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Clinician demonstrates utility of D-shaped phaco tip
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 Balamurali K. Ambati |
Use of a specially designed D-shaped phacoemulsification tip for a new carouseling in-the-bag technique prevents formation of an equatorial groove, a speaker said.
The D-shaped phaco tip bends 20° to the right, features a third irrigation port and has a flat distal shaft that reverses flare configuration and avoids choking, Balamurali K. Ambati, MD, PhD, MBA, said at Hawaiian Eye 2011.
Dr. Ambati said that little motion occurs when using this tip, and its 20° bend allows for planarity within the lens and bag.
"Flatten your hand once you engage the lens," he said.
In clinical practice, he enters the capsule peripherally, parallel to the floor and planar to the lens, and the tip's third irrigation port inflates the peripheral portion of the capsule.
"Go as peripheral as possible," Dr. Ambati said. "Viscoelastic can facilitate entry in early cases."
He encouraged his colleagues to keep the sleeve as high as possible on the phaco tip, in order to maximize the value of the third irrigation stream behind the bevel.
- Disclosures: Dr. Ambati reports a financial relationships with MST, is a co-founder of iVeena, and is a consultant for Ambrx, Genentech and Inspire.
This new technique requires carouseling the nucleus within the capsular bag, and the D-shaped phaco tip has been designed with this objective in mind. The Ambati tip may hold promise for softer nuclei that are smaller in diameter and therefore easier to rotate. Many divide-and-conquer surgeons struggle with these softer nuclei, which are not brittle enough to crack in half. I am not sure that the technique will offer as much of an advantage for denser nuclei, because they have less epinucleus and a greater diameter endonucleus. Of course, the greater proximity of the phaco tip to the equatorial capsule creates some risk if the tip is not positioned correctly.
– David F. Chang, MD
OSN Cataract Surgery
Board Member
Disclosure: Dr. Chang has no relevant financial disclosures.
Hawaiian Eye and Retina 2012 will be held January 15-20 at the Grand Wailea Resort & Spa in Maui. Learn more at OSNHawaiianEye.com or RetinaMeeting.com.