Phaco windmill technique minimizes zonular stress, requires no chopping

J Cataract Refract Surg. 2011;37(7):1179-1182.

A novel phacoemulsification technique enables rapid lens removal without division or chopping of the lens nucleus, according to a study.

"Compared with previous techniques, the phaco windmill technique presents shortened surgical and phacoemulsification time, reducing endothelial damage. This finding must be replicated in future studies," the study authors said. "The technique is particularly effective for cataracts with small soft nuclei and weak zonules. It is highly recommended for trainees, as well as for expert surgeons."

The procedure involves hydrodissection and hydrodelineation to separate the inner nucleus and epinuclear shell from the capsular bag; aspiration of the epinucleus to create space and capture the inner nucleus; and removal of the inner nucleus through rotation and aspiration with a high vacuum setting and little or no phaco energy. It is performed through a clear corneal incision with two side-port incisions.

The authors said that the phaco windmill technique has been performed in about 90% of more than 200 cataract cases in their clinic since late 2009. Safe and uneventful phacoemulsification and IOL implantation were undertaken with the posterior capsule intact in all cases.

The procedure has yielded positive outcomes in cases involving soft nuclei, weak zonules, small pupils, dense cataracts and previous vitrectomy. No intraoperative complications such as posterior capsule rupture, anterior capsule tear or zonulysis were reported.

Preliminary results of a study comparing the conventional phaco-chop technique and the phaco windmill technique have shown that the new technique required less phaco energy and resulted in fewer postoperative complications than the standard method, the authors reported.