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Ravi Patel, Simrun Singh Virdee, Rynda Nitiahpapand, Corrado Gizzi, Shafi Balal, Anant Sharma; Phaco sleeve-assisted hydrodissection in cataract surgery: a novel technique for more controlled hydrodissection.. Invest. Ophthalmol. Vis. Sci. 2019;60(9):2057.
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© ARVO (1962-2015); The Authors (2016-present)
Hydrodissection in cataract surgery can be complicated by a surge in intraocular pressure, iris prolapse, and further sequaelae, particularly in eyes with mid-dilated pupils, shallow anterior chambers or at risk of intraoperative floppy iris syndrome. We describe preliminary outcomes of a new technique, phaco sleeve-assisted hydrodissection (PSHD), which aims to reduce these complications by sealing the main wound, and controlling egress of fluid away from the plane of the iris.
After capsulorrhexis, a phacoemulsification sleeve is inserted through the main incision, sealing it. The sleeve is advanced until its tip reaches the centre of the anterior chamber (Fig. 1). Hydrodissection is then performed with a cannula via the side port without removal of the viscoelastic. Following hydrodissection, the sleeve is withdrawn and remaining surgery carried out as usual. A single operating surgeon performed cataract surgeries with PSHD in cases where risk factors for iris prolapse and intraoperative floppy iris syndrome were identified. We report experiences with the technique, as well as intraoperative and short-term postoperative complications rates.
45 patients underwent uneventful cataract surgery using PSHD. Intraoperatively, in all cases, the anterior chamber remained formed without collapsing. A fast and effective hyrodissecting wave together with less turbulence at the level of the iris plane was often noted. The phaco sleeve exhibited good manoeuvrability. An occasionally displaced phaco sleeve could be easily and safely repositioned. There were no cases of the phaco sleeve contacting the corneal endothelium, no cases of iris prolapse or other intraoperative complications, and no postoperative complications at 5 week follow-up.
PSHD is a simple technique that has the potential to offer a more controlled hydrodissection, with minimal extra resources and no substantial modification to conventional surgical steps. We expect a sealed main wound and egress of fluid from a more central position in the eye has less potential for complications. Although the preliminary data suggest this technique is easily learnt, safe, and effective, controlled studies with larger patient numbers are needed to verify this hypothesis.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
Phacoemulsification sleeve in situ, to seal the main wound and shift the point of fluid egress centrally away from the plane of the iris.
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