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Hello. I don't know if anyone can hear me. I don't know if anyone can hear me. Okay. All right. Uh, had quite a delay. It's I've been a challenge setting up this system, so we didn't everybody. My name is Doctor David Ogbonnaya. I'm a senior resident with the Eye Foundation Hospital. Good Nigeria. So the topic. I'll be taking this cataract surgical techniques and I'll take it in this outline introduction, The history of cataract surgery, the pre op assessment of a patient who you wanted to catch up surgery for the steps of the surgical techniques. I'll describe including the e, C, C or achy, as some people call it, the physical and modification, this monetization cataract surgery. And then we tried to compare those techniques and conclude my objectives. Objectives in this lecture is to outline the historical development of cataract surgery and describe the common techniques of cataract surgery and compared advantages and disadvantages of the different techniques. It's an introduction. I would say that the eyeball is the organ of sight, of which many structures help with in the eye helping focusing images on the retina. One of these important structures is the human lands. As we know, cataract is a pathological condition in which the length of the eyes become a pacified, causing changes in vision that may include blurriness, color changes, halos around light, and that is worst blindness. It has plenty risk factors and causes, but the commonest is due to aging. And as of 2020 the reported incidents worldwide was about 94 million. We expect this to include us. Uh um, factors. Socioeconomic factors of people get better. People live longer. You expect that people age more and add to the pool so it's a topical condition is a topic of public health and chest. This is a picture showing a normal undilated eye. It's an eye with a dense cataract that precludes, uh, passage of light to the to eliminate the back of the eye. So I'll go through the historical development of cataracts surgery, and I'll start with couching, and I'll say that one of it's one of the earliest surgical interventions for cataracts dating as early as the fifth century BC, and it's coin from a French word culture you need to put to bed. And this method, the sharp needle is used to pierce the I near the Limbaugh's until the provider, the culture is able to dislodge the contract. It's dislodged, typically backwards, towards the vitro's chamber, out of the visual access. How, um however, in most of the places where it's still practiced, it's done in a very in antiseptic condition, and it's quite rough. Hence the resulting poor outcomes. Some of the common complications include secondary glaucoma, hyphema end of to might ease, and these often results to blindness. Unfortunately, northern Nigeria and some other West African countries have the highest, uh, reports of couching still happening in their societies, and the reason it's still prevalent is mostly of factors, including some of those places are unfamiliar with modern procedures. There's a general fear of surgery, and the cultures are still preferred because they have earned the trust of the people. So I'll attempt to play a video that was uploaded by doctor professor Dr Hans Ryan, hard coach in conjunction with Doctor Mahmoud Abdu Ramin of Nigeria at the title observations in Nigeria. I think this was taking, uh, yeah, yeah, okay, so I've been told that the audio isn't showing. So this is a a video showing the couch done by a culture in northern Nigeria and the person, as shown earlier, dislodge the contract. And then, uh, the patient at least can count fingers. So, yeah, the history of extract capsular contract extraction. While many historically where many used the coaching technique, they're still texts as early as 600 BC document The use of a primitive extracapsular, uh, cataract extraction X E And these, uh, manuscripts belong to a famed Indian surgeon called So So Shooter. I tried to find his picture. He has a statue dedicated to him in India. On the top left hand corner of the screen, there's a statue. And, uh, for centuries, there was a huge lag from then, in terms of documented surgical procedures for cataract surgery until in 1917 47 where a French surgeon called UH, Je D V L documented, he's a series of achy, and he's described as created as father of modern cataract surgeon. He would he would make uh, a large Konya wound of greater than 10 millimeters with a corneal knife. Then he would use a block needle to puncture the lens capsule and extract the lens using a spatula and the cure it. He used post operative dressings, uh, which were cotton soaked and wine. Two part the eye and the patient was made to line in a darkened room for a few days, even though this was a great advancement advancement from the couching, as we even saw in the video, he had significant complications like posture. Capsule of classifications retained lens matter, POSTOP infections. But it was a significant development where the whole the capsule was brought out of the eye instead of being pushed behind. Then, in a few years after, within at least the next six years 1917 53 a London surgeon by the name of Shamma Samuel Sharp documented the earliest, uh, the documented form of the ICC, the Intracapsular contract extraction. And he tried to Do you have various variations, uh, that we had mentioned, but essentially all of them required lies in the Zoom HLA support of the of the of the lens and extracting the lens, the lens back complex, wholesome through a large limb balance Asian. Obviously this modification came about because when the extracapsular extraction, as documented by uh, Mr DVU, was done because of the retained capsule there were plenty, uh, capsular or pacification post surgery. So this was like an improvement because the whole bag complex bag lens complex came came out through a large limbal decision. The issues they had were because the capsule was a barrier between the anti and posterior chamber is remove our costs vitreous prolapse and subsequent retinal detachments, among other complications. Furthermore, removing the lens and capsule in one piece needed a very large incision, resulting in longer healing times and higher infection rates. So after a few years, it wasn't exactly very popular again. A very significant, um, a very, very significant event in the 20th century that improved the, uh, the cataract surgery that was done was the introduction of intraocular lens. And this was, uh, something that wasn't, you know, planned for originally Sosa. Harold Really, who was managing a lot of Air Force pilots, especially those um, involved in the Battle of Britain. He had a patient and he had the patient. I think the patient had multiple surgeries with him, and he noticed that the patient had a lot of, uh, actually series of patient's, and they had shrapnels lodged in the eyes. Some had pure glass. Some had a kind of plastic, and I realized that those from who had ocular trauma with plastic retained in the I had almost no inflammation. As through that he would expect why those who had glass had a lot of inflammation in the eye. So he opined that a certain kind of glass would not be wouldn't elicit inflammation in the eye. And in collaboration with the plastics division of Imperial, uh, Imperial Chemical Industries, it developed the first i o l middle of, uh, Lomotil polymethyl methacrylate. And and this is where many used in airplanes at a time. So he's credited to perform the first i I l oppression at Saint Thomas Hospital in 1949 in London, a very significant event, Also less than 10 years after, was that done by Charles Kellman, American ophthalmologist, that invented the fickle emulsification, or tentatively called fecal? It was an alternative approach to the where the the entire new close is removed from the eye without making as large as a decision done in the conventional IPCC. So he said that he could make it 3 to 4 millimeter incision. He produced an ultrasound, uh, probe which helped him in Morse If I and break down the lens, uh, nucleus and aspirated while inside the I. This was a revolution and cut truck surgery In 1972 the Opthalmic viscal surgical devices enter the scene, and it also improved cataract surgery because he helped to maintain the intraocular space, preventing deflation of the globe and protecting the structures within the eye. Then, in 1978 Kaizu implanted, the first affordable I o l made a made of silicon. And this this helped the 3 to 4 millimeter incision made earlier by Charles Kellman made it even smaller that you could use two millimeter, 2.53 millimeter incisions and with affordable I o l you could pass through and, uh, inject the, uh I o L into the eye. And this led to faster healing and fewer infections. So, um um, so the progress of the world from 7. 17 mid 17 hundreds up to them for, like, 200 years out to the mid, uh, 19 hundreds, it moved very quickly, as as opposed to the previous 2500 years, you know, but and this was moving on the the world. The cataract surgeons are effective. Surgeons are moving towards trying to make, uh, faecal more available better fickle machines and and, you know, penetrate the world. But a very simple thing happened in the turn of the century. In 1990 Man called Santic, Santa Cruz, you is from Nepal. While working in the POL, he described a procedure that, initially seven years prior, had been described by a man called Blumenthal in 92 it described as an alternative to the E. C. C. He thought that one could make this clearer decision and through that clearly incision enter into the anterior chamber and and perform the conventional E. C. C. The advantage was that it was self sealing, so he he could make a decision that wasn't as small as the fake whole, but not as large as the conventional E. C. C E. And this. This helped the wound to self seal. The way the wound was created helped it to self see. There was there was no need for futures, and there was no need for bulky equipment that the faecal required. And this has so revolutionized the practice of cataract surgery in the developing world and, uh, most places, especially in sub Saharan Africa, practice the Manus small incision Cataract surgery. So we credit Mr Sandhu route, uh, to that wonderful invention and technique. He's still very active in the till. Till Ganga I center in Kathmandu, Nepal. He he has formed a company that is, after he's greater to have done over 100 80,000 cataract surgeries and his his company is involved in making cheaper I o l's and, uh, making it more available and accessible to, uh, two places with lower socioeconomic, uh, indices, countries developing and undeveloped countries. So this I've just run through the history I intentionally left things like laser Fanta second laser assisted, uh, cataract surgery because, um, it's not as well practice. They don't know the the Nana Laser Cataract surgery is just like the fake. Oh, it's just that use laser technology, Nana, laser technology and the development is in the last less than 10 years. So I would I would want to focus on those that are practiced more within our environment. So the pre op assessment of a patient who is to undergo cataract surgery starts with the history. Look at the ocular complaints usually reduce the blood vision over. You know, uh, while usually not accurate except a process of caps like a track that can cause Claire usually altered contract sensitivity, they can be altered color. Even They can be monocular diplopia double vision in one eye. If it's significant and it's splitting the images, you it's important to ask for the ocular history, including history of trauma. I can make the zones unstable, including history of, uh, previous surgery, whether I, uh, previous eye surgery the and previous history of uveitis because of the POSTOP inflammation that is required. Uh, previous history of glaucoma, retinal vein occlusion is things basically that would make posts, uh, up healing from cataract surgery. Worse. You know, one of the most difficult situations to be in is we have, uh, patient's that come towards from sub Saharan Africa. Uh, perhaps poor, not our means. And you're not seen, and you see a very large contract and you have you remove them and the person's vision doesn't improve. It's usually like, uh, puts puts you in a very bad state to say you're not competent, so it's very important to do a very good pre op assessment of the patient who you'd want to, uh, do the cataract surgery, for it's important to take the medical history, including history of dammit, diabetes, hypertension? Um, COPD. Because that can. You can have a patient with a positive pressure while on the table and you can have explosive hemorrhage, and that is a horrible thing to have on the table. It's important to know whether the patient, uh, has infections like HIV hepatitis. Obviously, we routinely screen for those most places who routinely screen for those, even sarcoid. Those is because of the inflammation that you expect there are important things to look out for. It's important to ask for factors that will make, uh, cataract surgery difficult issue of claustrophobia. This is also important in the choice of anesthesia. You would you would use issue of cost claustrophobia, restless legs in, uh, syndrome. When the patient is always kicking and can stay together, those with a D, H, D and other, uh, attention deficits Patient's with head trauma. Tremors like Parkinson patient's or patient's with other musculoskeletal disorders is important to find out before you meet, uh, surgical surprise. Even language barriers are important and history of deafness. If you have someone with language barriers, you have deafness. Do it general anesthesia. And so you don't have to tell the patient to move and you're having issues on the table. Obviously, when screening is important to do a general and systemic examination you're looking at for things you know, like you've listed in the history, evidence of them on examination. Your ocular history starts with your visual acuity and you look through do refraction. You attempt a refraction, you do a little exam. Looking out for past evidence of infections, the varieties or, uh, you know, uh, prevent accumulation anywhere. It's important to find out, you know, with the better techniques. Now they're not. These are not as emphasized when the ICC was more prevalent. Some patient's who talk about being kept in the hospital a week before they would dream their lashes. They will, uh, you know, give them very intense pre op antibiotics and all that. But even with better techniques is important to rule out anything that will cause the POSTOP infection and end of dermatitis well done until and push your segment exam. We'll do. We'll actually, when you have you're not able to see the back of the eye Some tests that helps you to look and estimate prognosticate whether the patient to improve after cataract surgery include the light projection test. Uh, obviously as describing the books the potential acuity meters which are not very available in, uh, Saharan Africa. Ocular investigations like the ultrasounds can help us look behind the eye. Look, look out for detachments Visual some originally and very importantly, biometric. It's important to estimate the power of the i o l to be insulted. Um, the regular serology complete blood count E s are serum electrolytes here and creating in fasting blood sugar. They're all educated, so I'll just go on to describe I assume that this patient has had whatever anesthesia had was agreed upon, general or or local anesthesia and whatever. If it's local, whatever type was was agreed on very boba. It's obtain on even the intra camera. It's all I assume that has been done, So I will go to describe the three techniques. I'll start with the extracapsular contract extraction because it's still a path with the small incision cataract surgery in sub Saharan Africa as the commonest ones that are done. So I would I would. I would describe both of them first, the first step in an EK EKG is doing the cornea limbal incision, usually superior early, usually greater than oil equal to 10 millimeters. Uh, most people we don't have a caliber measuring, so when you go from 10 o'clock 10 o'clock, hours to two o'clock at 10 o'clock to two o'clock usually is up to, UH, 10 millimeters. Then this gives access to the anterior chamber, the insurance capsule, esteemed to make the the the capsule of the lens more visible. And then there's a capsule at here that is done. Either a capsulorrhexis or a capsulotomy is done to have access to the length nucleus. Then a hydrodissection is done, which is really using fluid to separate the nucleus from the epi nucleus. And usually when that is done, the it's rotated to make sure that it has completely separated. And, uh, usually we look out for a golden ring that shows you that it's all, uh, separated from the AP nucleus. The nucleus is delivered first into the church in, but then out of the eyes through it, can it can be delivered with the use of infected tissue with the use of viscal, uh, stomach viscal device? Or that just the tip of the cannula. Can you know when the when the lens the nucleus is already in the anterior chamber and the wound is adequate when you depress it, usually to rule out, Um, Then the remnant lens matter is irrigated and aspirated out of the eye with the simcoe canola when the L is implanted into the capsular bag. The last step, which is not sacrosanct, is followed like this because some people would put a suture on the wound after removing the nucleus to kind of form the anterior chamber bag and have enough space to put in the i o. L. So I would I would just going to show the videos I have, because it's better to describe them and this list out a list of steps. So this is the corneal incisions. Superior Court realization, you can see is from 10 o'clock to two o'clock, um, being done. So it's having a wide enough decision to go into the eye so that he has not still entering in the church and by still making a decision and then the entrance to the chamber, then with it died at this point. Trypan blue, uh, di, usually under a bubble to protect the endothelium. And then, uh, viscal surgical device is is put in, then a capsule. Oh, regs. This has been done. Usually this is done with the 26 gauge needle, which is usually the, uh, orange colored needle. And it is bent, and the tip is made enough to grab made, uh, turned in to be able to grab the castle. And gradually it here, usually for a key, is six millimeter radius is adequate, or at least try to maybe reach towards the edge of the uh So what's the edge of the poop? You, or at least more than half the distance between the center and the and the popular is dilated. That should be enough. Just a rough estimate. So this is quite adequate has gone around. If one doesn't know how to do it. Capsulorrhexis you can just puncture different and a can opener uh, capsulotomy can be done. Just punch around and, uh, retract them. Now a hydrodissection has been done and is rotated once a leap. Once the lip of the nucleus is done is gradually rotated, rotated into the anterior chamber. You can see it into a tear chamber. Then he's using the corneal scissors to expand the wound to allow for the delivery of the lens out of the eye. So, like I said, it's given the nucleus first from the first incident to your chamber, then secondly, out of the eye. See, it's coming out quite easily. The next will be for this particular surgeon, Ashraf Amir. He put his future three switchers, too, you know, reform the anterior chamber so you will not have a global collapse then. But you can still see that with between these teachers there's enough space. So we do where you have this form and church. Chamber is now irrigating and aspirating the remnant of the lens matter and the epi nucleus. Uh, and they open. It was out of the eye with a simple canola. It's a double barrel canola. Put an irrigation and aspiration port, and it's, uh, very not too difficult to manipulate. At this point, you have a large incision site. There's nothing to do a side pot or a secondary entry because your incision site is is large enough to manipulate all this, uh, has gone. It added a little bit of, uh, viscoat, and the L is inserted when it's inserted. The leading haptic is first inserted under the bag, and then the secondary haptic is it follows suit. It can be rotated now and centred appropriately, and the teachers are reapplied. If most teachers are necessary, you apply. Most people use up to five signatures, but in this case he left three switchers in, and the eye seems to be, well, uh, not leaking feud. It's important to regain any remnant risk a well out of the eye, because it could cost post operative Cornell edema and a rising and chocolate pressure so you can see shining Read. It reflects showing that the the retina is healthy. There are no tears. There's no detachment. I can see you're getting any leftover. The school opthalmic viscal surgical devices out of the eye. It's important to irrigate even behind the lens. Once you have, you have good control. You don't go and cause it here. But when the lenses centered well, you're less scared of having a rent. Um, the antibiotics built into a camera and, uh um, Subconjunctival, uh, injected. And that's the end of the procedure. The spectrum is removed, so that's an example of, uh, and achy. So I'll move on to do to talk about a fickle intensification. Similar steps to the key boats. Peculiar. The peculiar differences are in the incision site. The incision, usually right now is 2 to 3 millimeters wide, and other parts of entries, depending on the surgeons choice, are made to have access when removing the epi nucleus and line strain remnants the once there's entry into the entire chamber, a capsulorrhexis is done just as usual. Hydro hydro dissection and lens rotation. Now the difference between the achy and a faecal is that you don't There's no, uh, delivery of the lens out of the I. T. S m ossified and aspirated right there in in Tripoli and usually most faecal machines. You see defense settings, but if you can, if you defied. If you divide the procedure in 23, you have what we call the nucleus sculpting, which is like making a groove in the nucleus. Uh, the nucleus in the eye and then usually Fico is a by manual device, so the surgeon should be comfortable with both hands. You'll have difficult probe probe and a second divide. The second instrument to help divide all you want to achieve is to crack the lens into smaller, uh, pieces. So you now have the what is called a fecal chop. Usually divide and conquer technique or, uh, there are many other techniques are described. And once it's broken down into smaller, uh, fragments, you now change to the quadrant removal mode on the device that helps to a spirit. Those little, uh, lens fragments removed them out of the eye, Then the regular the additional indication of lens remnants as usual. Then most people would use, uh, affordable i o L and inject it into the capsule. It helps you to maintain the small, uh, Cornell incision, and it's it's very, very, you know, convenient. I've seen some people who don't have a, uh, affordable I are. They now expand their corneal incision and, uh, insert a rigid. Are you well, which I mean, why go through that? If you can just do an E c C. But even at that, you may not make a 10 millimeter precision. You can still have, like a five millimeter at the most six millimeter incision, which is still cosmetically better than the key. Then usually the Kenya wound is sealed by hydration. So which means that you don't need the future to make the I sealed. So this is a video of a focal notification taken from Prisma eye care hospitals, India. So this is an incision, uh, side, part decision. And then you can see the main incision is a 2.5 millimeter clear corneal incision and and enter into the anterior chamber. Then he injected the fiscal device into the eye. Next, you will do a capsule rent is it didn't stain. But, I mean, the ritual nation gives enough view to see the capsule as it's been taken out, so you can see it. The capsule the capsular exist is smaller for the fickle. We don't need the red white capsule. It's advantageous in stopping, uh, a postal capsule opacity from happening from occurring. So usually it 42 for millimeter red use of, uh, capsulo Rex. This is important. Just colloquial. You can see halfway point between the center of the of the nucleus and the edge of the deleted PPO that's in, uh, all round Hydrodissection is done. You can see the golden ring of of the nucleus Qassim the golden ring very, very visible and all nice. So now difficult modification begins. You can see the faecal probe, and the second instrument is sculpted is being done right now like grooving the nucleus, the lens nucleus as a sculpting. And then you can see him rotating it and sculpting making like across, which is the divide and conquer, so it's broken into smaller fragments. The aim is to break it into at least four fragments. After this is done, then you know I have the quadrant mover since it's four. So he didn't bother to chop it into pieces adjusted, uh, or giant removal of four quadrants for more programs. That's the fragments that you are produced. So at this point is to aspirate the remnants of the lens nucleus so you can see that the uh fickle probe has been retracted. And then, uh, either is Cinco canola or by manual Aspirational aspiration devices is put, is put in and is moving the epinuclear from the eye at all times. You want to make sure that your red reflects is still intact, that you don't have a detached. I was detached. Retina can see a very nice, uh, caps capsule. Rex is showing, and then the affordable I l is implanted. Once it comes out of the cannula, it spreads across is centered, according the fiscal device is aspirated. And then the wound incision site is hydrated short. You can see the white parts coming out. That's what are entering into the surfaces of into the layers of the corner. Excuse me. Selling its shots. It's, uh, the the cornea edema at those points who live on their own, which is it can be a wonderful technique if done right. So I'll move on to the mana Small incision, Cataract surgery. This is the most common, uh, fastest growing technique being taught across. Uh, training programs has a very, very wonderful outcome because the, uh, stigmatism that results from it is much less than the achy. And it can even be a part with fickle. You've done right. The first step is to make if there is a because the wound is made in the sclera, you have to raise the phonics based conjunctival flap and you cultura eyes the epis Clara vessels that bleed, then creation of a self ceilings, Clara wound and tunnel to eternal from the wound into the anterior chamber. Usually a frown incision is made, and this size of it is usually 5 to 7.5 millimeters in length. It's usually done, uh, 2 to 3.5 millimeters per structure, the cornea limbo. So at my first attempt, I was told, When you get seven limiters, you do. Uh, usually at that time I will do a 3.5 and one on one edge 83 and 3.5. So you have when you join the three edges you have it from. So you get when you, when you measure from the cornea Limbaugh's you go behind actually to it. You do. Seven millimeters long. 3.5 here 33.533 point five When you join them, you have a frown people. Some people do 32.53. Anyone that works for you, uh, is to create an incision, and usually that frown decision neutralizes the astigmatism at that. At that point, that's why it's very, uh, common and helps the self sealing. They won't self seal. Then, uh, you have the entry into. Obviously, it's important when you're making the the going from the sclera towards the cornea to keep it at the plane. When when moving with it, you would feel this clearer. Fibers give way. It feels like thread that is being caught. So you have. It has to be maintained in that plane. If you go posteriorly too deep, you have premature entering today into the entire chamber. Or you have entry into the plus past planner, uh, area. If you go to too superficial, you have a bottom hole created, so you have to just be at that level. Then, when the inter chamber is entered, you have, uh, capsule stain wreck cyst like normal hydrodissection nucleus delivery, just like the achy irrigation of the length matter, just like achy and iron plantation. Just like so, it's really similar to Ikea, except that you make a self sealing scleral incision and, uh, Antonio, so I'll show you video showing the different steps of it. So this is the funny phonics based conjunctiva flap being raised from the Limbaugh's. Surely so it's quite enough wet field country, electoral country. In this case, you can use direct heat to a metal that's still fine. So you can see it from decision being made and then entry. Obviously this person is killed. It's not going even too far away from the limbo. Sit still. Fine. They all subsidies. All you want to have is a self sealing wound. So this is a C entry and expansion of the wound. Then injection of viscoelastic. Next to be is expanding the internal flat, entire leap of this clear out tunnel. Then next to be the capsular exist. Usually the capsule or it eases, made larger, quite larger, just like the key, or even a little bit larger. So was nearing the, uh, edge of the pit pill, then hydrodissection making sure that you see the good the the ring. So once one edge pops out, is rotated incident to your chamber. Very nice. Eaten. Uh, this particular surgeon used vectors two deliver it. Sometimes it's even better not to use the vectors is where for beginning for, uh, surgeons who are starting to learn so that you don't put the vet is posteriorly and cause the rent. Maybe maybe advantages. Re manipulate it until it just collapses. When you depress the inferior leap of the sterile, usually too, it will feel forward and come out if the wound is large enough, so he has removed every epinuclear this can see. The very nice posterior capsule and read reflects the leading haptic of the I'll is is put in. The second haptic is put in is rotated, and the aspiration is done. That's quite a quite a beautiful surgery that has been done. This this. Once you remove, it is self seals. There's no need for to live on hybrid the cornea. There's no need to, UH, which are. There's no need. This particular person even cauterized the condom Tiber, and it seals the opening of the Sclera wound. Oh, nice. So I'll talk about advantages of history and disadvantages for the key. The advantage would include a smaller incision, uh, sized, and the ICC obviously remember that it developed and I see came on board. I think it's a very, very large wound. Actually, it's more than half more than 1 80 degrees wound to be able to remove both the length and let the lens and capsule the whole complex. Uh, he has about 10 millimeters, a little bit more size of incision. Then the advantage of having a capsular bag separating the anterior posture chambers. And, you know, uh, stopping the pull ups of the features forward is there if they won't very large enough for want to manipulate it only the second, uh, side ports and all of those. Its advantages that there's when it once you put the future, you need to come back and remove it at some point. Uh, it has longer recovery times than Faycal and, uh, Manulis politician Contract surgery. There's higher levels of astigmatism. Obviously, at the central areas you have their stigmatism, uh, at those points and the corneal incision sites can leave his car even after it heals for the fecal modification. The advantages include small corneal decision. Uh, it removes the need for C chose and you have smaller post operative astigmatism, the length season modified right there inside the eye. So all the complications that come from manipulating the lens out of it out of the I will not result is not as high as you start. Doing. Cataract surgery is not very easy to you. know, prolapse it all. Whether actually, at the time you start having rents and you know a lot of complications. Usually it's done right in, and all those ones are. Those complications are reduced. The advantages is that it needs a bulky and expensive equipment that needs to be maintained periodically. He has a steep learning curve than, uh, small incision. Cataract surgery in achy. It's not very good for certain complicated contracts, like when you have, uh, fitted contract with cautious I Nicaea. It's not very easy to do a physical when you have, uh, hyper mature contract with a friable, uh, lenses. Not easy to manage to manipulating probe inside when you have other week zonas and shaking when the zones are not very, uh, stable, like in see the explanation or, you know, other big metric glaucomas or uveitis or post trauma. It's not very easy so, and it's not very good for complicated contracts. Uh, the M six is very advantageous because it's self sales. There's no need for structural, so there's no sexual removal. It has lower post operative astigmatism than achy. There's lower cost of care, which is the biggest attraction to patient's because you don't buy heavy equipment, you don't translate those costs. Patient's and they can. You can now plan, you know, huge, uh, programs for patient's that are low cost. And a lot of people can, uh, benefit from it Has a less deep learning cough than fickle. Uh, disadvantages that that side of the sclera is always week example with the patient has a trauma or has a some slap to face or anything. The potential weak spots at those scleral, uh, positions so it can become, even if he doesn't hear. Cannot have an anterior staphyloma coming out at that at that point, which can be very cosmetically, uh, bad. So, uh, actually with even very small color Trona So but that's just about it. The complications of all of them are similar because because that's not a scoop of this, uh, lecture. I'll try not to go dwelling a lot of needs. Uh, and I'll conclude by saying that contract is the leading cost of reversible blindness worldwide and is expected to increase as life expectancy increases and human lives live. Human humans live longer. It's expected that even more contracts to be seen. Um, uh huh um, there's being concept, considerably improvement in the last 300 years, Um, and especially the last 70 years. Improvement in cataract surgery. Like I said, I didn't talk about them to second Liza No, no laser fecal and and so on and so forth that there needs to be more research. There really needs to be more research because a lot still can be done. One of the things that has been researched is non surgical methods of, you know, treating contracts perhaps one day that can come about. But for now, surgery is the mainstay of treatment. Understanding the techniques, uh, and practice can help surgeons make better informed choices when counseling patient's when prognosticating and making a choice as to work procedure is best fitted pre situation of the patient, uh, medical history and all of that. It's very it's very wonderful to, um, it's very, very wonderful to be able to do all so that you can offer all and make a good choice with the patient, even gives a patient more confidence to say Okay, it's not because this is the one you can do, and that's why you're offering this is that this is what is best for me, so I think it's best That is a very, very good, you know, option to have. So I would like to stop here and see that if there are any questions, please type them into the chat box. And, uh, we'll try to handle them. Thank you for listening. Sorry for the breaking transmission in the beginning. And, uh, I think we'll move on from there. Thank you very much. Okay. So, please, if there are any questions, please. Um, type it as a at a chat box. I'll try to handle it as as as much as I can. Okay. Thank you, doctor. Here we go. Christiana says, are there any concentrations for different kinds of intraocular lenses? Yes. That's a whole huge topic on its own. Um, their first of all is, you know, the different types of intraocular lenses. Uh, commonly, we have the p m. It can be classified according to the material it's made of whether it's affordable or unaffordable. And also the things that are put in whether you have it has UV filters, whether it has, um uh, whether it's for just distance or it's try bifocal trifocal multifocal and all of that. So, um, the commonest the the initial one that was done is the P M. M. A problem. A teammate acrylics. They're better materials, better plastics that even are less reactive than the p m m e. Like gold. Gold is very in next chemical in the eye, you know, and, uh, some other other ones. People have described hydrogel once that they had issues of swelling. And, you know, it's either didn't give the POSTOP refraction that was expected. And, uh, development moved from the hydro gels. Just write for the full devils to the silicon silicon. Very, very good right now strive for the affordable type. So I would say that some of the contributions you would have, uh, number one cost. The patient usually wouldn't. Um, cost is a very big thing where we are. So some of them are costly than the others are not as easily sourced as the others. That's the first one. Second is the ones that obviously the, uh, single piece versus three piece. You know, there are some that have less. The square edged ones have better, uh, less complications of post, uh, post stroke capsular opacity than the, uh, normal design. So that's also a concentration, even though they are cost here. Also, the ones that have different focus, like the monofocal regular ones that we use or the trifocal or multifocal. So it's very good. It has a potential. The multifocal has a potential of not given person, not needing glasses if you have, If you get the biometry right and you put it correctly, the pessimist don't need glasses. Uh, going for. However, there's something called this photopsias positive and negative disc photopsias, and it's very, very important to center the multi focus. Make sure it's in the obstacle center because if it's not, there will be the fact the the passage of light through which will be distorted. And the patient will just have a lot of distortion, even a small error. You see, the person will come. You will do monocular, uh, VH especially see in 66 or 69 plus something. But the person just cannot is having. Diplopia is having just uncomfortable sometimes even needs to lead to X planting ex planting the I L. So it's, um, it's It's something you have to consider. Also be how few how how comfortable the surgeon is. If I mean, if you cannot manipulate and center well, why go to do in multifocal putting multifocal lens in? So those are the considerations, the power that you're putting, whether it's affordable or region, whether it's three piece or single piece, whether it's multifocal or monofocal. Uh, if you don't, you can do a mono vision if you're doing If you If you are doing for both category for both eyes, you can do put, uh, want to focus for distance and one from here, and teach the person how to, uh, not new glasses, even though what you lose is tear up sees when you do that. Uh, the next question is, how long is the postal recovery period for each of the techniques? As expected, the Q will have the the key and the manual. Six will have the longer POSTOP recovery for than the politician than the faecal. Um, but it all depends on one. How much of, uh, materials because in the example, if you have, if use minimal, uh, fiscal devices in the eye and you wash it out well, usually and then there are not much manipulations. The intraocular, uh, inflammation will be less, uh, and you have much less inflammation within a few days. Less than a week. Patient is completely fine, Uh, for the actually, because there's incision. Usually you try to bury the sutures, bury the knots, but the person will still feel you know, those things. And it's irritated. So even after the inflammation goes out and, uh, uh, the rednecks goes down person may still be feeling some sensations that may have some times on the average, you say, within the month, person would recover, you know, um, they will put the monitor six in between. It depends on the surgeon. If you do it Well, the self seals. Not much manipulations. Personally, I've seen people within a week, they're back to work. No redness. And, uh, obviously other things include anesthesia you gave. Let's say that you did, uh, a substernal uh uh, block, uh, anesthesia. And you cut some conjunct. I want you to be read. Uh, so that's not the intraocular manipulation, but you cut the conductor. It will heal to have some redness to heal. And that's also it's added in the, uh it's other than the recovery time. So on the average, within a week and a month average and you tell Italy your postop steroids adequately. Okay, so, uh, I purposely didn't go through the complications. It says Time, Please. Briefly mentioned the expected complications in the post operative period. There are plenty complications, even both intra up and POSTOP. I purposely didn't do that because I felt doing that, too. Along gave the lecture, and it's a full lecture POSTOP complications or complications of cataract surgery. Pray up INTRAL. POSTOP POSTOP immediately. You want to have a good contract surgery? A. Um, as you mean that the pre op assessment was correct. Intra up. You didn't have anything going. No surprises, no rent. Nose owner, dialysis. No Irish tears. Know vitrectomy done nothing. No, you did not. Um, I need to add any of that man efficient to your surgery. The expectation is that the things that could happen or normally happen Number one patient Virginia anesthesia looking anesthesia is still there. As it's wearing off, the pain will come. The pin can be a result of one pressure within the globe. The pattern if it's very tight in the eye and then the course that was done so usually will give pain Relief will give, Uh uh. Usually, most places will give Diamox tablets to reduce the pressure. Pre op and POSTOP, apart from pain. Immediate, immediate postop The things that could happen is if someone have seen someone who was coughing after and he flattened his A c said with them on our six. The idea was for it to sell. Sell that kind of thing. You The next day you you go. You examine the person, you'll see it. Prolapsing Iris For that kind of patient, you take the patient in deep in the A C uh, return. But, uh, the position the iris in inside the, uh inside the eye and your future at that point your future because you don't want it to keep upping that at that time it's expected that you should have even done a prep assessment to make sure that, um, the the person they have copied. I've seen some people who you will do everything. It seems like they're just waiting to finish surgery and start every drama they want to start and people go to toilet and strange. So much, So much muscle. Uh, everything is popping up, you know? So those are those are realities on ground then after after then when you come out, usually on the postop you can see issues with the cornea. Small corneal edema. Due to your manipulations, you can see stri in the manipulations. You can fool the plutonium usually within a week with appropriate care. Those ones resolve also things you can see if your if if you see heavy inflammation within 24 hours Hypo P in redness, pain out of pain and inflammation cells and then church in but usually the toxic reaction to something Perhaps you need to do a review of your provident iodine of your you know, your antibiotics, intracameral, antibiotics, your topical antibiotics, something you have to check Very well, usually, Uh, if it's end of term, it is usually starts after eating forms. Or, uh, after surgery, you start having reduced vision, pain, redness, and if you delete, you see that you have the treaties communal. The patient is to be admitted. You need to have obviously we know the end vitrectomy study and the recommendations, uh, that we are, you know, given, so the person is treated adequately as that hopefully one of our patient's, uh have capacity will get the end of. But you should know how to manage them if they do so, uh, usually pre op immediately. Issues of pain explaining how to use the eyedrops, making sure they get their eyedrops, Making sure that, uh, one of my consultants is very, very particular in talking about use our phones. I mean, we go with our phones. So everywhere in the toilet everywhere and people finish and there are people are happy calling congratulating them. Take the phone. You put it on the left. I just take it and you answer like this. You're just introducing everything in the toilet into your eye, so usually tell them, use loudspeaker or just stay off your phones for a few days. People talk about laying a certain side. Yeah, it's important. It's it's it's right, or it's nice if you say you have a right eye, surgery can lay until the left part of your your left side or face up, you know, but with the fake oh, and to an extent, the SEC. Because it's not sealed, you don't because it's sealed. You don't really need any of those So much of those issues of position in, but with the small incision cataract surgery because we expected to self seal. Yes, it needs to be some, um, care it, making sure that you don't have a lot of pressure coming to unseal the wound. That should, uh, self sealed. So, um, those are the conditions you expect have purposely not talked about, you know, delayed things. Or if you had an intro if you had the rent if you had a button hole if you had a premature entry if you had, uh, vigorous prolapse, those ones are complications that would come and they have the weight of managing them. I think it's someone somewhat beyond the scope of a normal regular cataract surgery to E C. C or fecal. Uh, one out of six. So thank you. I don't know if there are any more questions. Uh huh. Okay. All right. So, uh, yeah. Okay. So, uh, do you have thank you very much. So I would like to hear other people to, you know, talk. I really wanted to be here doing the before the electricity, so I will have a few who have a feel of each other at the level I was need to know. That is a mixed crowd. Medical students, residents even, uh, you know, consultants also. So it would have been nice so that, you know, you know how to talk. I was trying not to be so technical in the in the talking box. Um, hopefully he was understood. So please, uh let me see who I know inside. Doctor. Ear ego. Say something. How do I I hope you can talk. It'd be nice to hear somebody else talk. How? Please. How do I invite or can you go to speak?