|
Woodcutter's technique, I think is
very simple procedure & easier even for Phaco beginners.
It is easy to master it with clear corneal incision
as compared with scleral, because approach is direct
in clear corneal incision & manipulations are easy.
The needle can become hot as Phaco is on with tip occluded.
We
may feel that Phaco needle will touch the chopper. But
this will not because nucleus gets fragmented into two
even before you reach up to the chopper. That's why
you will never go up to equator i.e. peripheral soft
part of nucleus.
What
do you do when you feel that woodcutter's technique
is not working up to the mark?
Please note that woodcutter's technique will not work
in very soft nuclei. In this case other procedures are
easier & it is not necessary to go for woodcutter's
-
If the sleeve of Phaco needle is not pulled back
so as to get 1.5 to 2.0 mm of bare area, then Phaco
tip will not be able to penetrate in the depth of
nucleus.
- For
grade IV, hard nuclei, distance between Phaco tip
& sleeve should be more - around 2 mm. Here,
you should not be afraid that you might go deeper
& rupture posterior capsule. This doesn't happen,
because hard nuclei are more than 4 mm in thickness
antero-posteriorly. Sleeve will not allow tip to
go beyond 2mm. So you always have a safety zone
of 2 mm around hard nucleus.
- It
is better to learn with clear corneal incision.
- The
angle of Phaco hand piece should be more vertical
(70 or 80 degrees). There should be good hold of
nucleus before the tip reaches the center of capsulorhexis.
Then only you get enough space to move the tip towards
chopper and get division of nucleus. If you get
hold of nucleus when the tip reaches periphery then
it is difficult to perform this procedure, as there
is no space to move the Phaco tip towards chopper
with Phaco on.
HOW
TO LEARN
[ For Phaco Beginner ]
After
you have mastered sculpting & making partial thickness
groove you can directly start learning woodcutters technique.
This can be better learnt by replacing nucleus in goat's
eye by nucleus from stored eye bank eyes, which are
not useful for keratoplasty. By this you get exact feeling
of having operated on patient's eye. Make main Phaco
and side port incision on goats eye. Then do capsulorhexis.
Make a larger self sealing incision of about 6mm on
goats eye from opposite side. Then push the nucleus
taken out from the eye bank eye through the large incision.
Embed this nucleus in soft cortex of goats eye by passing
through capsulorhexis. Then suture the large incision.
Now learn woodcutter technique on this nucleus. For
that matter you can learn any technique of dividing
nucleus in this way.
[
For Phaco master ]
Follow the steps (see above) in grade three or four
cataract. Do not get disheartened even if you are unable
to do it in first case. The technique shall not do any
harm to the patient's eye even if it fails. Gradually
you shall be master enjoying the fruits of learning
this technique
|
