Bimanual phaco allows for 1.4-mm incisions

SAN JUAN, Puerto Rico — The technology exists today for microincision cataract surgery using a bimanual technique, Lincoln Freitas, MD, of Sao Paulo, Brazil, said at the Pan-American Congress of Ophthalmology.

Dr. Freitas said performing phaco through a small incision using the bimanual technique gives surgeons more control over all aspects of the surgery.

“Today, with all of the technology and new techniques, we are able to use a bimanual technique that uses two incisions of 1.4 mm,” Dr. Freitas said.

Learning to perform the technique entails familiarization with new instruments for the incision as well as for the capsulorrhexis, he added. He prefers to use Utrata forceps to create his 1.4-mm incision. “You are going to need a chopper that can irrigate during the surgery since you’ll be removing the sleeve from the tip of the phaco handpiece,” he said.

Dr. Freitas advised surgeons have their assistants irrigate the phaco tip during surgery, which will help to decrease the temperature.

“I have my assistant irrigate constantly during phaco,” he said. “If you keep using only small bursts of ultrasound, you are able to perform the surgery without burning the cornea. Use high vacuum, high aspiration, and when you use the ultrasound, you have to use it for a short time.”

A slight learning curve should be expected because of the smaller instrument size, Dr. Freitas warned. Also, using outside aspiration results in a “rain” or misting effect from the vibration of the phaco tip on the fluid.

Success using the bimanual technique is more than just partially relying on correct incision size, he added. If the incision is too large, the eye loses the ability to self-seal, he said.

“It is a good idea to use a knife that is not the knife you use for phaco, like a 15· knife, to perform both incisions. I would rather do it with a 2.75-mm knife, but I mark the knife at the point where it creates a 1.4-mm incision, because it creates a better self-sealing incision,” he said.