One-Handed Rotational Phacoemulsification Technique

Abstract

Introduction: We described a one-handed rotational phacoemulsification technique to decrease phaco time and power, and surgical stress on the cornea in eyes with different types of cataract.

Methods: In this technique a single sutureless corneal incision was made without any side-port incision. After hydrodissection and hydrodelamination were performed, a phaco tip was positioned in contact with the nucleus beside the capsulorhexis edge. By using a peristaltic pump, phacoemulsification was started with high levels of vacuum to keep the probe tip on the edge of the lens and to ensure the rotation of the nucleus, and with low ultrasound energy. The torsional mode used required less occlusion time and volume of fluid. The inclination of the tip was modified to 45-degree, directing it toward the lens center. So the nucleus was aspirated from the periphery toward the center by a rotational movement.

Results: The eye in the technical video had a NC4-NO4 cataract. The preoperative vision in this eye was 20/100 with no improvement with refraction. On postoperative day 1, visual acuity had improved to 20/20. We recorded low intraoperative parameters including ultrasound time (21.4 sec), phacoemulsification power (73%), balanced salt solution used (31 mL) and cumulative dissipated energy (7.27) at the conclusion of the case. After 1 month, Central Corneal Thickness changed from 504 µm to 516 µm, and Endothelial Cell Loss was 1.15%.

Conclusion: This technique uses a single clear corneal incision, high vacuum and low ultrasound power to reduce the exposition to excessive surgical maneuvers, fluid turbulence and ultrasound energy.

Keywords: cataract surgery; one-handed phacoemulsification; phaco-rolling; single corneal incision.

Figure 1

(A) The 15-degree phaco tip is positioned in contact with the nucleus–epinucleus surface so the nucleus was turned on its horizontal axis within the capsular bag. (B) The lens begins to rotate when phacoemulsification is started using a short series of ultrasound. (C) The volume is progressively reduced from the periphery toward the center by phacosuction and emulsification. (D) Also the epi-nucleus is emulsified and aspirated. (E, F) The irrigation/aspiration of residual cortex and the posterior capsule polishing are performed.