This article is more than 5 years old. Information may no longer be current.
Letter re: Flip-and-slice supracapsular cataract disassembly technique
Click Here to Manage Email Alerts
To the Editor:
In the Dec. 10, 2015, issue of Ocular Surgery News, Dr. Matossian describes a “flip-and-slice supracapsular cataract disassembly technique.” This technique has many advantages, including a lower incidence of capsular rupture and the ability to avoid floppy iris issues because phacoemulsification is performed in a relatively safe zone. By prolapsing the nucleus and rotating it into a position that is more or less perpendicular to the capsule, small pupil phacoemulsification is also not an issue because the lens is held in place during phacoemulsification by the “fish-mouthed” pupillary margin.
As a resident at the New York Eye and Ear Infirmary, Dr. Charles Kelman taught us the “Kelman prolapse maneuver” in the late 1970s/early 1980s at Lydia Hall Hospital. His maneuver was to prolapse the entire nucleus into the anterior chamber, parallel to and resting on the iris. Although he was a visionary, no one knew about the fragility of the corneal endothelium at that time, causing many early corneas to be sacrificed. In the 1980s, I learned the David Brown prolapse maneuver by observing him performing surgery at his facility in Fort Myers, Fla.
To this day, I prolapse one edge of the nucleus from the capsular bag to a vertical position on almost all cataract procedures. After capsulotomy, gentle continuous irrigation under the superior or inferior lip of the anterior capsule will lift the edge of the nucleus 90° away. The irrigation cannula can then be used to gently sweep the lower (non-prolapsed) edge of nucleus posteriorly initially and then parallel to the posterior capsule, which elevates the opposite upper (prolapsed) pole of the nucleus even further to the vertical position. Any preferred hook can be placed across the upper edge of the elevated nuclear pole to stabilize the nucleus during phacoemulsification, which can be performed almost entirely within or above the pupil. The hook can be used to control and feed nuclear material to the phacoemulsification needle, rather than chasing nuclear fragments with the phaco needle.
Although there is a somewhat steep learning curve to nuclear prolapsing and the technique requires rather demanding bimanual control of the nucleus, in our practice there are many posterior capsules that owe their intact existence to this technique. I have always been grateful to Drs. Kelman and Brown, and now Dr. Matossian, for their innovation.
Edward Deutscher, MD, MBALargo, Fla.