The Third Hand: Modified Irrigation Tip For Bimanual

During cortex aspiration after nucleus phacoemulsification, in a non femto case, the cortical fibrils are exposed beyond the area of the CCC margin. Thus making aspiration easier by merely pulling onto the tendrils of cortex and aspirating them. In a Femto cataract case, the cortex is cut 300µ below the capsule, thus making the margins of the cortical fibres flush with the CCC margins. In such a scenario if the pupil becomes miotic intraoperatively, the access to the cortex becomes challenging. Due to lack of view one may pull the bag. The modified irrigation tip was invented for this reason. To facilitate, the easy aspiration of cortical material, under full view. 

All cases with introperative miosis were selected, irrespective of systemic conditions. The same surgeon operated all the cases. All cases were otherwise uneventful. 

When intraoperative miosis occurred, intracameral mydriatic agents were used in an attempt to dilate the pupil which failed. Hence the Modified irrigation tip was used to retract the iris and view the cortical fibres under the CCC margin. After successful cortical aspiration, the IOL was successfully implanted in the bag in all cases.

Successful phacoemulsification after femto cataract in a small pupil case is facilitated by the used of iris retractors. To maintain the chamber, this modified iris retractor is a cruicial invention. 

The modified irrigation tip is a useful tool in successfully carrying out I/A in a small pupil cataract cases.