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VIDEO: V-slice allows phacoemulsification of a soft lens
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The purpose of this technique is to help with phacoemulsification of soft lenses, which can be surprisingly resistant to the usual tactics.
The operation begins per routine: After the creation of a normal diameter capsulorrhexis, a blunt-tipped chopping instrument (we like the Seibel handpiece) is slid across the nuclear face, underneath the anterior capsule and around the lens equator at the 5 o’clock and 7 o’clock positions. Then, it is passed through the body of the lens (at approximately one-half to two-thirds depth), aiming for the 12-o’clock position and stopping immediately if any resistance is encountered to avoid putting undue stress on the zonules. The combination of these two passes produces a central, pre-sliced, v-shaped nuclear piece, bounded laterally by two crescentic pieces. Gentle hydrodissection and hydrodelineation are then performed, and viscoelastic is injected in the cracks between the pieces to further separate them. Phacoemulsification can then proceed, usually beginning with the central triangular piece first because it is frequently completely separated and floating at the level of the capsulorrhexis. The two lateral pieces can likewise be removed with the phacoemulsification handpiece and the assistance of a second instrument of the surgeon’s choice.
Soft lenses may resist many of the standard techniques for phacoemulsification because they tend to lack rigid cleavage planes, which can frustrate typical cracking maneuvers, and because they tend to be sticky, so they resist nuclear rotation. As a result, mobilizing and segmenting them can be surprisingly challenging, especially for beginning surgeons. The v-slice was therefore designed to permit nuclear division and elevation without depending on either cracking or rotating. It can also be performed one-handed and using the instrumentation that the surgeon is likely to already possess. Its chief drawback, however, is that it may be suitable exclusively for soft lenses because attempting the maneuver against harder lenses may place undue stress on the lens zonules.
In the past 3 years, approximately 200 patients have been operated upon at Callahan Eye Hospital, Birmingham, USA, with the v-slice, and no complications related to the technique have been encountered, which is perhaps a testament to its inherent safety, considering that most of these procedures have been performed by residents learning to operate.
Disclosure: The authors report no relevant financial disclosures.