been published

Showing that use of intra camera antibiotics may help prevent and off the midis and so we’ll put that in this eyes well so here’s the cataract already loosened from its attachment of the caps are back put the fake au probe in the eye and it will do a chop technique so buzz in with a fake au probe but the chop or the nucleus and split apart and there we go looks like

Two halves have been created now the first hemi nucleus can be brought up out of a caps or bag like that and emulsified rather quickly again this is not a very dense cataract this is pretty typical for what we see here in the west side of los angeles los angeles is a humongous city of more than 10 million people in the greater metropolitan area and we have other

Neighborhoods in the city where we’re more likely to see a very dense or burn essent or white cataract but in this part of town this is a typical case so the cataracts being removed nuke is almost completely gone that looks great a little bit of cortex to be cleaned up next i pro being readied now we’ll place that inside the eye of course high flow high vacuum for

The ie and we’ll get all this cleaned up do you need to put an intrical antibiotic for every case again that’s a surgeon decision some people say yes for every case some people say no just do it for select cases i don’t think you can be faulted either way similar with the anti-inflammatories we know that cataract patients do benefit from having anti-inflammatory

A medication to the post-op period but you can just use them topically which is the most common you don’t have to actually inject them intra camera lee in this case we’re doing it because we just want stronger anti-inflammatory activity and the patient has indicated that she may have difficulty placing some of these drops so let’s start off by really quelling the

Initial bout of inflammation with the triamcinolone the total dose the triumph still knows very little it’s about one milligram and again it’s just placed in the anterior chamber and we’ll place that at the very end of the case after we’ve sealed up our incisions so if could inflate of the capsular bag here will now implant our single piece mono focal acrylic lens

It’ll go right in the capture bag and we’ll deliver that and that looks just about perfect and i think that capsule raxus will overlap the optic for 360 degrees looks like a 5 millimeter or so caps or exes and of course that lens has a six millimeter optic and there’s the overlap looks great going behind the lens to remove our viscoelastic now the triumph salon

Has one additional benefit as well and that is if there is retained viscoelastic you’ll see that when the triumph sign was placed in the eye because that one area with the retained viscoelastic will not have any triamcinolone particles if we have complete removal of the viscoelastic you’ll see a very even dispersion of the triamcinolone particles again looks like

A beautiful rex is time to seal up our incision here going back and forth with some balance soft solution on a 27 gauge blunt cannula just to give enough hydration there i don’t overdo it same thing here son of the lens wash out the angle and let’s seal it up now here come the medicines let me show you first the triamcinolone total dose only about one milligram

Just a little bit like that now the dilute carbajal to swirl that around but also to have an meiotic effect and maybe a mild i hope you effect and then the last thing there was the preserver for you moxifloxacin a very small dose placed inside the antechamber so just something to think about thanks for watching

Transcribed from video
IntraCameral Medications during Cataract Surgery By Uday Devgan