Large bore phaco tip, femto laser lens fragmentation reduce effective phaco time

Phacoemulsification techniques have led to smaller incision sizes with increased wound stability, elimination of corneal sutures, and reduction or elimination of surgically induced corneal astigmatism. Corneal clarity and optimal vision after cataract surgery are dependent on many factors, most importantly the status of the corneal endothelium, and causing the least amount of endothelial damage during phacoemulsification is a priority for all cataract surgeons. Phaco tip trauma and mechanical contact of lens nuclear fragments are considered principal causes of endothelial damage. Other factors include age of the patient, anterior chamber depth, axial length, lens thickness, phacoemulsification time and power, infusion volume, effective phacoemulsification time and postoperative ocular inflammation.

The combination of femtosecond laser techniques with phacoemulsification is rapidly changing the field of cataract surgery. Femtosecond laser pretreatment of the cataractous lens has been shown to significantly reduce the effective phacoemulsification time and, hence, cause less potential iatrogenic injury to the corneal endothelium. Further optimization of lens fragmentation patterns and improved surgical techniques can also decrease potential corneal endothelial cell loss during cataract surgery.

In this column, Drs. Gollamudi and Crothers describe using a large bore phaco tip combined with femtosecond laser nuclear fragmentation. Continued long-term evaluation is needed to establish safety, reproducibility and efficacy of this cataract surgery modification.

Click here to read the full publication exclusive, Surgical Maneuvers, from Ocular Surgery News U.S. Edition, October 10, 2014.