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Surgeon explains flip-and-slice supracapsular cataract disassembly technique
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NEW YORK — A flip-and-slice supracapsular technique can be efficient, fast and safe in soft, medium and hard lenses during cataract disassembly, according to a speaker here.
“A prepared surgeon, when he or she walks into the operating room, has to have a fully loaded tool kit because you never know what you’re going to expect when you start your cataract. And as a result, the supracapsular cataract surgery technique may end up being one of your tools,” Cynthia Matossian, MD, FACS, said at OSN New York 2015.
Cynthia Matossian
Matossian recommended using a flattened tip cannula to hydrodissect and hydroprolapse the lens out of the capsular bag using a 5-mm capsulorrhexis.
The first step is to “burp” or remove some of the ophthalmic viscosurgical device (OVD) out of the capsular bag and anterior chamber before hydrodissection because otherwise there may not be enough room and there could be a posterior capsular rupture, Matossian said.
The next step is to hydrodissect gently and repeatedly, while never forcing the lens to prolapse out of the bag.
“Four attempts is my maximum. If after four times that lens does not hydroprolapse out, I abort that technique and go to something else,” she said.
Lastly, the lens is flipped down to the iris plane, the space between the posterior surface of the cataract and the corneal endothelial dome is filled with OVD, and phacoemulsification can be performed.
“It is efficient, fast and safe, even in small pupils,” Matossian said. “There is less risk for capsular damage because you’re working outside of the capsule. There is less stress on the zonules. And there is excellent visibility.” – by Kristie L. Kahl
Disclosure: Matossian reports she is a consultant for Abbott Medical Optics, Alcon Laboratories, Allergan, Bausch + Lomb, Marco, Physician Recommended Nutriceuticals and TearLab; is a speaker for Abbott Medical Optics, Alcon Laboratories, Allergan, Bausch + Lomb, Ocular Therapeutix, Physician Recommended Nutriceuticals and TearLab; performs contracted research for Physician Recommended Nutriceuticals, Shire, Softec and TearLab; and has ownership interest in Physician Recommended Nutriceuticals, Rapid Pathogen Screening, Strathspey Crown and TearLab.