Learn Step by step small incision cataract surgery- scleral tunnel

[@superchargenurse]

ive had both cateracts done in the last month..vision is brilliant

[@mercykoech1487]

Tell me more..my daughter has white substance and the doctor recommends operation..I am scared

[@superchargenurse]

@@mercykoech1487 absolutely nothing to be scared of..operation is weird full of bright light and colours but totally pain free and your vision is pretty much instantly better

[@mercykoech1487]

@@superchargenurse thanks alot..

[@BooksOverKindle]

This is the first video of SICS I've seen after reading the topic and there couldn't be a better one than this. Thank you so much!

[@RashmiKamath1201]

Wow it really helped me understand my textbook

[@IssaNignan]

Thanks

[@coronabibi2092]

Thank you so much for posting this video. I wasn't able to understand the steps at all from the book.

[@hsripathi5888]

Wonderful. Really I got technical knowledge about cataract surgery. Thank you.

[@soniavolpicella4474]

your videos are very good and have a wide message thank you

[@bipulkumar9310]

Sir, beautiful surgery..

[@ThePianoTester]

Amazing video. A few questions: 1. If I make the scleral incision a bit far away, let’s say around 2,5-3,0mm from limbus, I should suture the scleral with how many knots? I ask this because even though you made a scleral incision, you still induced some astigmatism the moment you suture córnea to sclera… 2. Is there a difference between marking the scleral incision like you did, completely straight or inverted (opposite do what you did, like a smile) ? 3. Is the superior rectua bridle really necessary? Many thanks…

[@bhattieyeclinic7176]

The astigmatism you induce depends on multiple factors: Whether you stay within the astigmatic funnel(which I have tried to do with the curved incision), how big your incision is overall and how far away from the limbus you make the incision, and also the integrity of your tunnel(how much you stretch it while removing the nucleus etc If your incision is further away from the limbus you induce less astigmatism(flattening of vertical axis). In my hands the wound compression (resulting in steepening of the vertical axis) by the suture is minimal as the bites are superficial and the gape introduced by the procedure in the long term (resulting in flattening of the vertical axis) is about a dioptre or so because the suture hitches up the tunnel and prevents its gape (flattening of vert axis). If I were not to suture I would probably get about 2 to 2.5 diopters of tunnel gape. Notice I am distinguishing between the short term result (wound compression by the suture) and the long term, say a year down the line, result, when the suture loses its effect (which is always gape- flattening of vertical axis). If you do not suture you always get gape only (long term and short term). A scleral tunnel gapes less than a corneal wound but it ultimately always gapes , nevertheless. By gape here I mean a subclinical stretching and flattening of the wound not an actual physical gape. The bridle suture is not always necessary esp if you do a 2 point retrobulbar injection with more anesthetic injected in the vertical injection, which makes the eyeball turn down slightly.

[@ThePianoTester]

@@bhattieyeclinic7176 Great ant thoughtful reply. Many thanks from Brazil.

[@rakshith_4eal]

hey doctor how to stop myopic progression and treatments for the same and your thought on lens induced myopia and prevention.

[@bhattieyeclinic]

to my knowledge myopic progression till the age of 18 or19 yrs is due to axial length increases because of growth and cannot be stopped. lens induced myopia would occur because of cataract progression in older patients, and would be treated by cataract surgery.

[@rakshith_4eal]

@@bhattieyeclinic do you mean the myopic progression will stop after 19 or what.

[@RashmiKamath1201]

@@rakshith_4eal it will be stable.. that's why contact lens is recommended after 18 yrs

[@ahmedfaahim3787]

​@@RashmiKamath1201What about using atropine drops for myopia progression? Has it good prognosis about myopic patients?

[@MrAniruddha44]

Where do you get 6mm enlarger blade? Can you give name of company?

[@solthetraveler]

can the patient see while this is occurring?

[@bhattieyeclinic]

usually not as the eye is anesthetised

[@pranavtripathi6336]

Sir does manual SICS have any advantages over SICS with phacoemulsification?

[@bhattieyeclinic]

If by SICS with phakoemulsification you mean phakoemulsification with insertion of a PMMA IOL , then there is no real advantage or disadvantage either way between the two techniques. However phakoemulsifcation with a foldable lens gives less surgically induced astigmatism which may be an advantage if there is no preexisting astigmatism or a disadvantage if there is preexisting astigmatism that you hope to correct by appropriate siting of the incision in manual SICS

[@renukarenuka5638]

Thank you doctor....

[@aiswalinggasumenep628]

Asurance cover bpjs

[@utkarshdeshmukh4381]

Wonderful sir 🙏🏻🙏🏻

[@bhattieyeclinic7176]

🙏

[@traumametaphysical7459]

This video is amazing. It helped me so much. Sir, whenever I enter AC and enlarge the main incision, my iris comes out. Could you please explain to me why this happens?

[@bhattieyeclinic]

probably premature entry through tunnel base into anterior chamber. If your scleral lip is intact iris does not usually prolapse.

[@traumametaphysical7459]

@@bhattieyeclinic Thank you so much for letting me know about this error. This helped me a lot really.

[@hanako-kun6902]

Thanks now I can do it in my home lol

[@Azerlems]

Auto She noooooo u can did if u have it only go hospital never home

[@amarjitsinghpatwalia5554]

in ur clear corneal incision . astigmatism

[@bhattieyeclinic]

This is a scleral tunnel . Even after suturing it induces approximately 1 D astigmatism on average. Here I refer not to the final astigmatism but to the surgically induced astigmatism. If the incision was limbal or corneal and sutured with 1 suture the induced astigmatism would be more: say 1.5 to 2 dioptres

[@boentikasingh3414]

But In textbooks they mentioned anterior capsulotomy after internal corneal incision with 3.2 mm keratome. Sir?

[@bhattieyeclinic]

If you first make an entry with a keratome then usually you have to fill the anterior chamber with viscoelastic to do the capsulotomy effectively. Here the capsulotomy is done under aqueous, so it is easier to directly enter the anterior chamber with the capsulotomy needle. The advantage is minimal use of viscoelastic.

[@amarjitsinghpatwalia5554]

sir kindly let me know how much is ur astigmatism

[@bhattieyeclinic]

The ultimate surgically induced astigmatism with a scleral tunnel if you take one stitch, in this technique, is about 1 to 1.5 dioptres of astigmatism (which represents flattening of the vertical meridian by 1 to 1.5 dioptres). This is the surgically induced astigmatism ; the final astigmatism will depend on the presurgical astigmatism plus the surgically induced astigmatism. For example of the patient had 1.5 dioptres with the rule astigmatism preop, the final post surgical astigmatism might be zero

[@rehanashaikh1592]

Interested

[@cherry2k794]

Which microscope is being used sir??

[@bhattieyeclinic]

Zeiss 1 FR

[@toalllove8523]

Good job ...

[@dr.hemathsaini1437]

What is the use of inferior tunnel

[@bhattieyeclinic]

The scleral tunnel is actually superior. This video is of the surgeon's view. The tiny corneal incision infero temporally is to allow the irrigating aspirating cannula easy access to the superior subincisional cortex

[@dibimene9428]

Thank you very much

[@ilhamigination]

thank you doc

[@mohammadbilalmangal6428]

Very nice ♥

[@abhinavsinha8959]

Lower haptic is in sulcus

[@gayatriperi2939]

You didn't bury the knot...but suture is not needed for good tunnel

[@bhattieyeclinic]

The knot is subconjunctival ultimately and therefore doesn't really need to be buried in sclera. The suture ensures that surgically induced astigmatism is limited to about 1 D or so. I have seen unsutured scleral tunnels which seem reasonable well made (of other surgeons of course: I always suture my SICS cases nowadays) with horrendous astigmatism of 4-5 D in some cases. I have also heard the surgeons who made these scleral tunnels claim that they never get astigmatism of more than 1.5 D. Personally, I just want the patient to get a good visual result; and am the most non macho of surgeons.

[@dr.selfimprover5329]

Why u r not doing suction time to time

[@bhattieyeclinic]

generally suction is to be initiated during irrigation aspiration only when cortex is just adjacent to the tip of the I/A cannula. Initially low suction is used to hold and bring the cortex to the centre and hen suction is increased to aspirate the cortex in the mid pupil area which is safer

[@sushantgarade9500]

thanks for this going to try this on my small brother JUST KIDDING

[@benita_sharon_]

Well explined

[@toalllove8523]

This surgery name is SICS...

[@satishbaviskar1169]

osm Doctor

[@moinuddinrajkotwala17]

Wow ,thankyou

[@fluminesesoc]

All those sharp objects near the eye....I know I would be jumping around lol

[@bishnuchetri7569]

Dear...they wont bring devices in front of patients..after lying down of patient n tighten their hands n covering their face only they bring devices..

[@malinivohra2498]

How suture reduce astigmatism

[@bhattieyeclinic7176]

Any sugical wound will gape to a greater or lesser extent (this gape may be subclinical- not noticed on slit lamp) but it will be there and will cause the meridian straddled by the incision to be flatter. Taking a suture reduces but does not completely eliminate this "gape" .

[@maghizhJGR]

Superb

[@Locksmithcreator1]

Sir We are Quality Manufacturer eyes ophthalmic instruments ,and related surgical all accessories

[@wassmmd8521]

Good

[@medicoonline15]

Better than phaco because you do not need to carry a Retina specialist along with you.

[@bigboynoodles8717]

Bro handle it gently you literally just doing it the pain bro that's why do lazer instead of blade👹🐄🐖🐐🍉😨😩😩🤐🤢🤮🤧😱🤯🤒🤕🤭🧐😈👿👹👺💀😷👨‍⚕️

[@AnjaliSharma-fq5hn]

Done under anaesthesia so no pain.

[@sujanbaral4192]

👏

[@jceliasn]

👏👏

[@Azerlems]

Nononono omg no if u do at home u will die

[@anmolxyz871]

I am in class 10 & niw their is a little knowledge for me about catract 😅😅

[@pankajgoswami8415]

Uff you are extremely slow .....and suture is not required .....you did so many opening just for IA and dialing of lense ......not really needed ......

[@bhattieyeclinic]

A smart, fast and hasty surgeon who skips necessary steps is aware that the patient takes all the risks !! Personally I prefer to be slow and meticulous: it makes for happier patients. In my opinion, the single suture makes for much better and consistent refractive results (lesser in amount and more consistent surgically induced astigmatism). Another one of the aphorisms I live by is to make the surgery easy by technique and do it clumsily, rather than make the surgery difficult and try to do it skillfully. The choice of ports for IA is calculated to make access to difficult areas easy, so great skill is not required. All cortex could be removed from the scleral tunnel itself, without an inferior side port, but I am aware, (especially when I teach residents) that the maximum incidence of capsular rupture and dialysis occurs during removal of subincisional cortex, and this is greatly reduced by accessing this cortex from a diametrically opposite and self sealing sideport.

[@prashantnagpure6391]

Very manipulative

[@armanyousefi6143]

Thank you so much