O vídeo mais acessado do Retina Tips em Junho de 2019 foi sobre um caso de núcleo na cavidade vítrea, compartilhado pela Dra Caroline Oliuza de Salvador – Brasil.

This is a case of dropped nucleus shared by Dr Caroline Oliuza from Salvador – Brazil
One of the most common surgical complication in cataract surgery is the rupture of the posterior capsule of the lens, and eventually, as a result, there may be dislocation of the nucleus or fragments into the vitreous cavity.
There are two options to approach a posterior disloacated nucleus:
You can either use the Fragmatome or, in aphakic eyes, to use Perfluorcarbon liquid to bring the nucleus to the anterior chamber and remove it with the phacoemulsification probe.

In this case the surgeon decided to remove the nucleus using the fragmatome.
So after posterior hyaloid detachment and trim the vitreous base, the surgeon placed PFCL covering the posterior pole to avoid the macular trauma generated by the swirling of the infusion.

Tip#1 – Before inserting the Fragmatome, you can remove the soft fragments (cortex and soft nucleus) with the vitreous probe. To make this step more effective you can decrease the cutting speed to about 350-450 cuts/min.
With the fragmatome you can remove all all hard nucleus.

Tip#2 – It´s important to avoid aspirating the fragments directly with the Fragmatome near the retina. The instrument tip can transfix the material and may inadvertently touch the retina and choroid.

Tip#3 – You can remove the residual material safely using the bimanual technique if a chandelier light is available. Using a soft tip or backflush in one hand, aspirate and bring the fragments away from the retina, and with the other hand, use the Fragmatome to safely remove then.

Caroline Oliuza – Salvador
Filipe Lucatto
Juliana Prazeres
[email protected]