Bimanual Vs. Single-Piece I/A In Cataract Surgery: A Comparison Of Posterior Capsule Tear Rates From The Australian Experience

Controversy exists over the optimal irrigation and aspiration (I/A) technique during cataract surgery, with bimanual and single-piece being the preferred two methods. Regardless of technique, posterior capsule (PC) tear remains one of the most common complications, with reported incidence rates between 1.0% and 2.1%. The purpose of this study was to evaluate the rate of PC tears in bimanual vs. single-piece users.

 Department of Ophthalmology, The Alfred Hospital, Melbourne, Australia. An Australian university-attached quaternary referral centre. 

Retrospective cohort study of patients who underwent phacoemulsification over a 10-year period at The Alfred Hospital, Melbourne. Only cases performed by consultant ophthalmologists were included in the study. Bimanual was defined as I/A ports on two separate handpieces, while single-piece was defined as I/A ports on a single hand-piece. 

Over the 10-year period, there were 65 PC tears in 5,339 phacoemulsification cases (rate 1.2%). Of these, 3,963 cases were performed using bimanual technique (74.2%), while 1,376 cases were performed using single-piece (25.8%). There were 35 PC tears identified in the bimanual group (0.9%) and 30 PC tears in the single-piece group (2.2%). Chi-Square analysis showed single-piece technique was significantly more likely to be associated with PC tears than bimanual technique χ² (3, N = 5339) = 14.28 p<0.001.

This study suggests that the incidence of PC tears is considerably higher in the single-piece I/A when compared to bimanual I/A. Other ophthalmology teaching centres may wish to consider these findings when electing how to best teach phacoemulsification to new trainees.