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Surgeon: New phaco approach may be safer for posterior subcapsular cataracts
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NUREMBERG, Germany — A phacoemulsification technique that first removes nuclear material from around the periphery of a posterior subcapsular cataract may reduce the rate of complications associated with surgery for this type of lens opacity, said one surgeon here.
M.D.K. Ramalingam, MD, told attendees at the German Ophthalmic Surgeons meeting that posterior subcapsular cataracts are often challenging to remove because the lens capsules can be particularly weak, increasing the risk of dropping the nucleus. The risk is increased when surgeons use hydrodelineation or hydrodissection, which can cause or enlarge an existing capsular tear, he said.
To avoid such complications, Dr. Ramalingam developed a technique he calls encirclage phacoemulsification. In the procedure, phaco begins with a standard scleral tunnel incision and a continuous curvilinear capsulorrhexis. During phaco, however, the probe is moved in a circular fashion around the periphery of the lens. Low ultrasound power and a low vacuum setting of 50 mm Hg are used to remove the peripheral nuclear material, leaving the central core overlying the opacified area of the lens, Dr. Ramalingam said.
He said this procedure is possible because the nuclei in such eyes are always soft and do not need to be mobilized for phaco to proceed.
After the peripheral lens material is removed, the remaining island of opacified lens material is removed using an irrigation and aspiration handpiece and high vacuum of 400 mm Hg, he said.
“One can also use the ultrasound tip to remove the entire nuclear core,” he said.
Dr. Ramalingam said he has used this surgical approach in 20 eyes of 20 patients, including six eyes with existing capsular defects. He said no eyes suffered a loss of cortical material and no nuclear fragments fell into the vitreous cavity. Five eyes required limited anterior vitrectomy.
Dr. Ramalingam noted that visual acuity improved to 6/6 in 17 of the 20 eyes (85%) at 6 weeks follow-up.