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Phacoemulsification of black and brunescent cataracts with the retrochop technique

Poster Details

First Author: M.Seiyu Yogi BRAZIL

Co Author(s):    G. da Luz Guzzatti   G. Aquino Junior   Aquino Junior               

Abstract Details

Purpose:

Phacoemulsification provides efficacious outcomes in regular cataracts and it is considered the main technique for cataract extraction . Many phacoemulsification techniques have been described for cataract removal. Furthermore, the management of rock-hard cataracts can be complex, even with popular techniques, as phaco-chop and stop-and-chop, and may cause corneal endothelium injury, posterior capsule rupture or damage to the uveal tissue. Besides, its leathery posterior plate makes difficult to divide the nucleus completely. This study present the retrochop technique, developed for black and brunescent cataracts, and we describe a chopper, the retrochopper, created to be used in this hard lens nucleus.

Setting:

Department of Ophtalmology. Federal University of São Paulo, and CEMA Hospital, São Paulo, Brazil.

Methods:

A 7,0mm x 5,5mm oval capsulorhexis is created, with the larger axis close to the paracentesis. The phaco tip, in the bevel-down position, and the retrochopper are inserted in the anterior chamber. The phaco tip is embedded in the central nucleus and the lens is tilted to expose part of the posterior face, creating room for the retrochopper. This new chopper allows the upper cutting edge to be moved in the direction of the phaco tip, creating a complete fracture that starts at the posterior portion of the nucleus. The same action is repeated, disassembling the nucleus into smaller fragments.

Results:

In the retrochop technique, the oval capsulorhexis, facilitates the acces of the retrochopper in the posterior part of the nucleus and helps to positioning the posterior chamber intraocular lens. The fracture of the nucleus starts at the posterior portion, with the aid of the retrochopper that divides the nucleus in a safe way, because it is placed far from the posterior capsule and moves away from it. Besides, bevel-down position of the phaco tip burries the nucleus and lift it without downward pressure. This technique decreases the amount of energy, the heat and the particle movement in the anterior chamber.

Conclusions:

Phacoemulsification can be a challenge in brunescent and black cataracts. The difficult to divide the nucleus can lead to unwanted outcomes, such as endothelial cells damage and posterior capsule disruption. In the retrochop technique, hard nucleus cataracts, can be safe and successful managed. It demands a particular instrument, however has a short learning curve and can be adopted by apprentice or expert surgeons.

Financial Disclosure:

NONE

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