Bimanual microincision phaco affords advantages in routine and complicated cataracts

Chicago-While considered by many to be a technique ahead of its time, the benefits of bimanual microincision phacoemulsification make it a better method of lens removal and an especially advantageous technique to use in complicated and challenging cases, said I. Howard Fine, MD, Eugene, OR, in his delivery of the inaugural Charles D. Kelman Lecture to conclude the “Spotlight on Cataract Surgery 2005” session during the annual meeting of the American Academy of Ophthalmology.

Dr. Fine explained that bimanual microincision phaco not only further reduces incision size, but by separating infusion from aspiration, it provides unique fluidic advantages. In addition, it permits surgeons to switch instruments behind hands, and it has led to the introduction of new microsurgical instruments that can be particularly useful in certain complicated situations.

Dr. Fine illustrated his points using intraoperative videos from a series of challenging cataract cases, including in eyes with high myopia, a posterior subluxated lens, zonular dialysis, or a history of radial keratotomy.

He also demonstrated the benefits of microincision instrumentation for performing intraocular pupilloplasty, intraocular cautery of persistent microhyphema, and for late reopening of a fibrosed capsule or late recentering of an IOL with insertion of a capsular tension ring.

In addition, Dr. Fine presented a case of refractive lens exchange to show why he considers bimanual microincision phacoemulsification to be the least invasive and safest way to perform that surgery.

“Charlie Kelman taught me personally to follow my instincts, teach what I believe is the right thing to do, and to continuously try to improve. Bimanual microincision will not reach its full promise until we have microincision lenses available. Nevertheless, for me it is still like money from home, providing many benefits without disadvantages,” Dr. Fine said.