Name: A Novel Capsulorhexis Technique Using Shearing Forces with Cystotome (Video) | JoVE Journal
Uploaded: 2010-05-15T17:00:00.000+00:00
Duration: 4 min 53 s
Description: Learn a novel capsulorhexis technique using shearing forces with cystotome for cataract surgery. This method enhances precision, reduces OVD extrusion risk, and improves control during the procedure.

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5 minutes

We would like to thank Dr Clemens Wagner from VR magic for his support. We also like to thank Dr Nail Modi for helping out with the video recording.

Part 1 : Purpose:
To demonstrate a capsulorhexis technique using predominantly shearing forces with a cystotome on a virtual reality simulator and on a human eye.
Part 2 : Method:
Steps:
<ol>
	<li>Our technique involves creating the initial anterior capsular tear with a cystotome to raise a flap.</li>
	<li>The flap is then left unfolded on the lens surface.</li>
	<li>The cystotome tip is tilted horizontally and is engaged on the flap near the leading edge of the tear.</li>
	<li>The cystotome is moved in a circular fashion to direct the vector forces.</li>
	<li>The loose flap is constantly swept towards the centre so that it does not obscure the view on the tearing edge.</li>
	<li>Re-engage the needle to the tearing edge frequently to create a suitably sized continuous curvilinear capsulorhexis.</li>
</ol>
Part 3 : Results:
Our technique has the advantage of reducing corneal wound distortion and subsequent anterior chamber collapse. The capsulorhexis flap is moved away from the tear leading edge allowing better visualisation of the direction of tear. This technique offers superior control of the capsulorhexis by allowing the surgeon to change the direction of the tear to achieve the desired capsulorhexis size.

<ol><li>Neuhann, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Theorie+und+Operationstechnik+der+Kapsulorhexis%5BTitle%5D)+AND+%22Klin+Monatsbl+Augenheilkd%22%5BJournal%5D)">Theorie und Operationstechnik der Kapsulorhexis.</a> Klin Monatsbl Augenheilkd. 190, 542-545 (1987).</li>
<li>Gimbel, H. V., Neuhann, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Development+advantages+and+methods+of+the+continuous+circular+capsulorhexis+technique%5BTitle%5D)+AND+%22J+Cataract+Refract+Surg%22%5BJournal%5D)">Development advantages and methods of the continuous circular capsulorhexis technique.</a> J Cataract Refract Surg. 16, 31-37 (1990).</li>
<li>Gimbel, H. V., Neuhann, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Continuous+curvilinear+capsulorhexis%5BTitle%5D)+AND+%22letter%29+J+Cataract+Refract+Sur%22%5BJournal%5D)">Continuous curvilinear capsulorhexis.</a> letter) J Cataract Refract Sur. 17, 110-111 (1991).</li>
<li>Gimbel, H. V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Evolving+techniques+of+cataract+surgery%3A+continuous+curvilinear+capsulorhexis%2C+down-slope+sculpting%2C+and+nucleofractis%5BTitle%5D)+AND+%22Semin+Ophthalmol%22%5BJournal%5D)">Evolving techniques of cataract surgery: continuous curvilinear capsulorhexis, down-slope sculpting, and nucleofractis.</a> Semin Ophthalmol. 7, 193-207 (1992).</li>
</ol>

No conflicts of interest declared.

The EYESI Surgical Simulator is a realistic training platform for surgeons to practice complex capsulorhexis techniques. Capsulorhexis is the most important and complex part of phacoemulsification procedure. A successful cataract surgery mostly depends on a good capsuporhexis. The shearing forces technique is a suitable alternative and in some cases a far better technique in achieving the desired capsulorhexis.

<table><tbody><tr><td>0.06% Trypan Blue</td><td>DORC International</td><td>NEC0010(Clinic cat.)</td><td></td></tr><tr><td>EyeSi Cataract surgery simulator</td><td>VRMagic</td><td></td><td></td></tr></tbody></table>

a novel capsulorhexis technique using shearing forces with cystotome

A Novel Capsulorhexis Technique Using Shearing Forces with Cystotome

Purpose:
To demonstrate a capsulorhexis technique using predominantly shearing forces with a cystotome on a virtual reality simulator and on a human eye.
Method:
Our technique involves creating the initial anterior capsular tear with a cystotome to raise a flap. The flap left unfolded on the lens surface. The cystotome tip is tilted horizontally and is engaged on the flap near the leading edge of the tear. The cystotome is moved in a circular fashion to direct the vector forces. The loose flap is constantly swept towards the centre so that it does not obscure the view on the tearing edge.
Results:
Our technique has the advantage of reducing corneal wound distortion and subsequent anterior chamber collapse. The capsulorhexis flap is moved away from the tear leading edge allowing better visualisation of the direction of tear. This technique offers superior control of the capsulorhexis by allowing the surgeon to change the direction of the tear to achieve the desired capsulorhexis size.
Conclusions:
The EYESI Surgical Simulator is a realistic training platform for surgeons to practice complex capsulorhexis techniques. The shearing forces technique is a suitable alternative and in some cases a far better technique in achieving the desired capsulorhexis.

This video demonstrates a novel capsulorhexis technique in modern cataract surgery. Capsulorhexis is the most difficult and important part of phacoemulsification surgery.

Purpose:
To demonstrate a capsulorhexis technique using predominantly shearing forces with a cystotome on a virtual reality simulator and on a human eye....

Hi, I'm Shalin, one of the 10 ophthalmic surgeon working in Glasgow. I like to demonstrate a new and novel CAPSULORHEXIS technique using Sharing vector with cys. IC is a sophisticated simulator designed for intraocular surgical training.During simulated surgery, the surgeon manipulates realistic handheld instruments. There are inserted into the artificial eye. The motion of the instruments and the orientation of the eye are picked up by highly accurate sensors and transmitted to a computer, which renders the virtual operation scenarios into the IC microscope.The simulated software was programmed to obey the physical laws of mechanics. This allows a highly realistic representation of a true rexi. In the next video clip, we aim to demonstrate a novel capsulorhexis technique on the simulator.In our technique, a cone is used to initiate the anterior capsular tear. The flap is left unfolded on the lands surface. The ssam tip is tilted horizontally and is engaged on the flap near the leading edge of the tear.The scissor csit is moved in a circular fashion to directive vector forces. The loose flap is constantly swept towards the center so that it does not obscure the view on the tearing edge. This technique, which uses the csit, reduces the risk of inadvertent OVD extrusion and subsequent anterior chamber collapse.A cytoma can be mounted onto a syringe filled with OVD for a rapid refill of ophthalmic visco surgical device through the anterior chamber shallows. Unlike the forceps technique, this method does not distort a corneal wound, therefore offering an uninterrupted view of the surgical field. In addition, this a term is a better instrument in eyes with shallow interior chambers and it is cost effective.In this next video clip, surgeon initiates the tear on the anterior capsule and direct the direction of tear any clockwise direction, direct the anterior capsular tear in a circular, but parallel to the iris margin to complete the rxi. In conclusion, the IC surgical simulator is a valuable tool to an enable surgeon to practice new capsular ECTs maneuvers. The new shearing technique, which was successfully done on the IC surgical simulator, has been successfully performed on the human eye.This patient had a mature cataract, which required vision blue to facilitate the visualization of the anterior capsule. The capsular flap is raised. The sheik technique gives the surgeon superior control over the entire capsular axis procedure.Using the shearing technique, the capsulorhexis is completed.

a-novel-capsulorhexis-technique-using-shearing-forces-with-cystotome

Research

JoVE Journal

Medicine

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Learn a novel capsulorhexis technique using shearing forces with cystotome for cataract surgery. This method enhances precision, reduces OVD extrusion risk, and improves control during the procedure.

A Novel Capsulorhexis Technique Using Shearing Forces with Cystotome

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