OPERATION IN DETAIL: After informed consent was obtained, the patient was brought to the operating room for phacoemulsification with intraocular lens implantation. The patient’s head was taped in position, and the patient was prepped and draped in a sterile fashion for the procedure. A Lieberman lid speculum was inserted in the left eye.
Using 0.12 forceps and blunt Westcott scissors, an incision was made through the conjunctivae and Tenon’s capsule in the inferonasal fornix, through which 3 mL of 2% lidocaine was injected. A 1.0 mm side-port blade was then used to make a paracentesis wound at the 5 o’clock position on the cornea. Viscoat was injected into the eye through the paracentesis with a 30 gauge cannula to replace the aqueous.
A three-plane clear corneal incision was made at the 1 o’clock position with a 2.75 mm keratome blade. A cystitome was used to create a continuous curvilinear capsulorrhexis on the anterior capsule of the lens. Capsulorrhexis forceps was used to extract the anterior capsule remnant that was created.
Hydrodissection of the lens cortex from the capsular bag was performed with balanced salt solution on a 26 gauge cannula by placing the tip of the cannula under the lip of the anterior capsule at approximately the 10 o’clock position and pushing gently until a fluid wave was seen to flow under the lens.
The cannula was then used to decompress by gentle posterior pressure on the lens. The nucleus was rotated with the cannula, with caution to observe any potential zonular weakness in the highly myopic eye. None was noted. Healon was injected through the clear corneal incision to elevate the Viscoat to the corneal endothelium. A phacoemulsification handpiece was introduced, and a central groove was created in the nucleus.
An Osher instrument was inserted through the paracentesis wound, and the phacoemulsification tip as well as the Osher were used to crack the nucleus in half. The nucleus was then removed by phacoemulsification.
Irrigation and aspiration was then used to remove the remaining cortex from the capsular bag; however, there was hardly any cortical material remaining. No capsule polishing was necessary. Healon was injected to re-inflate the capsular bag and push the posterior capsule back in order to inject an Alcon AcrySof SA60AT +9.0 diopter intraocular lens into the bag.
A Lester manipulator was used to rotate the lens into a central position, and 10-0 nylon suture was preplaced in the clear corneal wound. Irrigation and aspiration was again performed to remove all viscoelastic from the bag by gentle pressure on the intraocular lens at both ends and from the anterior chamber.
Balanced salt solution on a 30 gauge cannula was injected through the paracentesis wound until the eye was felt to be adequately pressurized. The anterior lip of the three-plane corneal incision was positioned properly by injecting balanced salt solution on a 30 gauge cannula into the wound.
The wounds were sealed with balanced salt solution on a 30 gauge cannula by injecting into the corneal stroma on either side of the wounds. The wounds were dried with a Weck-Cel sponge and painted with a fluorescein strip to ensure they were watertight. They proved to be Seidel negative; therefore, the preplaced 10-0 nylon suture was removed as it was not needed. The eyelid speculum was removed and a drop of Betadine and a drop of Alphagan were placed in the eye.
Wet and dry sponges were used to clean the periocular skin. A metal eye shield was taped on the eye and the patient was taken to the recovery room in good condition.
