Blumenthal technique @ SN
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Transcript of Blumenthal technique @ SN
![Page 1: Blumenthal technique @ SN](https://reader034.fdocument.pub/reader034/viewer/2022052413/55a46e681a28ab22778b47eb/html5/thumbnails/1.jpg)
![Page 2: Blumenthal technique @ SN](https://reader034.fdocument.pub/reader034/viewer/2022052413/55a46e681a28ab22778b47eb/html5/thumbnails/2.jpg)
• Aka mini nuc tech…for mini nucleus outcome
![Page 3: Blumenthal technique @ SN](https://reader034.fdocument.pub/reader034/viewer/2022052413/55a46e681a28ab22778b47eb/html5/thumbnails/3.jpg)
• local anesthesia
• fornix-based flap (1mm conj)
• 5.5-mm partial thickness scleral incision with 1.5-mm backward cuts at each end was initiated 1.5-mm posterior to the limbus
![Page 4: Blumenthal technique @ SN](https://reader034.fdocument.pub/reader034/viewer/2022052413/55a46e681a28ab22778b47eb/html5/thumbnails/4.jpg)
• The tunnel was fashioned with a crescent blade; the incision usually extends approximately 2 to 2.5 mm into the cornea
• Dissection on both sides to create a funnel-shaped “pocket”.
![Page 5: Blumenthal technique @ SN](https://reader034.fdocument.pub/reader034/viewer/2022052413/55a46e681a28ab22778b47eb/html5/thumbnails/5.jpg)
• The blade was then angled to cut backwards so as to incorporate the backward cuts into the pocket permits extraction of most nuclei
![Page 6: Blumenthal technique @ SN](https://reader034.fdocument.pub/reader034/viewer/2022052413/55a46e681a28ab22778b47eb/html5/thumbnails/6.jpg)
• Visco-elastic into the anterior chamber through a paracentesis
• CCC was performed through the paracentesis using a cystitome.
• Complication : relaxing incisions in small CCC , because of fluidics can extend completely – PCR. Avoided by converting it into beer can opener
![Page 7: Blumenthal technique @ SN](https://reader034.fdocument.pub/reader034/viewer/2022052413/55a46e681a28ab22778b47eb/html5/thumbnails/7.jpg)
• MVR is used to make a 1-mm entry into the anterior chamber in clear cornea through the bed of the tunnel under the scleral flap at the inferior limbus
• An anterior chamber maintainer connected to a bottle of irrigating fluid was inserted through an additional paracentesis
![Page 8: Blumenthal technique @ SN](https://reader034.fdocument.pub/reader034/viewer/2022052413/55a46e681a28ab22778b47eb/html5/thumbnails/8.jpg)
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![Page 10: Blumenthal technique @ SN](https://reader034.fdocument.pub/reader034/viewer/2022052413/55a46e681a28ab22778b47eb/html5/thumbnails/10.jpg)
• Complication : if ACM is not completely inside A/C and flow is started it can l/t DMD , altering visibility and hence surgical outcome
• Prevented by keeping ACM OFF while insertion + end of ACM atleast 1mm beyond Descemet membrane
• Rx : full chamber air bubble at the end of surgery
![Page 11: Blumenthal technique @ SN](https://reader034.fdocument.pub/reader034/viewer/2022052413/55a46e681a28ab22778b47eb/html5/thumbnails/11.jpg)
• The anterior chamber was entered with a 2.8-mm Keratome, the internal incision was about 8-9 mm
![Page 12: Blumenthal technique @ SN](https://reader034.fdocument.pub/reader034/viewer/2022052413/55a46e681a28ab22778b47eb/html5/thumbnails/12.jpg)
• Complications :
1. iris prolapse : since ACM is on , if tunnel is not self sealing or keratome entry is not proper
2. Bleeding
• During / at the end of surgery
• Stopped by increasing IOP ( bottle height)
• Continuous flow - No accumulation – no debris – no post op inflammation.
![Page 13: Blumenthal technique @ SN](https://reader034.fdocument.pub/reader034/viewer/2022052413/55a46e681a28ab22778b47eb/html5/thumbnails/13.jpg)
• Hydrodissection was performed inferiorly to prolapse the upper pole of the nucleus into the anterior chamber
• Complication : from side port if hydro done @ 3 / 9 o’clock , canula prevents nucleus to pop out of bag + fluidics from ACM - PCR
![Page 14: Blumenthal technique @ SN](https://reader034.fdocument.pub/reader034/viewer/2022052413/55a46e681a28ab22778b47eb/html5/thumbnails/14.jpg)
• the Blumenthal canula was introduced just under the anterior capsule to the equator between 10 and 12 o’clock
• the canula moved in the same plane toward the pupil and then anteriorly thus manipulating the upper pole of the nucleus into the anterior chamber
![Page 15: Blumenthal technique @ SN](https://reader034.fdocument.pub/reader034/viewer/2022052413/55a46e681a28ab22778b47eb/html5/thumbnails/15.jpg)
PCR + Vit in A/C
• Bimanual vitrectomy
![Page 16: Blumenthal technique @ SN](https://reader034.fdocument.pub/reader034/viewer/2022052413/55a46e681a28ab22778b47eb/html5/thumbnails/16.jpg)
• Presence of ACM reduces fluctuation & turbulence in A/C
• Vitrectome through tunnel – increases fluctuation – more vitreous loss – difficult to perform vitrectomy tunnel + enlarges PCR
![Page 17: Blumenthal technique @ SN](https://reader034.fdocument.pub/reader034/viewer/2022052413/55a46e681a28ab22778b47eb/html5/thumbnails/17.jpg)
• Sheet glide was then inserted between the nucleus and the posterior capsule and the nucleus was extracted
![Page 18: Blumenthal technique @ SN](https://reader034.fdocument.pub/reader034/viewer/2022052413/55a46e681a28ab22778b47eb/html5/thumbnails/18.jpg)
• cortex extraction with a single port-aspirating canula on a syringe
• A posterior chamber lens (PMMA lens with optic diameter of 6.5 mm) was placed in the bag;
![Page 19: Blumenthal technique @ SN](https://reader034.fdocument.pub/reader034/viewer/2022052413/55a46e681a28ab22778b47eb/html5/thumbnails/19.jpg)
MANUAL ASPIRATION V/S I/A
• CANULA doesn’t affect fluidics, so even if very close to PC, rarely it ll be engaged.
• Simcoe’s / automated I/A does
![Page 20: Blumenthal technique @ SN](https://reader034.fdocument.pub/reader034/viewer/2022052413/55a46e681a28ab22778b47eb/html5/thumbnails/20.jpg)
FLUIDICS
• FLUCTUATION IN A/C DEPTH
• TURBULENCE OF FLUID
• IOP
![Page 21: Blumenthal technique @ SN](https://reader034.fdocument.pub/reader034/viewer/2022052413/55a46e681a28ab22778b47eb/html5/thumbnails/21.jpg)
ADVANTAGES
• PUPIL DILATATION
• FACILITATES RHEXIS
• EXPULSIVE CHOROIDAL H’GE: REDUCE/ ELIMINATE
• CME REDUCED
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