Novel Method For Nucleus Extraction In Extracapsular Surgeries And Related Procedures
Published 2025 - 43rd Congress of the ESCRS
Reference: PO303 | Type: Free paper | DOI: 10.82333/k82v-8z82
Authors: Aya Wattad* 1 , Avinoam Shye 1 , Igor Kaizerman 2 , Gur Munzer 3 , Tzachi Sela 3 , Michael Mimouni 4 , Eyal Cohen 5
1Ophthalmology,Tel Aviv Sourasky Medical Center,Tel-Aviv,Israel, 2Ophthalmology,Barzilai Medical Center,Ashkelon,Israel;Ophthalmology,Care-Vision Laser Center,Tel-Aviv,Israel, 3Ophthalmology,Care-Vision Laser Center,Tel-Aviv,Israel, 4Ophthalmology,Rambam Health Care Campus,Haifa,Israel;Ophthalmology,Care-Vision Laser Center,Tel-Aviv,Israel, 5Ophthalmology,Tel Aviv Sourasky Medical Center,Tel-Aviv,Israel;Ophthalmology,Care-Vision Laser Center,Tel-Aviv,Israel
Purpose
Over the years of teaching anterior segment surgery, we have encountered numerous challenges and difficult situations. In this article, we focus specifically on the extraction of the nucleus from the capsular bag in a manner that is simple, reproducible, and independent of the surgeon's experience. Using precise guidelines and proven parameters, we have demonstrated that this maneuver is predictable and feasible, even in cases involving small pupils.
Setting
Patients were operated on by different surgeons at three different centers under the supervision of the authors. The centers included Pedro Lagleyze Hospital, Zambrano Foundation, and the Institute of Vision, all located in Buenos Aires, Argentina. Extracapsular cataract surgeries were performed in all cases.
Methods
Our technique uses the phacoemulsifier for nucleus levitation. Its customizable settings enhance surgical efficiency and precision. After hydrodissection and rotation, the nucleus is elevated into the anterior chamber via vacuum and ultrasound. This method works with various phaco systems and vacuum pumps
- Venturi Systems:Phaco power set to 50%, vacuum at 350–450 mmHg.
- Peristaltic Systems:Phaco power set to 60%, flow rates between 38–45 mL/min, and linear vacuum at 450–550 mmHg.
A side port instrument can assist, but the phacoemulsifier alone usually provides enough grip to elevate the nucleus
Results
We have performed 25 cases using this technique, encountering varying levels of complexity but no complications inherent to this maneuver. The technique has shortened surgical times and reduced complications associated with the procedure, which, in the hands of less experienced surgeons, often leads to intraoperative miosis due to iris manipulation or even zonular ruptures or dehiscences
Conclusions
Elevating the nucleus into the anterior chamber is crucial in extracapsular surgery and its variants. While sometimes straightforward, it can be challenging in cases of small pupils, zonular weakness, or other pathologies.
Once removed from the capsular bag and positioned in the anterior chamber, the nucleus can be expressed using the surgeon's preferred method.
Our pourpose is to achieve the complex maneuver of bag nucleus extraction in a safe and reproducible manner. This allows for easy removal of the lens from the eye using the method of choice, whether it be extracapsular surgery or MSICS. Our goal is for this maneuver to be adopted by training surgeons.