Bimanual microincisional phaco enables cataract removal in difficult cases

Paris—Bimanual microincisional phacoemulsification is a safe, efficient, and effective technique for cataract removal in challenging cases, said Rosa Braga-Mele, MD, at the European Society of Cataract and Refractive Surgeons meeting.

Dr. Braga-Mele told attendees that she is currently using the bimanual microincisional approach in all of her challenging cases, and she reported results from a retrospective review of 40 eyes with pseudoexfoliation as evidence supporting that decision. Those cases had 2+ to 4+ cataracts, small pupils, and a mean best-corrected visual acuity (BCVA) of 20/200.

Surgery was performed using the Millennium microsurgical system (Bausch & Lomb) with 100 msec burst width intervals, 20% power, vacuums ranging from 165 to 325 mm Hg (dual linear), and a bottle height of 105 to 115 cm. A capsular tension ring was placed in 50% of the eyes.

No complications were encountered intraoperatively, and postoperative visual acuity on Day 1 ranged from 20/25 to 20/50 with an average of 20/40. Slight central cornea edema was present in a few eyes that had counts fingers vision preoperatively or very dense nuclei.

"I believe bimanual microincisional phaco offers many advantages over a coaxial technique in the setting of capsular or zonular defects," Dr. Braga-Mele said.

She explained that the bimanual microincisional approach is associated with a tendency to use lower infusion volumes or pressure as well as lower flow and vacuum settings that minimize turbulence. In addition, the surgeon can direct the fluid stream coming through the side incision away from areas of zonular weakness, has the ability to approach nuclear material from different sites and angles to enable its removal, and may use less phaco time since in the microincisional approach, nuclear pieces are brought in with fluidics.

"Bimanual microincisional phaco offers a more tightly controlled system during all steps of the procedure and is a more stable and safer technique that we will be seeing more of in the future," she concluded.