Dr. Preeti Chaudhary Is Best Sutureless Cataract Surgery In Thakurli, Dombivli ( Insight Eye Care Centre ) I have sound experience in Sutureless Cataract surgeries under topical anaesthesia (without injection). A key issue in converting to sutureless cataract surgery is training. This article first describes the main surgical steps and complications of sutureless cataract extraction and their management.

CONSTRUCTION OF A SELF-SEALING WOUND - A stable, self-sealing wound of appropriate size is the precondition for sutureless cataract extraction. To create a valve-like incision, the tunnel has to be prepared 1 to 2 mm into clear cornea before the anterior chamber (AC) is entered. The required tunnel size can be anticipated by the appearance of the cataract and patient age.Deep brown nuclei in older patients will need very large tunnels, whereas cataracts in younger patients may require incisions just as large as the IOL. Use of sharp instruments and good catching forceps (Paufique or Pierce type) for scleral fixation help to achieve the desired results. In deep set eyes, where the operating field is difficult to access, the tunnel should be prepared temporally or supero-temporally rather than superiorly.

OPENING OF THE ANTERIOR CAPSULE - The anterior capsule can be opened either by capsulotomy or capsulorhexis. Capsulotomies are easy to perform. A capsulorhexis is more difficult, but will guarantee long term IOL centration. Linear capsulotomy: Rarely, an incomplete or oblique capsular tear will result, which makes mobilisation of the nucleus difficult.

HYDRODISSECTION - Hydrodissection separates lens cortex with nucleus from the capsule. In conditions such as posterior polar, traumatic or hypermature cataracts with risk of pre-existing posterior capsular dehiscence, hydrodissection should be avoided. Incomplete hydrodissection Hydrodissection is most effective if the fluid is injected directly under the capsule.

NUCLEUS DELIVERY - A variety of techniques can be used for nucleus delivery (see previous articles in this issue). However, similar complications may be encountered with all these techniques, especially when large nuclei have to be extracted. Small capsulorhexis: The nucleus cannot be tilted or prolapsed out of the capsular bag.