Invisible Pivot: Tip for Microincision Cataract Surgery- Winner of 2014 APACRS FILM FESTIVAL

The producers have no financial interest in the subject matter of this film Hung-Yuan Lin, Yu-Hsuan Huang, Ya-Jung Chuang, Pi-Jung Lin, Yi-Ching Chang Invisible Pivot Cataract surgeons should be familiar with the technique of continuous curvilinear capsulorhexis However, learning to achieve an adequate capsulorhexis through the smaller clear corneal
incision can be a challenge The devil is in the details, and the
technique is about the concept of Pivot In order to build this concept, we must imagine an invisible pivot point at the center of the clear corneal wound The capsular forceps should be centered
on a fixed pivot point to allow for a wide range of
movement inside the eye without rotating the eyeball and causing distortion of the cornea Practice makes perfect we can master this pivoting technique
with artificial eye models or porcine eyes The most common reaction of the young
surgeon is: Wow, how come the human eye is so much different compared with in the lab? The most common mistake made by young surgeons is to perform cataract surgery by
moving the instrument in a parallel direction instead of using
the pivoting technique The action can cause movement of the eye extensive corneal deformation, coupled
with striae and cause mechanical trauma When we follow the concept of invisible pivot the edge should not be pushed to avoid distortion rotation or injuries The point is, a true human eye will be rotatable during the operation How about a ROTATABLE eye model? Now using a compasses draw 3.5 mm circle radius on a ping pong ball Cut a hole then polish the edge The hole should be 7 to 8 mm Using a pin drill two small holes next to the wound The distance between the two holes is
2.75 mm Cut the end off of a staple Bend the staple into a U shape about 2.75 mm wide Let’s try it! Cut a cross into the other side of the
ping pong ball Insert a rubber band into the cross Put the ping pong ball into the patient
interface cone that is used in LASIK Fix the rubber band with tape giving it suitable tension Test the bounding force of the eye model Then place the eye model in a toothbrush holder Cut a 1.5 cm square from a candy wrapper This will function as the anterior capsule Put some tape on the eye model then cut around the edge of the hole Take off the tape Put the candy wrapper on top of the tape Carefully put the tape back over the hole and insert the U shape staple You can use CCC forceps to perform
capsulorhexis Now, you’ve got your very own rotatable eye model! This freely rotatable eye model not only simulates the movement of the
eyeball while receiving force which can not be reflected by artificial or porcine eyes In addition to that it can also provided an easy, cheap and repeatable way for young surgeons to practice After using the rotatable eye model,
practice repeatedly Although the pivot concept is difficult The young surgeon can finally realize what it means You can obviously see the difference
between with and without pivot concept Without the pivot concept any forceful pushing of the forceps within the eye by beginning surgeons would cause the eye to move away from primary gaze With the pivot concept we can keep the eye in the primary
position while performing CCC You can obviously see the difference
between with and without pivot concept Compared to a young surgeon, an expert
can manipulate a precise CCC without pulling or distorting the
patient’s eyeball In fact, the pivoting technique
demonstrates excellent maneuverability in not only capsulorhexis but also phaco probes and I/A tips A burst of heat by ultrasonic energy can burn the cornea within seconds With the pivot concept during manipulation of the phaco probe BSS stream can cool down the heat produced by the phaco tips The concept of invisible pivot is critical to microincision cataract surgery It can avoid corneal distortion,
stabilize the surgical field and most importantly, achieve a well
centered optimally sized and round enough
capsulorhexis through a smaller incision In this video, we provide a step-by-step
assembly guide for a freely rotatable eye model Its components are very common, its price
is quite low and you can definitely do it yourself with the rotatable eye model and invisible pivot concept you can practice anywhere Capsulorhexis in microincision cataract surgery won’t be the rock in the road ever again! Invisible Pivot

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