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| ORIGINAL ARTICLE |
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| Year : 2017 | Volume
: 4
| Issue : 3 | Page : 79-81 |
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Soft cataract: Improving surgical safety with modified phacoemulsification
Amarendra Deka
Department of Ophthalmology, Mission Nethralaya, Shillong, Meghalaya, India
| Date of Web Publication | 14-Sep-2018 |
Correspondence Address:
Dr. Amarendra Deka
Mission Nethralaya, Shillong, Meghalaya
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/bijo.bijo_7_17
Purpose: To describe a modified stop and chop technique for managing soft cataract to improve the surgical safety.
Materials and Methods: Capsulorrhexis is performed as usual with a 27-gauge needle. A trench is fashioned using low ultrasonic power. Hydrodelineation is performed by a cannula introducing directly in central lens substance. Hydrodissection follows next, and precise hydroprocedure is achieved. Nucleus is emulsified using ultrasound power, and intraocular lens is implanted.
Results: This technique results in easy rotation and removal of nucleus and epinucleus using low phaco power.
Conclusions: This modified phacoemulsification technique is safe and very effective to emulsify soft to moderate hard cataract where direct chop is not possible.
Keywords: Complication, easy rotation, hydroprocedure, low phaco power, soft cataract
How to cite this article:
Deka A. Soft cataract: Improving surgical safety with modified phacoemulsification. Albasar Int J Ophthalmol 2017;4:79-81 |
| Introduction | |  |
The past couple of decades have witnessed several technical modifications in cataract surgery. Despite recent advances in technique and technology, phacoemulsification in soft cataract is challenging for the majority of young surgeons.
At the same time, numbers of soft cataract surgery are increasing day by day in recent practice owing to increase in awareness among the patients. Several techniques are described for soft cataract;[1],[2],[3] however, scopes of improvement are always desired.
We propose a modified technique to perform precisely phacoemulsification in soft cataract.
| Materials and Methods | | |
All study participants provided written informed consent before enrollment. This prospective study was approved by the Institutional Review Board of Mission Nethralaya, Shillong, Meghalaya.
Surgical technique
A meticulous preoperative evaluation is performed before scheduling phacoemulsification. Surgeries are performed under topical anesthesia. A 2.2 mm corneal incision is made. After continuous curvilinear capsulorrhexis, a central trench is sculpted extending from one edge of capsulorrhexis to the other edge [Figure 1]. Low phaco parameters are used [Table 1]. The depth of the trench is about 70% of the total lenticular thickness. Delineation is performed by rapid injection of a balanced salt solution into the central lens substance using a 29 gauge cannula [Figure 2]. A golden ring within the lens is confirmation of successful delineation. | Figure 2: Cannula is introduced in the central lens substance after sculpting to perform inside-out delineation
Click here to view |
Once hydrodelineation is completed, cannula is penetrated between anterior capsule and cortex to perform hydrodissection [Figure 3]. In cases of posterior subcapsular cataract (PSC), central soft nucleus is emulsified with low ultrasonic power [Figure 4]. In NS2 cataract with PSC, nucleus was emulsified using stop and chop technique. As the nucleus collapses during hydrodelineation due to central trench, the nuclear rotation is easier and phacoemulsification is safer. Epinucleus and cortex are aspirated out, and intraocular lens is implanted. | Figure 3: Cannula is introduced between capsule and cortex after delineation to perform hydrodissection
Click here to view |
| Results | | |
A total of 49 eyes of 37 patients were operated with this modified technique. Seventeen patients were male and remaining 20 patients were female with mean age of 58 ± 4.5 years. Mean follow-up time was 12.5 months. Preoperative visual acuity was 20/40 in 16 eyes, 20/60 in 21, and 20/80 in 12 eyes. Optical biometry was performed in 22 eyes, and in remaining 27 eyes, contact biometry was performed. Cataract grading as per lens opacities classification system III[1] was NS1 + P2–10 eyes, NS1 + P3–13 eyes, P3–9 eyes, P4–8 eyes, and P5–9 eyes.
Mean surgical time was 7 min, and low phaco parameters were used [Table 1]. Best-corrected postoperative visual acuity of 20/20 was achieved in all the cases.
| Discussion | | |
Soft nuclei are not generally conducive to traditional chopping techniques and required alternate technique to remove it safely.[2] Several techniques are described for safe phacoemulsification of soft cataract.[2],[3],[4],[5] However, each technique has its own limitations. Variations are made to make the technique more endothelial cells friendly and lower complication rates.[5] Vasavada and Raj[6] described inside-out delineation in the context of posterior polar cataract; however, certain steps are different in cases of soft cataract as described here.
In this technique of reverse hydroprocedure, we created a central trench; then, hydroprocedure was carried out. As low phaco power is used during this step, it does not stress on the zonules. Surgeons have the option of injecting fluid into the desired plane for cleaving the nucleus with precision. Then, hydrodissection collapses the nucleus at the center due to the space created by the central trench. Furthermore, a chance of posterior capsular pulling is less during hydroprocedure compared to conventional approach. It is also observed that rotation of the nucleus during phacoemulsification was smoother in this procedure. Loose soft nucleus can be emulsified easily by using low phaco power.
Several phacoemulsification techniques are described for soft cataract. All claimed safe surgery and good outcome. In most of the cases, rotation of nucleus is difficult owing to softness of the nucleus. Sometimes, even emulsification of soft nucleus is difficult due to stickiness with epinucleus.
In this modified technique, we have observed that prior sculpting does not stress the zonules. Intralenticular delineation is possible so that surgeon can precisely delineate at the desirable site. This technique results in easy rotation and removal of nucleus and epinucleus. This technique is recommendable for soft to moderate hard cataract where direct chop is not possible.
| Conclusion | | |
Soft cataract management is challenging for the majority of eye surgeons. By simple modification of technique, management of soft cataract can be made simpler and safer.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Chylack LT Jr., Wolfe JK, Singer DM, Leske MC, Bullimore MA, Bailey IL, et al. The lens opacities classification system III. The longitudinal study of cataract study group. Arch Ophthalmol 1993;111:831-6.  |
| 2. | Braga-Mele R, Khan BU. Hydro-chop technique for soft lenses. J Cataract Refract Surg 2006;32:18-20. |
| 3. | Fine IH. The chip and flip phacoemulsification technique. J Cataract Refract Surg 1991;17:366-71. |
| 4. | Güell JL, Vázquez M, Lucena J, Velasco F, Manero F. Phaco rolling technique. J Cataract Refract Surg 2004;30:2043-5. |
| 5. | Koch PS, Katzen LE. Stop and chop phacoemulsification. J Cataract Refract Surg 1994;20:566-70. |
| 6. | Vasavada AR, Raj SM. Inside-out delineation. J Cataract Refract Surg 2004;30:1167-9. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1]
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