Adaptation Of A Silicone-Tipped Irrigation/Aspiration Device To Allow Bimanual Aspiration Of Cortical Material With Minimal Additional Equipment

The silicone-tipped irrigation and aspiration device offers both flexibility and safety for cortical material removal during phacoemulsification. However, sub-incisional cortical material can occasionally present difficulty. We sought to identify a method of modifying this device to achieve this.

Ophthalmology operating theatres at a tertiary referral teaching hospital (Queen’s Medical Centre, Nottingham)

 

Methods & Results (photographs of setup are available)

The silicone-tipped irrigation/aspiration device (Bausch&Lomb) consists of a handpiece and two connecting pieces of piping, one for irrigation and another for aspiration. Once the surgeon is ready to remove sub-incisional cortical material, and has difficulty with the combined irrigation/aspiration approach through the main incision, the irrigation is ceased and the aspiration piping disconnected from the handpiece. 

 

A small rubber bung (available as part of most brands of viscoelastic device vials) is then connected to the empty aspiration connector on the handpiece to prevent fluid reflux. A bimanual aspiration cannula can then be connected to the phacoemulsification machine, and can conveniently be inserted through the side port for sub-incisional cortical material removal, with the silicone tip handpiece now being used for irrigation through the main incision, negating the need for additional incisions.

Using this method, a surgeon who prefers the silicone tipped irrigation and aspiration device need not prepare additional equipment in the event of difficulty in subincisional cortical removal. Modifying the handpiece as and when required is cost-effective whilst optimising safety.