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Instrument can offer surgeons increased safety during phaco
Hand-shaped instrument allows for bimanual manipulation of the cataract, surgeon says.
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---The Winter Helping Hand offers surgeons increased safety during phacoemulsification.
The Winter Helping Hand (Rhein Medical; Tampa, Fla.) offers surgeons increased safety during phacoemulsification. If you were able to insert your own hand through the paracentesis site and it was small enough to help maneuver the cataract toward the phaco tip, in many ways, the most ideal shape would be the shape of your own hand. This instrument is designed to do just that.
The palm of the Helping Hand allows the surgeon to facilitate bimanual manipulation of the cataract with the nondominant hand and bring the cataract toward the phaco tip. The gentle curve of the instrument allows it to go underneath and lift the nucleus off of the capsule. Once off the capsule, by rotating the instrument 90° into the vertical plane, one can back cut or reverse chop the nucleus. The back of the thumb of the instrument is, in fact, a blade. By keeping the blade up, one is far less likely to encounter the posterior capsule or inadvertently chop through to the vitreous. By chopping anteriorly or toward the cornea, one reduces risk of vitreous entry.
Technique
This instrument can be introduced through a paracentesis site in the paralimbal or clear cornea at the 3-o’clock position with the left hand or at the 9-o’clock position with the right hand. One of the biggest advantages of this instrument is that when it is introduced, it can follow the lens capsule underneath the nucleus and lift and separate the nucleus. Then, as one phacos toward the instrument, it is there to protect the posterior capsule from vaulting or trampolining during a post-occlusion surge or from the inadvertent advancement of the phaco tip posteriorly. The palm of the Hand is best placed directly underneath the phaco tip so that the two instruments approach each other in a chopstick fashion, especially during the burst mode.
With the gentle curve of the palm, the instrument also can be advanced into the periphery to help scoop cortex and bring the cortex toward the tip while in the vacuum mode.
Differing roles
Depending upon the phaco machine used, the Helping Hand plays a different role. With the Alcon Legacy (Fort Worth, Texas), where, in my hands, the chance for a post-occlusion surge is slightly higher than with the Bausch & Lomb Millennium (Claremont, Calif.), it is important to keep the Helping Hand more posterior to the nucleus. Whereas with the Millennium, with dual-linear control, the Helping Hand can be useful for reverse chopping while utilizing the linear phaco and vacuum powers. I have found that with the Allergan Diplomax (Irvine, Calif.), this instrument works best when used like the Legacy — behind the cataract in the cortical plane.
Reverse cutting or back-chop is another way to approach cataract extraction, similar to stop and chop or lollypopping the nucleus into the iris plane. If the periphery of the cataract is brought into the iris plane on a diagonal toward the phaco tip, the instrument can help maneuver the cataract to maintain this position and “feed” the phaco tip.
For Your Information:
- Duncan F. Winter, MD, can be reached at 83 Main St., Saranac Lake, NY 12983; (518) 891-5189; fax: (518) 891-1992. Dr. Winter has no direct financial interest in any of the products mentioned in this article, nor is he a paid consultant for any companies mentioned.
- Rhein Medical can be reached at 5460 Beaumont Center Blvd., Ste. 500, Tampa, FL 33634; (813) 885-5050; fax: (813) 885-9346; e-mail: info@RheinMedical.com; Web site: www.RheinMedical.com.