20 EyeWorld Asia-Pacific | September 2024 by Ellen Stodola, Editorial Co-Director The choice between using bimanual or coaxial I/A depends on a number of factors, including the physician’s preference, and the type of case. Rom Kandavel, MD, and Cristos Ifantides, MD, MBA, discussed what they use and what may be beneficial for different cases. CATARACT Comparing Bimanual And Coaxial I/A Dr. Kandavel said that he has been in practice for 18 years, and initially began using a mixture of bimanual and coaxial I/A. He came out of training primarily performing coaxial. In practice, his partner was primarily using bimanual. “After a period of acclimation, I switched over after I was convinced of the benefits of the technique. “I will certainly use coaxial when I teach at different institutions, and there are hybrid models,” he said. Dr. Ifantides uses both bimanual and coaxial I/A. “Very rarely will you find one instrument or technique that will work in every situation better than any other method,” he said. “There’s no perfect technique or tool. We have to adapt to the scenario.” Advantages of coaxial I/A Dr. Ifantides currently prefers coaxial I/A for several reasons. Firstly, it is also used by other surgeons in his practice, so it’s about ease of use for the technicians. “The outcomes are very good, I can get access to everything I need, and I think it’s faster,” he said. For routine cases and when pupil size and dilation are good, Dr. Infantides thinks coaxial is the best method. Dr. Kandavel said he would choose to use coaxial I/A in some cases, specifically if he was averse to creating a second paracentesis. “There are not a lot of scenarios where you can’t fit a second paracentesis, but it could happen if the paracentesis was near a preexisting trabeculectomy or if you have a large LRI,” he said. It also depends on surgeon’s preference, and some surgeons don’t want to have to take an additional step to the procedure. However, the time savings in not creating a second paracentesis could be made up by saving time during cortical cleanup, he said. Advantages of bimanual I/A “I think the single biggest advantage is the dexterity and reach that bimanual I/A can afford for cortical cleanup and chamber stability,” Dr. Kandavel said. “Removing the residual cortex after the lens has been placed and getting into the sulcus of the bag as well as 360 degrees around the posterior surface of the anterior capsule is a crucial step in modern refractive cataract surgery. This leaves less cortical material 360 degrees within the capsular bag. This reduces inflammation, asymmetric capsular contraction, IOP, and facilitates IOL exchange in the future.” Coaxial I/A is shown here. Source: Cristos Ifantides, MD, MBA
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