1 / 12

Second instrument use during Phacoemulsification – does it really protect the posterior capsule?

Second instrument use during Phacoemulsification – does it really protect the posterior capsule?. James Tee Ameet Shah Brian Little Royal Free Hospital, London, United Kingdom Authors have no financial interest .

stefan
Download Presentation

Second instrument use during Phacoemulsification – does it really protect the posterior capsule?

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Second instrument use during Phacoemulsification – does it really protect the posterior capsule? James Tee Ameet Shah Brian Little Royal Free Hospital, London, United Kingdom Authors have no financial interest

  2. Does a second instrument protect from posterior capsule aspiration? • Common practice to place a second instrument between posterior capsule and nuclear fragment during phacoemulsification • Intuitively provides added protection against capsular aspiration by the phaco tip • In our experience the posterior capsule can easily wrap around a second instrument and still be aspirated by the phaco tip

  3. Leakage from second instrument use Leakage occurring as a result of incision gape

  4. Incisional Leakage in Coaxial Phacoemulsification • Significant fluid loss occurs with routine second instrument use compared with no second instrument (176 ml vs 75 ml) ✪ • Leakage destabilises chamber • Risk of posterior capsule aspiration increases with capsular fluctuation • Logically this risk is reduced if segment removal is performed without a second instrument • Liyanage S, Wong C, Angunawela R, Little BC. Incisional leakage causing chamber instability • in coaxial phacoemulsification. J Cataract Refract Surg (accepted Jan 2009 JCRS-08-634R1)

  5. Purpose of Study • But is the second instrument being used optimally whilst it is routinely placed in the eye during segment removal? • We undertook an observational analysis of the actual use of the second instrument during segment removal phase of phacoemulsification

  6. Methods • 54 consecutive video recordings of cases performed by 5 surgeons were randomly allocated to 2 residents for analysis • The 5 surgeons were unaware of study purpose, each used own technique which involved intraocular second instrument use during the entire duration of segment removal phase • Sub-sample of cases reviewed by senior author to check for inter-observer variability

  7. Parameters measured • Total time (taken from commencement of segment removal until aspiration of last nuclear segment) • Second instrument idle time (when held stationary or performing non-purposeful movements which did not involve touching nuclear fragments) • Statistical analysis performed using MedCalc Software Version 9.6.4.0 for subgroup analysis

  8. Results Statistically significant idle time difference between consultants and residents. Two tail probability value as calculated with Mann-Whitney test, p =0.0008

  9. Idle time (no subgroup analysis) Count Idle time [%]

  10. Idle time (subgroup analysis) Count Idle time [%]

  11. Conclusion • Second instrument used sparingly to re-crack and reposition nuclear segments • Hence cracking quadrants completely prior to segment removal can greatly reduce need for second instrument during this time • The second instrument can be inserted and removed when necessary instead of being left lying idle in the eye

  12. Conclusion • We suggest that phaco is safer performed without the routine intraocular presence of a second instrument during segment removal, i.e. remove it when not using it • Sideport leakage is significantly reduced • Chamber stability is enhanced • Posterior capsule fluctuation less likely hence the chances of posterior capsule aspiration by the phaco tip is reduced

More Related