Panel debates ‘best choice’ for MICS

LISBON, Portugal — After designing numerous irrigating choppers and having used many others, Alessandro Franchini, MD, said the best choice for microincision cataract surgery is the front opening chopper with a 19-gauge diameter.

“As a straightforward consequence of the Poseuille law, the 19-gauge open ended chopper guarantees the best irrigation of 77.20mm/min, with the bottle placed at 140cm,” he said here at a panel discussion during the European Society of Cataract and Refractive Surgeons meeting. “In comparison, both the 20 gauge and all the choppers with lateral openings are far less efficient.”

The problem of increased turbulence created by the irrigation flow being concentrated on just one point has been overcome by the introduction of the most recent advances in phaco technology.

“Turbulences are insignificant in contrast with the followability and holdability of the new software,” Dr. Franchini pointed out. For better insertion and maneuvering, the chopper blade should be angled at 110°, he added.

Peter De Lint, MD, agreed, and added that a further advantage of front opening choppers is the capability of converting to divide-and-conquer technique in the course of surgery.

“Most surgeons are used to divide-and-conquer, and when they start using MICS they are likely to prefer an instrument that will allow them to get back to their old habits if the procedure is not coming out successfully,” he said.

A new oval shaped 20-gauge irrigating chopper with a 70° angulation was introduced during the session by Fernando Arraujo Gomez, MD.

“When a circular instrument is inserted through an incision, it creates an oval opening with too much empty space for leakage on both sides of the circular device. This forces you to place the bottle in a very high position or to set high flow of about 75mm. Some leakage is necessary, but not too much,” he said.