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Technique allows IOL insertion through sub-2-mm incision after coaxial phaco
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BEIJING — A technique for cataract surgery that allows IOL insertion through an incision of less than 2 mm following coaxial phacoemulsification will lead ophthalmologists to say "Sayonara, Bimanual," according to Takayuki Akahoshi, MD.
He described his novel technique at an Alcon sponsored satellite symposium here at the Asia-Pacific Association of Cataract & Refractive Surgeons meeting.
Dr. Akahoshi said his "Sayonara" technique uses a counter-traction method for IOL insertion. He also said his coaxial phaco technique requires none of the “expensive and unfamiliar equipment” needed for bimanual microincision cataract surgery (MICS).
“We can use conventional instruments and techniques, and it is not necessary to use expensive capsulorrhexis forceps or unfamiliar irrigating choppers” such as those needed for bimanual MICS, Dr. Akahoshi said.
The technique is performed with a flared phaco tip with a small-diameter sleeve on the Alcon Infiniti phacoemulsifier, he said.
In eyes with dense cataracts, Dr. Akahoshi said, he supports the nucleus with a device called a nucleus sustainer. Using the ASICO Universal Prechopper, he divides the nucleus into smaller pieces to allow easier emulsification.
Following cataract removal, Dr. Akahoshi inserts a 6-mm Alcon AcrySof IOL through the unenlarged sub-2-mm phaco incision with a standard cartridge injector using the counter-traction technique.
Loading the C-cartridge, Dr. Akahoshi places both haptics on the optic and places the lens in the cartridge at a downward angle. After affixing the cartridge to the injector handpiece, he stabilizes the eye with the nuclear sustainer, which also serves to provide a counterforce to the injection. The cartridge will not fit through the ultrasmall incision, so Dr. Akahoshi places it just at the edge of the incision and pushes the plunger to inject the lens into the eye through the unenlarged sub-2-mm incision.
A key to the technique, Dr. Akahoshi said, is the elbow joint between the optic and the haptic on the AcrySof lens. When he pushes the lens through the incision, “the elbow can easily open the incision and open into the anterior chamber,” he said.
Dr. Akahoshi said any AcrySof lens works using this technique because of this elbow design.
Other key aspects to performing the procedure successfully, Dr. Akahoshi said, are using the proper phaco settings, maintaining a firm anterior chamber with viscoelastic, using counterforce properly with the nuclear sustainer, continuously inserting the lens once insertion has begun, and using a new cartridge with every insertion.
“With these techniques we now can perform sub-2-mm incision coaxial surgery successfully,” Dr. Akahoshi concluded.