This article is more than 5 years old. Information may no longer be current.
Surgeon: New technique provides greater endothelial protection in phaco
Click Here to Manage Email Alerts
GOIANIA, Brazil — A new technique called MaxPro phaco provides maximum endothelial protection and a new, easier solution for intraoperative complications such as capsular bag tears.
"The MaxPro technique consists in performing the phaco with a single viscoelastic injection," said Carlos Figueiredo, MD, of São José do Rio Preto, Brazil, at the International Congress of Cataract and Refractive Surgery.
In many cases of cataract with moderate hardness, the endothelium can be hurt as the nucleus pieces hit it, he said, especially when the surgeon does not use enough viscoelastic. When that happens, the surgeon has to reinsert the injection to add more viscoelastic, which can be difficult.
"That's why I came up with this system, in which we hold the phaco [tip] with the left hand and the viscoelastic injector with the right hand," he explained. The technique must be done with pre-chop, and as the surgeon picks up the nucleus fragments, viscoelastic is injected as needed.
Dr. Figueiredo studied 20 cataracts patients with hardness of +2 in both eyes. He performed phaco without MaxPro in their right eye and phaco with MaxPro in their left eye.
At 6 months, 12 patients (60%) operated without MaxPro had lost up to 20% of endothelial cells, and eight patients (40%) had no endothelial cell loss. Of the 20 eyes operated with MaxPro, four (20%) had lost 7% of their endothelial cells, and 16 (80%) had no endothelial cell loss.
"This shows the additional protection that this technique provides. The harder the lens, the more important this protection is. This statistic will probably be lower for softer lenses and higher for harder lenses," he said.
One day after the surgery, there were almost no corneal striae in the eyes operated with the new technique. Dr. Figueiredo also showed a case of a white cataract in which there were no striae 1 day after the surgery. "If the MaxPro technique had not been used, there probably would have been many more corneal defects," he noted.
He showed an eye in which the capsular bag had been torn during the procedure, and the results at 10 days postop were just as good as if the capsular bag had not been torn.
"When the capsular bag is torn, the first thing you have to do is inject viscoelastic to push the vitreous back. If you are using the MaxPro technique, you can inject the viscoelastic with your left hand immediately," he said. He called this procedure floating MaxPro phaco because the vitreous is pushed back by inserting viscoelastic with low irrigation and creating a cushion from which the remaining pieces can be picked up.
To perform this technique, Dr. Figueiredo developed a special sleeve for the injector, which provides better support and allows the surgeon's left hand to move freely and inject the viscoelastic without the help of his right hand.