1. MICRO-BIAXIAL PRECHOP AT THE IRIS PLANE Arturo Pèrez-Arteaga M.D. Medical Director, Centro Oftalmològico Tlalnepantla, Mèxico. Poster Presentation, ASCRS meeting. Boston, 2010.

2. FINANTIAL DISCLOSURE I HAVE NO FINANTIAL INTERESTS OR RELATIONSHIPS TO DISCLOSE

3. P URPOSE To demonstrate the safety and efficacy of performing pre-chop at the iris plane in a bi- axial mode.

4. A DVANTAGES OF P RECHOPPING Decreases the Phaco Time and Power. Uses mechanical forces instead of ultrasound. Facilitates Phacoemulsification. Improves followability. Decreases the force applied to capsular tissues. Decreases total surgical time.

5. C OMPARISON OF TWO F RAGMENTATION SITES Inside the Capsular BagOutside the Capsular Bag To work at the iris plane decreases the Capsular and Zonular Trauma

6. B I -A XIAL P RECHOPPING WITH TWO 25G C ANNULAS (BAPC25G) It uses only two viscoelastic cannulas to fragmentate the nucleus. The fragmentation is outside the capsular bag with the “Lens Salute Technique”. It uses the Iris Plane. It uses a Bi-Axial approach with two cannulas “face to face”.

7. SURGICAL TECHNIQUE. BIAXIAL PRECHOP 25 G 1. Wide Capsulorrhexis. 2. Vigorous Hydrosurgery. 3. Nucleus placed in “Lens Salute Position”. 4. Intraocular tissues protected with viscoelastic. 5. Cannulas introduced at 120 to 180 degrees. 6. Force applied between two cannulas, to fracture the nucleus at the iris plane. 7. Multiple fragmentations. 8. Phaco as usual.

8. C OMPARISON S TUDY B ETWEEN T ECHNIQUES. 200 EYES, ONE SURGEON, 8 MONHTS, INTRAOPERATIVE AND POSTOPERATIVE RECORDS. Total surgical time Corneal edema Phaco power & time Time of visual recovery. Final visual outcome SIX CASES OF CAPSULAR DAMAGE. Total surgical time Corneal edema Phaco power & time Time of visual recovery Final visual outcome TWO CASE OF CAPSULAR DAMAGE Prechopp at the Capsular Bag. Forceps & Choppers. Comparative Group, 100 e. Retrospective review. Bi-Axial Prechop.Iris plane. Two 25 G Cannulas. Experimental Group. 100e. Prospective data.

9. C ONCLUSION B IAXIAL P RECHOP WITH 25 G C ANNULAS We were not able to determine if the moment of capsular damage was during the prechop maneuver. We just did a comparison of capsular damage while performing both techniques

10. C ONCLUSION B IAXIAL P RECHOP WITH 25 G C ANNULAS It is a safe and effective method to produce mechanical fragmentation. It decreases the forces applied to the capsular bag and the zonula. It is cost-effective because it avoids expensive instrumentation

11. C ONCLUSION B IAXIAL P RECHOP WITH 25 G C ANNULAS It can be useful as a method of nuclear fragmentation for many other lens extraction techniques (Bi-Axial Phaco, Co-Axial Phaco, Manual Phacofragmentation techniques) It is not exclusive of Bi- Axial Techniques.

12. T HANK YOU VERY MUCH