Phaco-drainage Phacosection Amporn technique

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Presentation transcript:

Phaco-drainage Phacosection Amporn technique by Amporn Jongsareejit M.D. Thai Cataract & Refractive Surgery Society (TCRS) ampornj@gmail.com

No financial interest of this presentation.

Manual Small Incision Cataract Surgery (MSICS) - > 70 years after the innovation of IOL - from suture to sutureless surgery - from anaesthesia to no anaesthesia - from phaco-machine to no phaco-machine

- each cataract surgery has its adventages and disadvantages - because of logistical or financial reasons > suturelesss surgery > less astigmatism > early mobility > cost - effectiveness Nonphaco sutureless cataract surgery

Surgical technique the hardness of N. ♦ Hard Nucleus Amporn tech. Phacosection ♦ Mod. Nucleus ♦ Soft Nucleus Phaco-drainage

Amporn techniques for hard nucleus (Black & White cataract)

Phacosection for Moderate hard Nucleus

Concept of Phacosection 1) Crack the nucleus into two pieces in the capsular bag 2) Remove the pieces of nucleus through 5.0 mm. length scleral wound

Crack 1/3 of nucleus

Separate the nucleus by Mcpherson forceps

Phacosection for moderate nucleus Advantages 1. Short wound 2. Use basic instrument 3. Decrease the corneal endothelium trauma

Phaco-drainage technique for soft nucleus

Amporn Jongsareejit , M.D. ampornj@gmail.com

Patients and Methods 40 eyes of 37 patients with age-related cataract divided into 2 groups : Group 1 Phacoemulsification 20 eyes Group 2 Phaco-drainage 20 eyes All patients were randomization

Exclusion criteria - Glaucoma & ocular hypertension - Pseudoexfoliation syndrome - Corneal scar & corneal disease - Chronic or recurrent inflammatory dis. - Proliferative diabetic retinopathy - Endothelial cell count < 1500 cells/mm2 - Dislocated and subluxated lens

Pre-operative assessment Complete ocular examination Nucleus grading Endothelial cell counts Intraocular pressure (IOP)

Table 1. Patient’s characteristics. Characteristic Group(Mean  SD) Phacoemulsification Phaco-drainage Age (mean±SD) 68.05±6.12 64.35±9.95 Male 6 15 Female 14 5 Right eye 7 9 Left eye 13 11 Pre-op VA( Decimal) 0.2 0.2

All surgeries were performed by one surgeon. Group 1 All surgeries were performed by one surgeon. Group 1.phacoemulsification topical anasthesia(2%Xylocaine) clear cornea incision(3.2 mm.) phaco quick-chop technique acrylic foldable IOLs was implantation.

Group 2. Phaco-drainage Sub Tenon’s anathesia Clear cornea incision (3.2 mm.) Phaco-drainage technique Acrylic foldable IOLs was implantation.

Three special instruments 1) Anterior chamber maintainer 2) Aspiration cannula 3) Nucleus removal tube (Amporn tube)

Continuous Curvilinear Capsulorhexis under viscoelastic substance under balance salt solution under anterior chamber maintainer

Idea concept of Phaco-drainage 1) Crack the nucleus into small pieces in the capsular bag 2) Remove the pieces of nucleus through 3.2 mm. length corneal wound by tube 3) Use passive-aspiration force to remove the pieces of nucleus

Principle of Phaco-chop > ½ Depth of the nuclear thickness

Prechop by Utatar forceps

Results First post-operative day: ♦ Central cornea  clear ♦ C/F  trace ♦ Postoperative IOP & keratometry not difference in both groups

Intraoperative characteristics of phaco-drainage Average viscoelastic (ml.) 0.5±0.2 Average irrigating fliud (ml.) 160±13 Average time to manage nucleus(min.) 6.85±1.77 Average operation time(min.) 38±8.6

Postoperative BSCVA (at 3 months) Follow-up Gr. 1 PE Gr. 2 Phaco-drainage 1 week 0.80±0.16 0.82±0.18 1 month 0.83±0.09 0.85±0.13 3 months 0.87±0.09 0.88±0.11

Postoperative endothelial cell count and loss Endothelial cells Gr Postoperative endothelial cell count and loss Endothelial cells Gr.1 PE Gr.2 Phaco-drainage Pre-op(cell/mm2) 2335.92±376.52 2241.16±257.80 Post-op(cell/mm2) 1 month 2188.16±408.94 1931.22±306.49 3 months 2187.39±337.33 1894.87±232.32 Mean loss (%) 1 month 6.32±2.43 13.82±3.59 (p< 0.05) 3 months 6.35±1.90 15.44±2.36 (p< 0.05)

Complications No serious complications: capsular tear, vitreous loss, dropped nucleus in both groups - mild iris trauma 3 cases - corneal wound edema 2 cases

Discussion Advantages of Phaco-drainage 1. Less induced astigmatism (depend on wound length) 2. Faster visual rehabilitation 3. Cost-effectiveness

300 eyes of phaco-drainage surgery Corneal wound edema 22 eyes Iris trauma 15 eyes Descement membrane detactment 2 eyes Corneal decompensation -> not found Endophthalmitis -> not found

In conclusion: - MSICS is appropriate for cataract surgery in developing countries - We can perform sutureless cataract surgery without phaco-machine. - Phaco-drainage is the cataract surgery method that reduced the wound length until can insert foldable IOLs

Dr.Apple et al. in their editorial in Ophthalmology (1999) mention “ some unfinished tasks that remain of which to deliver primary surgery to huge backlog of cataract blind in the underprivileged world (25 million blind) is of paramount importance”

Thank you for your attention