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Suck and massage vs phacocapsulotomy in handling positive intralenticular pressure in intumescent hypermature cataract to accomplish adequately sized smooth curvilinear capsulorhexis

Poster Details

First Author: N.Khunger INDIA

Co Author(s):                        

Abstract Details


The most challenging aspect of phacoemulsification technique in intumescent hypermature cataract with shallow anterior chamber is achieving adequately sized continuous curvilinear capsulorrhexis and avoiding Argentenian flag sign. The root cause being positive intralenticular pressure due to trapped liquefied cortical fluid in the capsular bag. Purpose of this study is to compare safety profile and efficacy of 2 different techniques suck and massage and phacocapsulotomy for reducing intralenticular pressure by removing the trapped fluid before fashioning capsulorrhexis after puncturing the anterior capsule in the centre.


Randomized clinical study done in 50 eyes of intumescent liquified cataract with shallow anterior chamber by randomly dividing them into group 1 and 2. All surgeries done by single surgeon. In group 1:suck and massage technique and in group 2:Phacocapsulotomy has been used to remove trapped fluid before accomplishing capsulorrhexis.


After staining anterior capsule, Sodium Hyluronate 1.4% is injected in anterior chamber in both groups. Group1: suck and massage technique, small opening made in anterior capsule and capsular edge reflected. 26 gauge needle bevel down is used to suck cortical fluid. Bulge in the paracentral area is massaged with cannula centrally while injecting viscoelastic continuously. Group 2:phacocapsulotomy done with Torsional Phaco by placing kelmen tip at the centre and stabilizing globe with chopper and directly going to foot position 3 thus puncturing anterior capsule in centre and aspirating the intralenticular fluid. In both the groups capsulorrhexis is completed after this in usual manner.


Following outcomes compared: One complication of Argentanian flag sign None in either group 2-Sudden enlargement of cut in anterior capsule while handling Intralenticular fluid Group 1:3/25 eyes Group 2:8/25 eyes Group 3:Achieving adequately sized capsulorrhexis (5.5-5.75 mm) in single rotation. Group 1: Accomplished in 18/25 eyes and in 7 eyes capsulorhexis needed to be enlarged after IOL implantation to avoid capsular phimosis. Group 2: accomplished in 14/25 eyes and in 11 eyes capsulorhexis enlarged after IOL implantation. 4-Subjective ease and smoothness of performing Capsulorrhexis was better in Group 1.


Safety profile of both in avoiding Argentanian flag sign was equal . In other parameters compared suck and massage technique was statistically significantly safer as compared to phacocapsulotomy as the fluid was removed in more controlled manner and uniformly from all directions. We did not face any major complications due to sudden anterior capsular puncture in phacocapsulotomy in our study as this seems to be less controlled as compared to suck and massage. Thus we conclude that though overall safety profile is equal,suck and massage has better results.

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