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Non-fragmentation phaco technique removes soft cataracts
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SAN DIEGO — Surgeons of all levels of expertise can learn a new non-fragmentation technique for removal of soft cataracts, according to a speaker.
The new RAPID procedure has a short learning curve, a fair degree of reproducibility, a high safety profile and can be performed by surgeons of all levels of expertise, Shruti Mahajan, MS, said at the American Society of Cataract and Refractive Surgery annual meeting.
Soft cataracts are not easy to crack, and the material may “cheese wire” through the nucleus during that separation. Aspiration is difficult because of the cohesive nature of the nuclear mass, they are difficult to rotate, and there is increased chance of posterior capsular rupture, she said.
“So, we proposed a technique to have an effective, en masse, safe and simple phacoemulsification,” Mahajan said.
RAPID is an acronym-based technique: rotation of the nucleus freely after hydrodissection; alignment of the phaco tip sideways; placement of the phaco tip at the nuclear rim; impale into the nuclear rim; devour/emulsify the nucleus.
“A good sized 5 mm to 5.5 mm continuous curvilinear capsulorrhexis is essential, and in this technique, there is only hydrodissection with no hydrodelineation,” she said.
Mahajan and colleagues performed the RAPID procedure in 54 eyes of 54 patients with a mean age of 46.35 years and observed reduced cumulative dissipated energy, less fluid use, decreased operating time and minimal endothelial cell loss.
“There is no iatrogenic trauma possible to the posterior capsule or to the endothelium or the cornea because of the multiplanar technique,” she said.
There are limitations, however. It is difficult to perform when the capsulorrhexis is small or the nucleus is hard.
“It is only feasible in very, very soft cataracts,” she said. – by Patricia Nale, ELS
Reference: Mahajan S. Technique for soft cataract emulsification. Presented at: American Society of Cataract and Refractive Surgery annual meeting; May 3-7, 2019; San Diego.
Disclosure: Mahajan reports no relevant financial disclosures.