I&A tip can be a tool for performing capsulorrhexis in bimanual phaco

BEIJING — An irrigation and aspiration tip can be used to perform capsulorrhexis in bimanual phaco, according to Pannet Pangputhipong, MD, who devised the technique.

“I&A rhexis is an inexpensive and safe alternative to more expensive capsulorrhexis forceps or using a cystotome,” Dr. Pannet said here at the Asia-Pacific Association of Cataract & Refractive Surgeons meeting.

Dr. Pannet noted that micro-forceps for performing capsulorrhexis through a microincision are expensive. Using a cystotome is a less costly alternative, but it is slower than the I&A rhexis technique, he said.

The I&A rhexis procedure can be performed with or without viscoelastic, Dr. Pannet said.

When using the I&A tip for capsulorrhexis the surgeon must keep the vacuum level low, but high enough to grab and hold the capsular flap, Dr. Pannet said. He keeps the vacuum setting between 100 mm Hg and 150 mm Hg.

He cautioned that there is a lengthy learning curve for the procedure, but he stressed that the procedure can be worth learning for its safety without the expense of micro-forceps.

He said he first learned the procedure while performing standard coaxial cataract surgery and then adopted it for his bimanual microincision cataract surgery procedure. He recommended this approach to the learning process.