Microincisions must prevent leakage insofar as possible and enable easy introduction of the instruments to be used. However, the narrower the incisions, the less room for movement for the instruments, which slightly complicates the surgery and causes real difficulties when transitioning to bimanual phaco. Choosing phaco must therefore be a careful and well thought out decision insofar as one of the two incisions will necessarily be made with the non-dominant hand, which involves a short learning curve.
The width of the incision must be perfectly adapted to the instruments used by the surgeon to prevent tensions and deformation of the incision while continuing to prevent leakage. This will therefore be a determining factor in the selection of the knives to be used in performing the surgery. In fact, an incision that is too big will increase leaks and perioperative chamber instability, which can cause capsular rupture. Conversely, an incision that is too small will cause a deformation of the cornea and reduce visibility during the procedure. Stretching wound edges during surgery often results in poor leakage prevention at the end of the procedure.
Most of the bimanual phaco instruments currently in use have a diameter of 20 G (as mentioned in the chapter on the choice of instruments) and in our experience are easily manoeuvred through a 1.2 mm incision while making it possible to maintain good stability in the anterior chamber. Instruments with a 19 G calibre can more easily be introduced through a 1.4 mm incision. Therefore, two tunnelled incisions of 1.2 mm or 1.4 mm in breadth and 1.5 mm in length are performed with a precalibrated knife in the superior and inferior temporal area by a surgeon situated temporally, or supernasally and temporally for a surgeon situated in a cephalade position. The incisions are performed in the limbus in a clear cornea, in a direct or stepped fashion. Precalibrated knife tunnelling is carried out at a 45° angle to the corneal plane, parallel to the plane of the iris.
The depth of tunnelling is very important. After a short corneal pre-incision carried out with the tip of the precalibrated knife directed downward, the corneal tunnel should be placed at a sufficient depth within the corneal layers to prevent the roof of the incision from losing its shape during the procedure or implantation and not resulting in leakage at the end of the procedure.
The length of the tunnel will determine the shape of the incision and its characteristics in terms of deformation, resistance and instrument mobility.
The square shape, with length equalling breadth, has self-sealing and trauma resistant properties known since the work of Paul Ernest in 1991. The inconvenient aspect is the limited manoeuvrability of instruments that often results in deformed edges in these square incisions. They can be performed with the Clearcut Side Port instrument range.
In making a rectangular incision it is recommended to avoid tunnels of insufficient length, which can cause the inclusion of a hernia of the iris in their edges during surgery, with decreased post-operative resistance and the persistence of Seidel-positive results due to the lack of a valve effect.
Ideally, the incision should have a trapezoidal shape with an endothelial corneal incision of 1.2 mm and an external limbic base of 1.4 mm. Trapezoidal incisions improve instrument mobility while eliminating leakage. For this use I would recommend the disposable Duet® 1.2 – 1.4 mm knife. Its upward bevelled-edge blade has two reference marks to facilitate the incision. The distal point corresponds to the internal 1.4 mm incision and the point nearer the handle to the external 1.6 mm incision, the distance between these two points being 1.5 mm.
At the end of the procedure, absence of leakage from the incision must routinely be verified by placing a triangular sponge on the external edge of the microincisions. To facilitate coaptation of the incision valve, hydration of the corneal stroma by BSS® injection with a Rycroft canula into the lateral wound edges will promote post-operative leakage prevention.
Performing these two corneal microincisions separated by a 90° angle does not induce astigmatism, as has been evidenced by pre- and post-operative corneal topographs from patients having benefited from ultrathin implants.
Mothers-to-be whose skin tone is great and elastic either due to the fact of heredity or due to the fact they have maintained years of healthy nutrition and positive exercise habits might go through one or more pregnancies without any striations. Others, by keeping weight gain gradual, moderate and steady may well be able to minimize and possibly stop stretch marks.
These are essentially scars that are formed underneath your skin due to tearing on the dermis layer. These scars are mainly caused due to pregnancy, bodybuilding, and weight gain. It could be a great idea to cover up these stretch marks with make-up . You’ll be able to effortlessly hide these lines with some smart concealers.
Stretch marks are scars which are produced on the skin mostly on account of pregnancy and childbirth. These are present as lighter lines of the skin, having a whitish hue. Though stretch marks are generally associated with pregnancy and childbirth, it really is not in fact true. Stretch marks may also occur on account of obesity, excessive physical labor involving a particular part of the skin, bodybuilding, pubertal adjustments, dieting, etc. Stretch marks are called as striae distensae medically. Nevertheless bad they may appear, stretch marks are usually a cosmetic problem and they’ve no repercussions on the well being of the person.
Many people know that stretch marks are a widespread cosmetic issue encountered usually by pregnant females and body builders, due to the rapid change in body shape which are associated with both these body changing situations. Nevertheless, stretch marks are also something that is commonly encountered during puberty by both boys and girls, and they can cause a whole lot of anguish and poor body image.