This is a scleral tunnel . Even after suturing it induces approximately 1 D astigmatism on average. Here I refer not to the final astigmatism but to the surgically induced astigmatism. If the incision was limbal or corneal and sutured with 1 suture the induced astigmatism would be more: say 1.5 to 2 dioptres

The ultimate surgically induced astigmatism with a scleral tunnel if you take one stitch, in this technique, is about 1 to 1.5 dioptres of astigmatism (which represents flattening of the vertical meridian by 1 to 1.5 dioptres). This is the surgically induced astigmatism ; the final astigmatism will depend on the presurgical astigmatism plus the surgically induced astigmatism. For example of the patient had 1.5 dioptres with the rule astigmatism preop, the final post surgical astigmatism might be zero

If by SICS with phakoemulsification you mean phakoemulsification with insertion of a PMMA IOL , then there is no real advantage or disadvantage either way between the two techniques. However phakoemulsifcation with a foldable lens gives less surgically induced astigmatism which may be an advantage if there is no preexisting astigmatism or a disadvantage if there is preexisting astigmatism that you hope to correct by appropriate siting of the incision in manual SICS

In this case a 20dioptre indirect ophthalmoscopy lens is being used

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The astigmatism you induce depends on multiple factors: Whether you stay within the astigmatic funnel(which I have tried to do with the curved incision), how big your incision is overall and how far away from the limbus you make the incision, and also the integrity of your tunnel(how much you stretch it while removing the nucleus etc If your incision is further away from the limbus you induce less astigmatism(flattening of vertical axis). In my hands the wound compression (resulting in steepening of the vertical axis) by the suture is minimal as the bites are superficial and the gape introduced by the procedure in the long term (resulting in flattening of the vertical axis) is about a dioptre or so because the suture hitches up the tunnel and prevents its gape (flattening of vert axis). If I were not to suture I would probably get about 2 to 2.5 diopters of tunnel gape. Notice I am distinguishing between the short term result (wound compression by the suture) and the long term, say a year down the line, result, when the suture loses its effect (which is always gape- flattening of vertical axis). If you do not suture you always get gape only (long term and short term). A scleral tunnel gapes less than a corneal wound but it ultimately always gapes , nevertheless. By gape here I mean a subclinical stretching and flattening of the wound not an actual physical gape. The bridle suture is not always necessary esp if you do a 2 point retrobulbar injection with more anesthetic injected in the vertical injection, which makes the eyeball turn down slightly.

@@bhattieyeclinic7176 Great ant thoughtful reply. Many thanks from Brazil.

By Weiss ring I presume you mean the ring seen over the disc in posterior vitreous detachment. This does not have any particular "setting " required but you do need a fundus viewing lens like, for example, a 90 D indirect ophthalmoscopic lens or a contact lens like the mainster lens to be used along with the slit lamp. You could also view it without using the slit lamp by using a 20 D indirect ophthalmoscopy lens with a smartphone (ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-rB5Pk3y0Z-I.html)

you may contact me by email on bhattieye@gmail.com. What would you be requiring these images for?

generally suction is to be initiated during irrigation aspiration only when cortex is just adjacent to the tip of the I/A cannula. Initially low suction is used to hold and bring the cortex to the centre and hen suction is increased to aspirate the cortex in the mid pupil area which is safer

usually not as the eye is anesthetised

I will post a new video of capsulorhhexis in a few days with voice over. Thank you for the suggestion

Zeiss 1 FR

A smart, fast and hasty surgeon who skips necessary steps is aware that the patient takes all the risks !! Personally I prefer to be slow and meticulous: it makes for happier patients. In my opinion, the single suture makes for much better and consistent refractive results (lesser in amount and more consistent surgically induced astigmatism). Another one of the aphorisms I live by is to make the surgery easy by technique and do it clumsily, rather than make the surgery difficult and try to do it skillfully. The choice of ports for IA is calculated to make access to difficult areas easy, so great skill is not required. All cortex could be removed from the scleral tunnel itself, without an inferior side port, but I am aware, (especially when I teach residents) that the maximum incidence of capsular rupture and dialysis occurs during removal of subincisional cortex, and this is greatly reduced by accessing this cortex from a diametrically opposite and self sealing sideport.

People who are blind from birth usually have problems in other parts of the eye which are often not treatable.only if they have a problem limited to the cornea will a corneal transplant help.

The thread used is 10-0 nylon suture which needs an operating microscope to see and handle

Corneal transplant will only help if the cause of blindness is any type of corneal opacity with the rest of the eye being healthy.The whole eye is not replaced. Only the cornea can be replaced.

Usually the interface opacity can be seen.after some years it may blend in and be less visible