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Cataract Extraction

PROCEDURE IN DETAIL:  The eye was dilated using phenylephrine 2.5%, Cyclogyl 1% and Mydriacyl 1%, one drop to the eye to be operated on, every five minutes times three.  One drop of Ocufen was placed in the eye to be operated on every five minutes times three. The patient was brought into the operating room.  The eye to be operated on was prepped and draped in the usual sterile manner.  A 1-mm incision was made into the anterior chamber using a slit knife, and injection of lidocaine 1% MFP, Amvisc and viscoelastic was performed.  Entry was made at the limbal area with a 3-mm diamond keratome.  A cystitome and Utrata forceps were used to form a circular capsulorhexis.  The lens was then hydrodissected and hydrodelineated.  Phacoemulsification of the lens nucleus, as well as aspiration of remaining lens cortex were performed.  An additional amount of viscoelastic was placed in the capsular bag.  A Chiron intraocular lens was placed in the capsular bag.  The remaining viscoelastic was removed and replaced with balanced salt solution.  Stromal hydration of the wound margins was performed.  The wound was noted to be watertight.  Vancomycin 1 mg in 0.1 cc of fluid was injected into the anterior chamber.  A drop of Tobradex was placed in the eye.

PROCEDURE IN DETAIL:  Prior to prepping the patient, tetracaine drops and 2% Xylocaine ointment were instilled into the previously dilated operative eye.  A Honan pressure device was then placed on the eye with the pressure between 30 and 40 for approximately 10 minutes.  After this was removed, the eye was prepped and draped in the routine sterile ophthalmic manner, and a superior fornix-based flap was made.  Hemostasis was obtained with diathermy, and a 3.5-mm incision was made at the superior surgical limbus using a 69 Beaver blade, then dissected into clear cornea using a beveled-down crescent knife.  A stab incision was made at approximately one o'clock with an eye knife.  A 2.5-mm keratome was placed through the superior incision in a three-plane fashion and Viscoat was instilled into the anterior chamber.  An anterior capsulotomy was begun with a bent 27-gauge needle, and continued with capsulotomy forceps.  Hydrodissection and hydrodelineation were carried out and the nucleus was rotated within the capsular bag to make sure it was loose.  The phacoemulsification handpiece was placed in the eye using a 30-degree tip, and cortical material on top of the nucleus was removed.  A central groove was made in the nucleus and the nucleus cracked into two halves using a cyclodialysis spatula and the phacoemulsification tip.  The phacoemulsification tip was buried into one of the halves of the nucleus and a Rosen hook was used to divide the nucleus into small pieces, and was emulsified in the iris plane and in the posterior chamber.  The second half of the nucleus was done in like fashion.  Epinucleus was removed using the phacoemulsification tip, and cortical material was cleaned up using a 3-mm I-A tip.  The posterior capsule was polished with a Terry squeegee.  Viscoat was instilled into the anterior chamber and into the capsular bag.  The superior wound was opened using the keratome to its full 3.5-mm width, and the intraocular lens was placed in the eye and into the capsular bag using folding forceps.  Miostat was instilled into the eye to loosen the Viscoat from the angle, and the Viscoat was removed using the 3-mm I-A tip.  Miostat was instilled into the eye through the stab incision and the cornea in the stab incision was hydrated.  The wound was checked for leaks with a fluorescein strip while pressure was applied.  Once the eye was normal pressure and no leaks were seen, the conjunctiva was closed with wetfield cautery.  Maxitrol ointment was applied and the patient was taken to recovery in good condition.