EyeWorld Asia-Pacific March 2013 Issue

24 EWAP CATARACT/IOL March 2013 torsion, low vacuum, and moderate aspiration. When the foot pedal of the phacoemulsification unit is depressed, irrigation and aspiration is introduced at a fixed rate. Various settings can be used depending on the phacoemulsification machine used. The next sequence of events occurs simultaneously. The foot pedal is depressed and the anterior capsule is punctured with the phaco tip. This creates the initial anterior capsule puncture, and the phaco tip is introduced into the lens (Figure 2A). Milky cortex will become visible and is quickly aspirated into the handpiece. The phaco tip is further embedded into the nucleus to sculpt the nucleus and further remove the milky cortex. This sculpting motion can be made repeatedly, with each successive motion removing more of the lens. Once the surgeon determines that enough of the cortex and fluid is removed, the phaco handpiece is removed from the eye. OVD is then injected to refill the anterior chamber and the nonuniform tear of the anterior capsule can be visualized (Figure 2B). Next, using a capsulorhexis forceps, a leaflet of the anterior capsule can be grasped, and the capsulorhexis can be completed in a curvilinear fashion (Figure 2C). Hydrodissection can then be performed and nucleus removal can be performed in the usual fashion. Discussion Phaco capsulotomy is an effective technique to debulk the lens and remove the impetus for the Argentinian Flag Sign to occur. The main complication that I have encountered using this technique is wound burn. This occurs when the phaco tip embeds immediately into the nucleus and occludes, leading to an interruption of aspiration. Wound burn can be effectively countered by pulsing the foot pedal upon entry of the phaco tip or by using burst mode. Pearls to performing this technique include using a second instrument and using a 2.75-mm wound and larger phaco tip. Eyes with mature intumescent lenses frequently have shallow anterior chambers, and when the phaco tip is introduced, the eye will be pushed to a nasal position. A second instrument can be placed into the paracentesis to pull the eye back to an ortho position before the phaco capsulotomy is performed. A larger wound and phaco tip are also advantageous because there is less chance of the handpiece becoming occluded, thereby decreasing the risk of wound burn and facilitating removal of the dense lens fragments. In conclusion, phaco capsulotomy is a safe and effective technique for preventing the Argentinian Flag Sign. By using the phaco tip to simultaneously create an anterior capsular puncture and remove the liquefied cortex and nucleus, the lens/capsule apparatus is decompressed and the impetus for the capsulorhexis to spontaneously tear outward is eliminated. EWAP References 1. Rao SK, Padmanabhan P. Capsulorhexis in eyes with phacomorphic glaucoma. J Cataract Refract Surg. 1998;24:882-4. 2. Kara-Junior N, de Santhiago MR, Kawakami A, Carricondo P, Hida WT. Mini-rhexis for white intumescent cataracts. Clinics (Sao Paulo). 2009;64:309-12 2. Bissen-Miyajima H. Ophthalmic viscosurgical devices. Curr Opin Ophthalmol. 2008;19:50-4. Editors’ note: Dr. Teng is affiliated with the Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, NY, USA; New York Medical College, Valhalla, NY, USA; and New York University School of Medicine, New York, NY, USA. He has no financial interests related to this article. Contact information Teng: cctengmd@gmail.com Preventing - from page 22 025,$ 6 $ UXH *HRUJHV %HVVH $QWRQ\ )5$1&( 3KRQH )D[ PRULD#PRULD LQW FRP ZZZ PRULD VXUJLFDO FRP 7KH FRPELQDWLRQ RI D KLJK WHFK FRPSRVLWH PDWHULDO DQG WKH WUDGLWLRQDO VWDLQOHVV VWHHO 7KH EHVW FRPSURPLVH EHWZHHQ SHUIRUPDQFH DQG FRVW HIIHFWLYHQHVV 0RULD PDGH LQ )UDQFH TXDOLW\ DQG NQRZ KRZ $Q LQQRYDWLYH DIIRUGDEOH DQG FRQYHQLHQW FRQFHSW The new generation of ophthalmic instruments E\ Come and discover this innovative reusable range of instruments at ASCRS San Francisco Booth #2417