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Bimanual phaco safely performed through small incision: study
Bimanual phacoemulsification can be performed safely through a 1.2 mm incision without an irrigation sleeve, a small clinical trial found.
Eric Donnenfeld, MD, and colleagues with Ophthalmic Consultants of Long Island, performed bimanual phaco using micropulse technology without an irrigation sleeve on 10 patients. In each case, the operating surgeon created a 1.2 mm clear corneal incision. All cataracts were nuclear sclerotic and grade 2 or 3.
The study was designed to evaluate the efficacy and wound-temperature gradients of Advanced Medical Optics’ WhiteStar micropulse technology for bimanual phaco in humans. The authors noted that previous lab studies indicated the decreased thermal effect achieved with the technology would allow phaco to be performed without an irrigation sleeve.
“The decreased thermal effect achieved with WhiteStar technology makes an irrigation sleeve unnecessary because the phaco needle does not need to be extensively cooled during cataract extraction,” the study authors reported.
A thermocouple consisting of a 30-gauge copper wire was inserted into clear cornea directly adjacent to the wound to digitally record temperature gradients at the wound. Endothelial cell counts were evaluated preoperatively and postoperatively.
All 10 patients maintained corneal clarity with “no signs of thermal damage to the wound,” the authors reported in the Journal of Cataract & Refractive Surgery. During surgery there were no signs of corneal clouding or wound disturbance.
“During phaco with WhiteStar technology and a bimanual technique, the anterior chamber remained stable and followability of nuclear fragments was markedly improved,” the authors said.
Mean preop endothelial cell count was 2,105 cells/mm2. At 3 months postop, the mean was 1,949 cells/mm2, an endothelial cell loss rate of 7%.