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Tip 136: Visualization
This Phaco Tip column addresses the first of the two
critical elements required for consistently successful eye surgery. Although
it may seem obvious that excellent visualization is required to perform
precise intraocular surgery, it is all too easy to violate this rule.
For example, in previous columns I have advocated that
any failure to successfully divide the nucleus by any technique (divide
and conquer, phaco chop, etc.) would immediately alert the surgeon to
the need to reduce the thickness of the central nucleus by additional
sculpting. In other words, the central nucleus, and particularly the posterior
nuclear plate, needs to be weakened prior to further attempts at nuclear
division.
I have observed that failure to adequately thin the nuclear
plate is nearly always due to poor visualization, i.e. inadequate use
of the microscope to achieve magnification and precise focusing to permit
safe and accurate sculpting.
Other examples include operating on an eye that is too
soft (due to excessive incision leakage, inadequate infusion bottle height,
etc.). Resultant corneal striae reduce visualization and greatly increase
the possibility of a surgical misstep.
Next Phaco Tip: Stabilization
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