prepared during lens session

1. SUTURE
MATERIALS,NEEDLE TYPES
&OPHTHALMIC
VISCOSURGICAL DEVICES
Bipin Bista
Resident-Ophthalmology

2. INTRODUCTION
• One of the most important steps of cataract surgery.
• Superior and inferior are must for for beginner.
• Biggest achievement is primary position of eyeball .

3. SUPERIOR RECTUS BRIDLE
SUTURE
• Insertion of the superior rectus at 7.7 mm from superior limbus
• Instruments : superior rectus forceps, silkocks needle holder, 4-0 thread and round
body curved needle.
• Procedure : held at junction of the proximal 1/3rd and distal 2/3rd .

4. SUPERIOR RECTUS BRIDLE
SUTURE
• Advantage :
1. For maintaining primary position of globe.
2. Good exposure for superior part of the globe.
3. For easy entry.
4. Incision making becomes easy and well appreciable.
5. Easy to put visco.
6. Entry of capsulotome or capsulorrhexis needle becomes easy.
7. Easy entry of phaco probe.
8. Facilitates visco expression of soft nucleus, epinucleus and small pieces of
nucleus.

5. INFERIOR RECTUS BRIDLE
SUTURE
• Situated at 6.5 mm from the inferior limbus.
• Instruments similar to SRBS.

6. INFERIOR RECTUS BRIDLE
SUTURE
• Advantage :
1. Gives counter pressure so that it hastens easy entry into anterior chamber by
keratome for sideport incision.
2. For proper capsulorrhexis.
3. Easy during trench, nuclear holding and lifting
4. I/A of epinucleus & cortex

7. BRIDLE SUTURES ARE MUST
• Small palpebral fissure
• Deep socket
• In dicey situation
• Combined cataract and glaucoma surgery.

8. OTHER SUTURES
• 10-0 nylon 8-0 silk cutting body is used for suturing incisional defects.

9. INTRODUCTION TO OVD
• Also called as viscoelastic agents.
• Use in AS surgery beginning in 1979
• Profound influence in extracapsular and phacoemulsification
• Decreased the incidence of corneal edema as a complications.
• OVDs contain one or more substances in varying concentrations (Sodium
hyaluronate, chondroitin sulphate, or hydroxypropyl methycellulose.

10. SODIUM HYALURONATE
• Biopolymer
• Occurs in many connective tissue throughout the body.
• High molecular mass (2.5-4 million)
• Low protein content.
• Carries a single negative charge for the dissacharide unit
• Half-life of approx. 1 day in aqueous and 3 days in vitreous.

11. CHONDOITIN SULFATE
• Biopolymer similar to hyaluronate
• Possess a sulfated group with double negative charge.

12. HYDROXYPROPYL
METHYLCELLULOSE
• Doesn’t occur naturally in animal tissues, but cellulose is widely distributed in plant
fibers such as cotton and wood.
• Cellulose polymer modified by addition of hydroxypropyl and methyl groups to
increase the hydrophilic property.
• Methylcellulose is a nonphysiologic compound doesn’t appear to be metabolised
intraocularly
• Eliminated in the aqueous but can be easily eliminated in the vitreous?

13. PHYSICAL PROPERTY
• Result of chain length and molecular interactions both within chains and between
chains and ocular tissue.
• High viscosity : higher the molecular mass, greater flow resistance to shearing
force, function of concentration, molecular mass, and the size of the flexible
molecules in this material.
• Viscoelasticity : reaction as an elastic material or gel when energy is transmitted at
high frequency, at low it acts as viscous.
• Pseudoplasticity : ability of OVD to transform from a gel to a liquidlike substance
under pressure
• Cohesive and dispersive

14. CHARACTERISTICS OF OVD
• Space maintenance ability : keeps AC formed despite the presence of one or more
incision.
• For easier manipulation away from corneal endothelium and posterior lens capsule
• Used for viscomydriasis
• To keep the plane of anterior capsule flat – CCC
• Less traumatic lens implantation
• Pars plana injection for lens elevation
• Coating the endothelium

15. REFERENCES
• Ophthalmology : yanoff and duker : 4th Edition
• American academy of ophthalmology : section 11 : 2014-2015

16. THANK YOU