1. IN THE NAME MY GOD 1

2. Phacoemulsification in long and short eyes Dr. memarzadeh MD 1387/11/30 1387-11-30 Dr memarzadeh MD ophthalmologist 2

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5. Features of long axial length eyes relating to phacoemulsifcation 1.Deep AC 2.More mobility of lens 3.Zonular laxity 4.More liquefied vitreous 5.Thin sclera 6.Younger age onset cataract 7.The degree of maturity of cataract on SLE examination dose not commensurates with the visual loss 5

6. preoperation evaluations 1.Careful SLE and fundus examination specially for macula and peripheral retinal breaks, holes, sever atrophic changes, CNV. 2. In doubtful situations PVA testing may helps 6

7. Myopic retina 7

8. Pre op examination cont… IOL power calculation: 1.Long axial length and posterior stapyhloma are of important sources of miss calculation. 2. Both A scan and B scan should be done concurrently to obtain the axial length from exact foveal fixation point. 3. The best formulas are SRK T and Holladay. 8

9. ...Intra operative considerations Anesthesia: Topical anesthesia is performed to decrease the risk of glob laceration but be aware that myopes are more photophobic and so less cooperative there by periocular anesthesia can be another option but be careful of globe laceration. 9

10. Intra operative cont… Wound constriction: Large tunnel incision causes corneal distortion which blurs visibility, hence shorter clear corneal incision (1.5 mm) is preferred. Capsulorhexis: The size of rhexis should be just smaller than optic diameter to minimize PCO but no too small to interfere the view of peripheral retina. 10

11. Intra operative cont… Hydrodisection: Because many myope patients are young there is tenacious corticocapsular adhesions therefore you may need inject multiple small volumes of BSS at various places. 11

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13. Intra operative cont… Nuclear emulsification: 1. As myopes have fragile zonula, liquefied vitreous, thin sclera, instruction of probe exerts a sudden positive pressure that pushes the iris peripherally and deepens the AC (breathing pupil phenomena) adjustment of bottle height or positive air pressure can minimize the problem. 2. Kelman bent needle is preferred because allows better approach without additional corneal distortion. 3. The maturity of cataract can be assessed deceptively soft in SLE hence increments of power is required to minimize stress on zonula and capsule. 13

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16. ضمن عرض پوزش بدلیل حجم بالای LECTUER ادامه اسلاید ها امکان پذیر نمیباشد در صورت نیاز به ادامه لطفا به واحد سمعی و بصری مرکز آموزشی درمانی فیض مراجعه و یا با شماره تلفن 03114476010 داخلی 392 تماس حاصل نمائید با تشکر