Surgeon should hold the shalaka (linganasha vedhani shalaka) steadily in Right Hand (Gripped with thumb, index and middle finger) and enter the left eye at Daiva Krita Chhidra i.e. Pupil (2/3 parts from Krishna-shukla sandhi and 1/3 parts from the Apang sandhi in the interpalpebral space). The Shalaka should be introduced in the eyeball ; a specific sound of entry of Shalaka inside the eye is experienced which follows a drop of water (Aqueous humour) through the vedhana site.
Steadily pushing forward & manipulating the shalakya until it reaches the drishti mandala (papillary aperture) i.e. on ant surface of the cataractous lens so that lekhana karma is completed under direct vision. Shalaka is to be gripped in left hand for operation on right eye.
Hold the entered shalaka in situ and irrigate the eye with mother's milk (Human milk) and apply mild sudation on the closed eye with Vata pacifying leaves e.g. R. communis leaves. This will prevent redness, discharge and pain.
There after assuring the patient, push the shalaka to the centre of pupil through rotatory movements.
With the tip of the shalaka in pupillary aperture, Kaphaja Linganasha (Cataract) should be scraped properly to disintegrate the organized material. To remove this disintegrated cortical/ nuclear matter, Close the nasal cavity opposite to the operated eye and ask patient to forcefully sneeze out through the open nare (ipsilateral to the eye being operated) while keeping the shalaka inside the eye. This will aid drainage of the liquefied cortical matter (by increasing the JVP and in turn increasing IOP.) Acharya Vagbhatta varies in its technique at this step of surgical procdure. He is of the opinion that ask the patient to see towards ground and gently push the cataract downside without any delay, then ask the patient to sneez (as above) so that cataract goes down enough leaving the pupillary aperture (Drishti Mandala) clear.
If the cataract is not completely scraped and extracted out or if it re-occurs (After-cataract) then irrigate the eye again with mother's milk, apply sudation (asearlier) and rescrap the cataract (in pupillary area).
When by doing this procedure the pupil become clear of all kapha/white material-Cataract (like sky clear of clouds) and patient starts seeing fingers threads like objects then shalaka should be slowly removed by rolling out movemnts.
Apply pure ghee in eye and apply the bandage.
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