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Surgeon-bent cystotome simplifies prechop technique in cataract surgery
A cost-effective prechop technique in moderate-density nuclei yields a shorter learning curve and positive postoperative results.
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A cystotome-assisted prechop technique for moderate-density nuclei can simplify cataract surgery with a shorter learning curve and effective postoperative outcomes, according to one surgeon.
The technique uses a surgeon-bent cystotome to bisect the nucleus in the capsular bag with a Nagahara chopper.
“The [cystotome-assisted prechop] technique is a highly efficient prechop method for removing cataracts without a grooving and sculpting approach, leading to a decrease in ultrasound energy delivered,” Baosong Liu, MD, told Ocular Surgery News. “Not requiring any special instruments, it simplifies the previous prechop techniques with a short learning curve.”
Technique
A Barraquer needle holder is used to bend one-fourth to one-half of a 27-gauge needle tip down, while the bevel is held up. While maintaining the needle orientation, the needle is bent near the hub at an angle of 60° to 90° at the tip and slightly less at the hub, according to a paper published in the Journal of Cataract and Refractive Surgery.
Next, the nucleus is engaged by the cystotome followed by a pull toward the main incision, while the chopper is slid under the cortex and capsule through the paracentesis. The blade should be perpendicular to the equator of the nucleus, with the hook tip toward the optic nerve. Then the cystotome is repositioned, sitting just inside the capsular rim at the 11 o’clock position, the paper said.
The chopper and cystotome are maintained in apposition at the same radial meridian. The chopper is pulled obliquely up toward the center, while the cystotome is pushed obliquely down to provide a counterforce. The nucleus is then split into two hemispheres and rotated 90°. The chopper is slid under the capsule again and pulled to the center, which creates two quadrants, and is done again in the other hemisphere.
Learning curve
According to the paper, the technique has been most successful in moderate-density nuclei, which are preferred for beginning surgeons. It was found that chopping the nucleus into pieces was easy, and there were significant decreases in phaco time and energy.
The technique has also been used in cataracts with soft and hard densities. For experienced surgeons, the procedure can be easily performed in soft cases, but any technique would be more of a challenge in hard cases, Liu said.
“The hard nucleus cataracts are relative contraindications for performing this technique according to the severity of disease and the experience of the surgeon,” Liu said.
In cases with complications, the incidence of posterior capsular break and zonular dialysis was higher. In hypermature cataracts, the fluid cortex with the mobile dense nucleus also caused difficulties. Proper placement of the chopper and cystotome, as well as deeply placing the cystotome firmly into the nucleus, is important in successfully performing the bisection, Liu said.
Technique development
Thousands of cases have been successfully treated using this technique in urban medical centers and rural hospitals throughout China, Liu said. The technique has been offered in an open course via WeChat to more than 4,000 ophthalmologists, while a corresponding CME course has been followed by more than 20,000 observers, Liu said.
Although this is an alternative technique to the growing use of femtosecond laser platforms, it is a cost-effective solution compared with the large financial costs of femtosecond devices, particularly in developing countries.
“The [cystotome-assisted prechop] technique provides a low-cost and highly effective prechop approach for surgeons to manage the nucleus and reduce intraocular energy injury, whether or not they have mastered the phaco chop technique,” Liu said. – by Kristie L. Kahl
Reference:
Chen X, et al. J Cataract Refract Surg. 2015;doi:10.1016/j.jcrs.2014.11.015.For more information:
Baosong Liu, MD, can be reached at Cataract Service, Wuhan Eyegood Ophthalmic Hospital, 403 Fazhan Road, Wuhan, China 430019; email: 2590588576@qq.com.Disclosure: Liu reports no relevant financial disclosures.