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Pivoting technique: the most important tip for the transition from conventional to microincision coaxial phacoemulsification

Poster Details

First Author: H.Lin TAIWAN

Co Author(s):    Y. Chuang   C. Lin   P. Lin        

Abstract Details


To describe one of the crucial techniques that enables easy maneuverability for ophthalmologists who perform conventional method, which requires a corneal incision of 2.75 mm-3.0 mm in width shift into microincision coaxial phacoemulsification that only requires a corneal incision of 1.8 mm-2.2 mm in width.


Universal Eye Center, Zhong-Li, Taiwan.


The pivoting technique indicates that using any surgical instruments, including traditional capsulorhexis forceps and phacoemulsification probe should be centered on a fixed pivot point within the incision to allow a wide range of movement because large movement outside the pivot point can produce only limited movement within the eye. We then apply this technique to achieve successful continuous curvilinear capsulorhexis (CCC) by using the traditional capsulorhexis forceps through a corneal wound of <2.2 mm in width. Of note, the curvature angle must be relatively larger to achieve a similar capsular opening of 5-5.5 mm. We will demonstrate the pivoting technique by diagrams, animation and real surgical video recorded with multiple-views to show how to perform CCC and coaxial phacoemulsification in microincision that requires a corneal incision of 1.8 mm-2.2 mm in width by experienced and junior trainee surgeons. We will also demonstrate how to discipline the junior trainee surgeons to overcome the narrowing clear corneal wound.


We do not need to change our technique, and we continue to use the traditional capsulorhexis forceps to create a good-quality and reproducible CCC through a corneal wound of 1.8 mm-2.2 mm even <1.8 mm in width as a lot of ophthalmologists would agree the most important step in phacoemulsification is making a CCC. In microincision coaxial phacoemulsification, using the pivoting technique can prevent complication from smaller incision (1.8 mm-2.2 mm) such as mechanical and thermal burn injuries to the corneal wound during surgery.


Over the year, and there has been a continuous reduction in cataract incision size, and this trend will continue in the future. The pivoting technique demonstrates excellent maneuvers using instruments. Most importantly, this technique enables us to perform a successful and much safer surgical procedure on our patients with minimal corneal wound lacerations, no thermal burn injury, a lower propensity for wound leakage, and reduce the incidence of postoperative endophthalmitis. That provides faster recovery of good vision so the patients may return to work as early as possible. We suggest that trainee surgeons keep this pivoting technique in mind during their learning. FINANCIAL INTEREST: NONE

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