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Dual incision bimanual I/A for cortical removal and polishing

Poster Details

First Author: D.Desai INDIA

Co Author(s):                  

Abstract Details



Purpose:

Today, cataract surgery is considered to be a refractive surgery too.With the advent of Toric, Multifocal and Accommodative intra ocular lenses (IOLs), targeting emmetropia and polishing the capsule has become necessary. This is normally accomplished through a third incision. Our technique allows omission of the third incision as in bimanual I/A, prevents primary incision leak and allows an approach for cortical removal and polishing over 360 degrees

Setting:

This technique has been devised at the Diva Eye Institute, Ahmedabad, India. It is routinely used by us during phakoemulsification surgery for cataracts. The Stellaris phako machine was used with a primary incision 0f 1.8 mm. and a side incision of 1.2 mm. A single right handed surgeon operated on all patients. The side incision was made at 90 degrees and to the left of the primary incision.The simple connector with two male openings on either side makes the difference.This allows use of different cannulas for cortical ,makes it different from bimanual I/A.

Methods:

A simple connector/handle is devised with male openings on both sides. Different canulas for 1) cortex removal 0.3mm bore and 2) for polishing with 0.2mm bore with sandblasted tip are attached to it's distal end. The end of the aspiration tube is attached to it's proximal end. The irrigation tube is left attached to the coaxial I/A probe and fluid is irrigated through the primary incision. This allows greater flow rate of 80-85cc/ min than with the bimanual I/A probe (35-40cc/min), as the coaxial I/A handpiece has a silicon sleeve. The coaxial I/A probe,, as usual, is used to remove the cortex over 360 degrees and to polish over 180 degrees. To use the second incision, the aspiration tube is then removed from the coaxial I/A handpiece and attached to the male adaptor with either the cortical removal or polishing canula. This allows removal of subincisional cortex and any other remnants. A polishing tip is now attached to allow polishing of the remaining 180 degrees of capsule which could not be approached through the primary incision. For cortical removal the linear vacuum is set at 500 and for polishing at 200 mm of Hg.

Results:

1. The third incision is avoided, decreasing corneal trauma and astigmatic changes. 2. The primary incision does not leak, as the coaxial silicon sleeve with tip I/A seals the incision. The high flow rate delivered through the primary incision via the coaxial handpiece (upto 85 cc/min) prevents surges. It also keeps the posterior capsule away while polishing, allowing better access. Thus the incidence of posterior capsular rupture is decreased during both stages. 3. The connector with male openings at both ends allows use of different canulas for aspiration during cortical removal and polishing.

Conclusions:

The dual incision bimanual technique offers several advantages over bimanual I/A using a third incision. The cortex could be comfortably removed and the capsule polished in all our patients. A third incision was never required. The high flow rate allowed adequate working space as it pushed the posterior capsule backward. There were fewer surges, with decreased incidence of posterior capsular rupture. This technique has even more significance with the advent of Toric, Multifocal and accommodative IOLs as it results in less corneal trauma,change in corneal mechanics and astigmatic changes. Polishing has now become a necessity with the use of hydrophilic and silicon materials used in Multifocal and accommodative IOLs FINANCIAL INTEREST: NONE

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