Hybrid Phaco : An Easy And Safe Way To Tackle Suprahard Brunescent Cataract

To describe an easy and safe technique of phacoemulsification in suprahard Brunescent cataract using two different phacotips.

Narang Eye Institute,Delhi, INDIA

After performing a routine capsulorhexis,hydrodissection phacoemulsification of suprahard cataract is done using two different types of phaco tips (19G and 20G).Trenching and chopping into the multiple pieces of the hard nucleus is done using 19G phaco tip. Then the phaco tip is changed to 20G and divided pieces are emulsified and aspirated using 20G phaco tip.

In all cases,full thickness segmentation of the hard nucleus including posterior plate was achieved with the help of 19G phaco tip. To prevent intraoperative surge and it's related complications 19G phaco tip changed to 20G tip for better safety. Phacoemulsification and intracapsular implantation of intraocular lens was safely performed in each case. No intraoperative complications  such as iris injury,anterior capsular tears, zonular instability or posterior capsule rupture occurred during surgery. No postoperative complication such as long standing corneal edema  or severe endothelial cell loss was observed in any case at 6 weeks postoperatively.

The technique is an efficient,safe,simple and easy procedure for full thickness nuclear segmentation,delivering advantage of microincisional phacoemulsification for suprahard brunescent cataract with few ocular complications.Suprahard brunescent cataract are challenging to perform for beginners and experienced surgeons too,keep in mind the possibilities of complications like zonular instability,posterior capsule rupture intraoperatively to postoperative long standing corneal edema. Various techniques and modifications have thus been described to overcome these challenges. The technique we describe here Hybrid Phaco,though takes a little extra time of changing the phaco tips but increases safety even in the hand of a beginner.