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Hydrosubluxation technique makes nucleus removal safer in RLE, surgeon says
The nucleus is displaced out of the capsular bag and held vertically within the rhexis.
A novel technique for nucleus removal makes refractive lens exchange procedures safer, according to a surgeon.
Kjell Gunnar Gundersen, MD, PhD, told colleagues at the European Society of Cataract and Refractive Surgeons meeting in Paris that refractive lens exchange (RLE) has gained widespread popularity in recent years. However, performing elective lens surgery requires even higher operative quality standards, he said, because “any complication is one too many.”
The focus of his study was to demonstrate the safety and efficacy of his technique of hydrosubluxation of the soft nucleus in early cases. Between January and December 2009, 200 consecutive patients with a mean age of 52 years underwent RLE. Mean preoperative uncorrected visual acuity was 20/40 and mean best corrected visual acuity was almost 20/20. Mean spherical equivalent ranged from –10 D to +8 D.
As in most RLE series, there were slightly more women than men.
Technique
“The first step of my technique was to perform a controlled capsulorrhexis, centered on the visual axis and with a maximum diameter of 5.5 mm. The second step is the actual hydrosubluxation. During hydrodissection, we utilized a slightly increased infusion pressure to displace the lens nucleus out of the bag, tilting it in the vertical position,” Dr. Gundersen said.
The luxated lens nucleus is then captured and fixated within the rhexis, which holds it like a belt.
“That’s why the capsulorrhexis needs to be fairly small. While it holds the nucleus, we can carry out our phaco maneuvers and aspiration in a controlled fashion, with the instruments in the middle of the eye, away from the posterior capsule,” he explained.
The rest of surgery is performed in the usual manner, with no need to alter routine microincision cataract surgery. Dr. Gundersen uses a bimanual technique of nucleus aspiration with the phacoemulsification tip placed centrally in the anterior chamber without any extra instrumentation. Minimum or no phaco energy is used. Finally, conventional bimanual removal of remaining cortical lens material is carried out, and the IOL is implanted.
“Mean absolute phaco time was almost 0 in all cases, and the technique could be reproduced fully in 92% of the eyes. No case of posterior capsule rupture occurred in this entire series,” Dr. Gundersen said.
Safety
Hydrosubluxtation is a safe and reproducible technique in patients younger than 60 years, Dr. Gundersen said.
“The combination of safe and atraumatic mobilization of the lens nucleus, stable fixation of the lens by the narrow rhexis and extremely low phaco energy increased safety and efficacy in RLE surgery at our clinic,” he said. – by Michela Cimberle
- Kjell Gunnar Gundersen, MD, PhD, can be reached at Haraldsgate 139, 5501 Haugesund, Norway; +47-52703900; email: kggunder@online.no.
- Disclosure: No products or companies are mentioned that would require financial disclosure.