Bimanual microincision cataract surgery a step forward

Before I tried microphaco, I asked the same question that many cataract surgeons ask about microphaco: What's the advantage of these smaller incisions if you still need to create a larger incision to implant the IOL?

For more than a year, I had read several authors' discussions of microphaco advantages, and I had been interested in learning more about the technique. I was not, however, inspired by the articles to become a microphaco surgeon myself.

I then had the opportunity to talk to a surgeon who had been using the technique regularly for some time. I posed my "What's the advantage?" question to him. His list of microphaco merits included a more stable chamber, improved fluidics in the eye, the addition of the irrigating stream as a "tool" within the eye, and the ability to switch hands with the instruments, therefore eliminating the problematic subincisional area. He spoke about microphaco with such conviction and enthusiasm that I decided to give microphaco a try.

I obtained the Duet bimanual microphaco system (MicroSurgical Technologies, Redmond, WA), which consisted of irrigation and aspiration handpieces, interchangeable irrigation/aspiration tips, and irrigating choppers, and a DVD by Dr. Fine about the microphaco technique. I found that the people at MicroSurgical Technologies (MST) were also an excellent source of advice and information about the microphaco technique.

I began my transition by initially converting only irrigation/aspiration (I/A) to a bimanual technique. I met with the OR team to introduce the new surgical steps and instruments.

I also obtained MST disposable steel 1.2- to 1.4-mm knives for my incisions, which are designed to work with the MST Duet system.

After the nucleus was removed, I hydrated my main incision and used the Duet bimanual I/A instruments through the two smaller incisions for removal of cortex. I immediately appreciated the chamber stability and improved access to all areas of the capsular bag with the bimanual technique. I found switching hands with the instruments to be very helpful for subincisional cortex removal. I found the bimanual I/A technique easy to perform and superior to coaxial I/A.

The next step in my transition was to convert entirely to microincisions. I prepared by meeting again with the OR team. I used the settings and phaco tip recommended by Dr. Fine for my phaco machine (Alcon Legacy 20,000 with Neo-SoniX).