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Noncracking, nonchopping phaco technique effective for soft nuclei
Turning the thinned nucleus 180° around its horizontal axis is a key step to the rock ’n’ roll technique.
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The Münchner rock ’n’ roll dance step from Germany was the inspiration for a noncracking and nonchopping phacoemulsification technique invented by Detlef Uthoff, MD, FSES, FABI, medical director of Bellevue Eye Hospital in Kiel, Germany.
“After using all different kinds of phaco techniques, there still lacked an effective way to handle a soft nucleus,” Uthoff, who developed the rock ’n’ roll method in 1999, said. “For those sticky nucleus materials, no other technique was available at the time, so the idea of a noncracking, nonchopping phaco technique was born, which would not use too much phaco power or unnecessary maneuvers on a soft nucleus.”
The greatest challenge in developing the technique was turning the thinned nucleus 180° around its horizontal axis.
“No one had previously tried such a maneuver,” Uthoff told Ocular Surgery News. “One might be afraid of hurting the zonula, but after thinning the nucleus, there is enough space left for the move.”
Detlef Uthoff
Key steps
In the Journal of Cataract and Refractive Surgery, Uthoff described his rock ’n’ roll phaco technique.
“First, the nucleus is hollowed out (sculpting), then turned around its sagittal axis in two 180° steps (nudging),” he said.
Returning to the starting point, the key step is then executed. “The nucleus is turned 180° around its horizontal axis (flipping) and kept below the pupillary level by a spatula,” he said. The final step is emulsification of the epinucleus.
To increase the likelihood of success with the technique, surgeons should start with a soft nucleus.
“It is also very important to perform a complete hydrodissection and hydrodelineation, resulting in a complete mobility of the nucleus, so that the key step can be performed without complication, prior to which the nucleus is thinned at least up to 50%,” Uthoff said.
It is highly recommended that the thinned nucleus be kept within or below the pupillary level by a spatula far away from the endothelium when emulsifying it from the rear side.
“In a soft nucleus, this technique is extremely efficacious by not using any cracking or chopping maneuvers,” Uthoff said. “By doing so, the capsular bag is protected more than when using chopping or cracking techniques or any kind of ‘freestyle.’”
Uthoff said the safety of any phaco technique is dependent on the experience of the surgeon: “In my experience using rock ’n’ roll phaco, safety is reached earlier in the surgeon’s career as opposed to the learning curve for other current phaco techniques.”
Advantages
Since 1999, Uthoff has performed approximately 2,500 cataract procedures using his technique.
“Our own observations show there are no disadvantages compared to other common phaco techniques such as divide-and-conquer and variations of mechanical fragmentation based on nucleus cracking,” he said.
Due to the limited number of maneuvers within the capsular bag while performing rock ’n’ roll phaco, the technique “potentially reduces the loss of endothelial cell density, shortens surgery time and is easier to learn for beginners,” Uthoff said. “Overall, this nonchopping, noncracking rock ’n’ roll phaco technique allows for fast and safe emulsification of the lens nucleus, with maximum distance from the corneal endothelium.”
The technique is also applicable for small pupils, but it is especially suitable for emulsifying harder nuclei. “However, novice surgeons should begin with cases of only soft nuclei,” Uthoff said.
For femtosecond laser-assisted cataract surgery, the rock ’n’ roll technique “eases significantly the emulsification and aspiration of the nucleus after its fragmentation by the femto laser, for which a corresponding study has already been established,” Uthoff said. – by Bob Kronemyer