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Hi guys, we are going to do a femtosecond laser on a cataract
we're going to perform it with the victus equipment from the Germany manufacturer Bausch and Lomb
these are the parameters we are going to use, the pattern we will use
we will make a 5 millimiters capsulotomy
we will make 4 radial, as we see here, of 6.5 millimeters in length
and 3 circular with the larger diameter of 3 millimiters
these is the pattern that we usually do the cataract
however, we can vary it according to the hardness of the lens
when the cataract is very hard, we make a larger circular diameter to have smaller quadrants, we take out first the bigger central and give a space to take out this hard cataracts
we already have with this equipment since July 2012 and we have gained enough experience doing cataract
we are doing almost all types of cataracts, hard cataracts, white cataracts, normal cataracts and congenital cataracts with very good results
ok,let see what Ricardo said to the patient to prepare for the femtosecond
Mr Augusto, we will do to you the laser procedure, it last about 3 minutes, it is very important during this time you be relax, do not move
it's very important not move your head, I will put you an apparatus in your eyes, you will fell a litter pressure, not pain just litter pressure
I will show you a light and we will star the procedure, it's important do not move and do not move your head
keep your vision right to the center, I going to put you the apparatus, at the beginning a little uncomfortable maybe
look a litter bit down, a litter bit more down, a litter bit to the right, ok, there, there, easy
adequate suction
ok, look a the light you have in front
you going to fill a clip, easy
this is the only equipment in this moment that is dual, it's works in both cataracts and corneas, in cornea we can do corneal transplant, intracorneals rings, the lasiks flaps
and in cataracts it's works,hard cataracts, soft cataract, white cataracts, black cataracts
this the only equipment that's works with an OCT with high resolution that works all the time, it's a real time OCT
it's not like the other equipment taking a photo in the preoperatory fase, this works both in the preoperatory and during the surgery and bringing us greater security this way
another thing is that it's works with a sensor to not create a lot of pressure and the patient has no discomfort
here you can see that the capsulotomy is ready and know it will work in the nucleus
here you can see doing the nucleus cuts
know we are going to proceed whit the corneals incisions
looks at here how the capsulotomy is completely free
know we are doing the corneals incisions, look here how is cutting the cornea and how are separating completely
ok, here we see the corneal incisions and the patterns of cuts we maked
we did a capsulotomy of 5 mm, in the nucleus we did 3 circulars cuts of 0.5, 2 and 3 mm
and 4 radials cuts of 6.5 mm, 1.5 beyond the capsulotomy
here we are going to do an expression of the capsulotomy
sometimes we do this way and sometimes aspirated it with the phaco tips
first, we emulsify the central circle that is cute also by the radials cut in many pieces
small pieces of nucleus that they don't need to much ultrasound
this is in order to create a central space where we can bring the quadrants
know, we proceed to separated the radials cuts
looks, how the bubbles coming out from behind the nucleus
by the accumulation of bubbles by the effect produced by the laser
we likes to be sure that they are very well separated
to start bring the quadrants to the center space that we made
this is why in the phacoemulsification we make spaces, to go bringing the pieces of nucleus to this empty spaces we have made
here we emulsify the first quadrant
and them move this second quadrant to the free space and them bring it to the center space we had create to emulsify it
equally we do the same with this quadrant, we move it forward where the is the space and emulsify it
and the last quadrant we move it forward where there is nothing and also emulsify it
them we proceed to aspirate the cortex, we don't do hydrodissection that we usually do in regular phaco
and we have no problem aspirating the cortex
we always use this silicone tips that are very friendly with the capsule
and is very difficult to hard the capsule
the we proceed to aspirate the posterior capsule, trying not ditritos remain
equally we like to aspirate the anterior capsule and everything is properly cleaned
in this case we use a restor +2.50
we always aspirate behind the lens
and them in front
one of the greatest advantages of this technique is that always the lens is very well centered
something that we will not ever achieve manually but with these femtosecond equipment