• Aka mini nuc tech…for mini nucleus outcome

• local anesthesia

• fornix-based flap (1mm conj)

• 5.5-mm partial thickness scleral incision with 1.5-mm backward cuts at each end was initiated 1.5-mm posterior to the limbus

• The tunnel was fashioned with a crescent blade; the incision usually extends approximately 2 to 2.5 mm into the cornea

• Dissection on both sides to create a funnel-shaped “pocket”.

• The blade was then angled to cut backwards so as to incorporate the backward cuts into the pocket permits extraction of most nuclei

• Visco-elastic into the anterior chamber through a paracentesis

• CCC was performed through the paracentesis using a cystitome.

• Complication : relaxing incisions in small CCC , because of fluidics can extend completely – PCR. Avoided by converting it into beer can opener

• MVR is used to make a 1-mm entry into the anterior chamber in clear cornea through the bed of the tunnel under the scleral flap at the inferior limbus

• An anterior chamber maintainer connected to a bottle of irrigating fluid was inserted through an additional paracentesis

• Complication : if ACM is not completely inside A/C and flow is started it can l/t DMD , altering visibility and hence surgical outcome

• Prevented by keeping ACM OFF while insertion + end of ACM atleast 1mm beyond Descemet membrane

• Rx : full chamber air bubble at the end of surgery

• The anterior chamber was entered with a 2.8-mm Keratome, the internal incision was about 8-9 mm

• Complications :

1. iris prolapse : since ACM is on , if tunnel is not self sealing or keratome entry is not proper

2. Bleeding

• During / at the end of surgery

• Stopped by increasing IOP ( bottle height)

• Continuous flow - No accumulation – no debris – no post op inflammation.

• Hydrodissection was performed inferiorly to prolapse the upper pole of the nucleus into the anterior chamber

• Complication : from side port if hydro done @ 3 / 9 o’clock , canula prevents nucleus to pop out of bag + fluidics from ACM - PCR

• the Blumenthal canula was introduced just under the anterior capsule to the equator between 10 and 12 o’clock

• the canula moved in the same plane toward the pupil and then anteriorly thus manipulating the upper pole of the nucleus into the anterior chamber

PCR + Vit in A/C

• Bimanual vitrectomy

• Presence of ACM reduces fluctuation & turbulence in A/C

• Vitrectome through tunnel – increases fluctuation – more vitreous loss – difficult to perform vitrectomy tunnel + enlarges PCR

• Sheet glide was then inserted between the nucleus and the posterior capsule and the nucleus was extracted

• cortex extraction with a single port-aspirating canula on a syringe

• A posterior chamber lens (PMMA lens with optic diameter of 6.5 mm) was placed in the bag;

MANUAL ASPIRATION V/S I/A

• CANULA doesn’t affect fluidics, so even if very close to PC, rarely it ll be engaged.

• Simcoe’s / automated I/A does

FLUIDICS

• FLUCTUATION IN A/C DEPTH

• TURBULENCE OF FLUID

• IOP

ADVANTAGES

• PUPIL DILATATION

• FACILITATES RHEXIS

• EXPULSIVE CHOROIDAL H’GE: REDUCE/ ELIMINATE

• CME REDUCED