Phaco-out cataract surgery

Session Details

Session Title: Combined Cataract Surgery: Techniques/Practice Styles

Session Date/Time: Tuesday 13/09/2016 | 14:00-16:00

Paper Time: 15:28

Venue: Auditorium C6

First Author: : P.Ramasamy IRELAND

Co Author(s): :    N. Horgan   P. Talty   J. Doris   R. Khan           

Abstract Details

Purpose:

Phacoemulsification methods such as divide and conquer and phaco-chop are widely used by cataract surgeons. However, the “phaco-out” method is less-popularised. It has been reported to be as safe as the stop-and-chop method with similar rates of complications. The purpose of this paper is to describe a new variation of the phaco-out technique using the safer, blunt Drysdale nucleus manipulator as a chopper.

Setting:

St. Vincent's University Hospital, Dublin, Ireland

Methods:

Corneal incision and capsulorhexis is created in a standard fashion. Hydrodissection is performed by injecting sufficient fluid at 2 and 10 o'clock positions to partially prolapse the inferior half of the lens out of the capsule. Using the phacoemulsification handpiece, the nucleus is impaled and stabilised with vacuum. With the Drysdale nucleus manipulator, a 2-3 clock hour segment of the lens is chopped using horizontal motion from the equator towards the nucleus, at the iris plane followed by phacoemulsification of the fragment. The process is repeated by impaling the nucleus, rotating remaining lens above the iris plane, chopped and phacoemulsified.

Results:

Retrospective review of 56 consecutive phaco-out cataract surgeries performed by a single surgeon was carried out. There were a variety of surgical complexities; 13 required mechanical pupil dilation (23.21%); 11 with white cataract (19.64%); 2 with PXF (3.57%). 48 patients (85.71%) achieved logMAR VA ≤ 0.2. Five patients (8.93%) achieved logMAR VA 0.3 - 0.4. Of these, 1 had posterior capsule opacification, 1 had macular degeneration, and 1 had intraoperative posterior capsule rupture and subsequent posterior capsule opacification. 2 patients (3.57%) achieved logMAR VA 0.6, both with macular degeneration. 1 patient (1.78%) had persistent postoperative corneal oedema with logMAR VA 0.9. The visual outcomes and complication rate were in keeping with other published studies using different surgical technique.

Conclusions:

The phaco-out technique is a safe and effective method of cataract surgery. It has the advantage of using the safer, blunt Drysdale nucleus manipulator as a chopper. It is fast, safe and does not require endocapsular use of phacoemulsification and thus, may reduce the rate of posterior capsule rupture. It is also of particular use in difficult cases, such as white cataract, pseudoexfoliation or zonular weakness.

Financial Disclosure:

NONE