The Third Hand: Modified Irrigating Tip For Bimanual I/A

In a small pupil, to make the technique of bimanual I/A easy, always reproducible and safe, we invented a modified version of the irrigating tip of the bimanual I/A

While performing routine cataract surgery there are scenarios when the pupil becomes miotic or we have cases where the pupil has high plasticity hence no pupil dilating device can come in handy, while some may cause undue sphincter trauma. In such cases the modified bimanual irrigating cannula can come in use. It is an atraumatic method of accessing the cortical fibres which are hidden under the miotic pupil without creating another corneal incision or damaging the sphincter.

In FLACS,cortical fibres get cut 200µ below CCC.Post FLACS,if there is miosis beyond the CCC,then bimanual I/A becomes difficult as there are no free cortical fibrils seen for aspiration as the bimanual I/A cannot hold on to the iris.So we modified the irrigating handle with a Y.This atraumatically retracts the iris during I/A to visualise the cortical end for safe aspiration all 360° around

Use of this modified tip of the bimanual I/A in miotic pupils / intraoperative miosis resulted in safe I/A post phacoemulsification leading us to safer surgical outcomes. The modified I/A also has other intraoperative uses such as feeding the aspiration port while aspirating a particularly dense piece of cortical matter,cortex aspiration post IOL implantation, hydroimplantation of IOL, lifting the IOL edge to irrigate the undersurface and aspirate out entrapped viscoelastic,hydro-assisted toric IOL alignment. 

The modified irrigation tip for the bimanual I/A reduces the need for multiple corneal incisions, instrumentations and pupil dilating devices while offering an easy solution to perform safe I/A in intraoperative miosis.