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Modified Akahoshi device chops nuclei up to grade 3
The Hybrid Combo Prechopper combines aspects of previous tools to allow more efficient prechopping in a variety of techniques.
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A hybrid prechopping instrument is effective for dividing nuclei up to grade 3 indensity, according to the designer of the device, Takayuki Akahoshi, MD.
Dr. Akahoshi presented his experience using the new prechopping instrument from ASICO at the annual meeting of the American Academy of Ophthalmology.
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The new design combines aspects of the ASICO Combo Prechopper and Universal Prechopper, allowing ophthalmologists to perform both the vertical karate prechop technique and the horizontal counter prechop technique with one tool, according to Dr. Akahoshi.
“I believe that the Hybrid Combo Prechopper is the ultimately designed perfect instrument,” he said in an e-mail interview.
The tip of the Combo Prechopper was modified to feature an angular edge with increased sharpness on the inside of the blade, Dr. Akahoshi said.
According to Dr. Akahoshi, soft nuclei of grades 1 and 2 can be easily prechopped with his device using the karate prechop technique. With the sharper tip, the blade is inserted vertically into the nucleus and, once at the appropriate depth, opened in order to split the nucleus apart. After the nucleus has been divided, the tip can be used to rotate the nuclear fragments prior to using aspiration and high vacuum for removal of the lens fragments.
“The initial idea of the Hybrid Combo Prechopper is, first, to make the insertion into the nucleus and the rotation of the prechopped nucleus easier [due to the design] and, secondly, to also make it possible to use for the counter prechop technique of grade 3 nuclei with a nucleus sustainer,” Dr. Akahoshi said.
The hybrid prechopper also features two rounded edges for safety.
“To protect the anterior capsulorrhexis edge on the proximal side during insertion, I made a part of the [upper] blade rounded. The other rounded side of the blade is used to safely ascertain the complete nuclear division close to the posterior capsule,” he explained.
Improved indications
An earlier instrument, the Universal Prechopper, was used during the counter prechop technique to decrease the amount of stress placed on weak ciliary zonules. The sharp Universal Prechopper, used in combination with a nucleus sustainer, allowed safe insertion into harder nuclei, Dr. Akahoshi said.
These cases can now be easily handled with the increased sharpness of the Hybrid Prechopper tip, according to Dr. Akahoshi. The modifications should make these techniques more accessible to all surgeons, including low-volume surgeons, he said.
“With the new Hybrid Combo Prechopper, surgery has become much easier, and I have received a lot of good feedback,” Dr. Akahoshi said.
With the design modifications, Dr. Akahoshi explained, “the Hybrid Combo Prechopper is useful both for karate prechop as well as V-prechop,” a technique described by Eduardo Viteri, MD, as an alternative to the karate technique.
For Your Information:
- Takayuki Akahoshi, MD, can be reached at Mitsui Memorial Hospital, 1 Kandaizumicho, Chiyodaku, Tokyo 101-8643, Japan; 81-3-3862-9111; fax: 81-3-5821-2446; e-mail: eye@bg.wakwak.com. Dr. Akahoshi has no direct financial interest in the products mentioned in this article, nor is he a paid consultant for any companies mentioned.
- ASICO can be reached at 26 Plaza Drive, Westmont, IL 60559; 630-986-8032; fax: 630-986-0065; e-mail: info@asico.com.
- Jared Schultz is an OSN Staff Writer who covers all aspects of ophthalmology. He focuses geographically on Europe and the Asia-Pacific region.