Sergio Canabrava MD (Brasil) es uno de los cirujanos oftalmólogos más innovadores y premiados del momento, sus técnicas y creaciones (Canabrava Ring) son utilizadas por miles de colegas alrededor del mundo y su compromiso con la enseñanza es sin dudas, un ejemplo para los jóvenes oftalmólogos.
Por eso hoy, en Oftalmo University podrás disfrutar de un canal exclusivo con todos sus vídeos, donde podrás aprender paso a paso sobre sus técnicas, tips y consejos para convertirte en un experto!
Bienvenidos al Canabrava Channel!
On Chapter one we showed you how the 4 flanged technique works with a non foldable IOL, based on Dr Malbran and Dr Yamane’s techniques
After presenting the IOL Punch on Chapter 2, we have been performing a number of tests with horizontal axis fixation. We tried it with a 3 Piece Sensar IOL, with a Tecnis Single Piece and with a Akreos IOL.
Up to this point the best results on our research we find when the technique is applied on the horizontal axis with the Akreos IOL , however we’ll keep on researching to find the best results.
- The use of triamcinolone to better vitreous visualization, making the anterior vitrectomy more effective.
- A new incision should be created 3.0 - 3.5 mm posterior to the limbus to access the vitreous behind. - The vitreophagus tip is used in maximum cutter.
- There are two modes to set the vitrectomy. The “Cutting – I/A” and the “I /A – Cutting”. The first one is indicated for the vitrectomy, because the machine “cut” the vitreous first. The second one is indicated after the vitrectomy has been performed. The rule is to set to the highest speed cutter, however, the aspiration, intraocular pressure, and vacuum must be set to lower limits. - Once the vitreous has been removed from the anterior chamber and the incisions, the next step is to switch to the I/A Cutting mode to remove the remaining cortex - The best IOL for posterior capsule rupture without posterior rhexis is a 3-piece IOL. It can be positioned in the groove and the optical zone is captured in the rhexis. It preserves the physiological optic zone plan, decreases the chance of IOL decentration and reduce the pigmentary dispersion.
- The vitrectomy through the main incision tends to lose more vitreous - Parameters: 23G tip: Bottle height: 75cm / Vacuum: 150-200mmHg / Flow rate: 10-15cc/min / Cutting: maximum. Surgeon: @sergiocanabrava #ophthalmosurgery #cataractsurgery #posteriorcapsulerupture #cataractsurgery #cataractsurgeon #cataract
Awesome and valuable tips, thank
Totally agree that extra vitreous loss if vitrectomy is carried out through the main incision. Unfortunately- In the U.K., only VR surgeons are allowed to carry out Pars plana vitrectomy, the argument being that if you’ve make a pars plana cut, you then have to have a viewing system to carry out an indented search to breaks, and only VR surgeons have this available to them.
I get around this by using a small paracentesis for the vitrectomy rather than the main wound
We would like to propose 3 modifications to facilitate it:
1. T position: Set a virtual “T” (45, 135 and 225 degrees) on the slip lamp before the surgery.
2. Double left: In this position it is possible to use the left hand to handling the 2 sclectomies and to insert the 2 haptics in the needle with the right hand.
3. Direct haptic: It is possible to insert the first haptic directly in the needle lumen. This Modification was describe for the first time for Dr. Brian Kim.
To ‘‘rescue’’ the capsulorhexis, the tear must be redirected
centrally and back to the desired circumferential
The first step in rescuing the tear , is to fill the chamber completely with an OVD.
The force applied to the capsule flap is then reversed in direction
but maintained in the plane of the anterior capsule.
To reverse the force, it is necessary to first unfold the
capsule flap so it lies flat against the lens cortex, as it did
prior to being torn
Force can then be applied with the capsule forceps holding
the capsule flap as near to the root of the tear as possible
and pulling backward, along the circumferential path of
the completed portion of the capsulorhexis. Traction
should be applied in the horizontal plane of the capsule,
The initial pull should be circumferentially
backward, and then, while holding the flap under tension,
directed more centrally to initiate the tear. The tear will
uniformly and predictably propagate toward the center of
- The phaco tip is buried in the center of the nucleus with high vaccum.
- Then, the 1.5mm chopper is inserted through the side-port and placed opposite the main incision at the edge of the nucleus.
- The chopper is positioned under the lower edge of the capsulorhexis and pulled toward the phaco tip.
- The two instruments are then moved in opposite directions to divide the nucleus into halves.
- This process is continued and the chopper is used to break the nucleus in smaller fragments.
- Mode US : Pulse or Burst
- High Vaccum : Above 350 mmHg
- High Flow Rate : Above 35 cc/min
- The main purpose of these techniques is to mechanically break the nucleus into smaller fragments with the help of a second instrument known as the chopper.
- This helps decrease the use of ultrasound power in nuclear emulsification and reduces surgical time, limiting endothelial damage and less zonular stress.
In the first time, this technique was descrideb using a haptic removed from a 3-piece prolene intraocular lens (IOL). This technique won a Runner-Up prize at ASCRS 2017 film festival - Los Angeles in New Technique category!
During the replace IOL process the pupil became small. Than, i decide to use an iris expansion ring (Canabrava’s ring – AJL Ophhtalmic – Spain) in association with an intrascleral double needle fixation by Dr. Shin Yamane, from Japan.