Surgeon: Maintaining balanced fluidics key to successful small-incision cataract surgery

NEW YORK — As the trend in cataract surgery moves toward increasingly smaller incisions, surgeons should expect additional challenges related to working through the narrower entries, according to a surgeon speaking here at the OSN New York meeting.

"The bottom line is, we are going to move toward smaller and smaller incisions," Uday Devgan, MD, FACS, said. "Smaller incisions mean smaller tubing and what I call the ultimate small-incision surgery using 25-gauge flow.

"The only problem is that it is really small because we are using such small incisions, so the challenge is that you are working in a very tight space," he said.

Although basic phacoemulsification systems are straightforward to use, such devices may not provide adequate protection against post-occlusion surge when using high vacuum levels unless the surgeon uses a special phaco tip that allows for aspiration bypass.

Phaco fluidics is particularly important in small-incision surgery because it essentially determines the safety of the procedure, Dr. Devgan said. Thus, surgeons must decrease fluid outflow to maximize efficiency, he said.

Because tubing sizes make a big difference, Dr. Devgan recommended keeping inflow bottles high to maintain a reasonable inflow rate. Also, using smaller tubing to restrict outflow can help prevent surge and improve stability, he said.

Maintaining balanced fluidics is one of the keys to successful surgery, he noted.

"To decrease that surge and [improve] efficiency in the eye, just make sure you are keeping the inflow [rate] significantly higher than the outflow," Dr. Devgan said.