Bimanual Microphacoemulsification versus Standard Coaxial Phacoemulsification in Brunescent Hard Cat

1
Bimanual Microphacoemulsification versus
Standard Coaxial Phacoemulsification in
Brunescent Hard Cataract with Soverign Whitestar
ICE

• Dr. Ajoy Paul
• Dr. Chandrima Paul
• Dr. Partha Biswas
• Dr. Pradeep.K. Bakshi
• B.B. Eye Foundation ,Kolkata
• India drsajoychandrima_at_yahoo.co.in

The author(s) acknowledge no financial interest
in the subject matter of this presentation.
2
Introduction

• Coaxial Phacoemulsification in Brunescent hard
  cataract-chopping technique-advanced fluidics1,
  power modulation ,neosonix, torsional phaco
• Bimanual Microphacoemulsification has been shown
  to be effective in early and dense cataracts6
• It has been criticized for slow procedure,
  inefficiency, lack of safety in hard cataracts
• 1.Vasavada AR,Singh R, Desai J, Step by step chop
  in situ separation of dense cataract. J
  Cataract Refract Surg 199824156-159
• 6.Alio JL,Microincision cataract surgery
  may be more efficient with phaco system. 2004
  Sept. Ophthalmoly Times

3
Purpose

• To Evaluate safety,efficacy and postoperative
  visual outcome of Bimanual Microphacoemulsificatio
  n versus standard Coaxial Phacoemulsification in
  brunescent hard cataract with
  Soverign Whitestar ICE.
• gt Effective phaco time (EPT)
• gt Post-op endothelial status
• gt Pod 1 UCVA

4
Methods

• Randomized prospective evaluation
• Two groups- 40 eyes each underwent 20g Bimanual
  and standard Coaxial Phacoemulsification.
• Same surgeon
• Cataracts LOCS Grade III Or IV
• Exclusion Criteria
• gt Cataract grade II or less
• gt Any retinal or corneal pathology
• gt Previous intraocular surgery
• gt Endothelial cell count below lt1800/sqmm
• Matrics Screen Effective Phaco Time (EPT)
• Post operative endothelial cell loss as
  percentage of pre - operative cell density
• Uncorrected visual acuity 24hrs post op

5
Phacoemulsification
Bimanual
Coaxial

• Two 1.2mm Incision
• Sleeveless Phaco Tip
• Front Open Irrigating Chopper
• Bottle Height 130-140cm

• Central 2.8mm Incision
• Sleeved phaco tip
• Bottle height 110cm

• .Central crater-direct chop
• .Vac 350-400mmHg
• AFR 30-40cc/min
• Power 20-60,
• Whitestar ICE DB/CF

6
Effective Phaco time(EPT)
Results
3.5s
2.8s
3.51.6s-COAXIAL 2.81.3s-BIMANUAL
Reduced by 20
7
Endothelial Status
2266
8.7
2150
2069
8. 1
1978
8. 1 2.3-BIMANUAL 8.7 12.7-COAXIAL
Plt0.05
8
Uncorrected Visual Acuity- 6/12 or better
77

• 73

Post op Day 1
9
DiscussionEffective Phaco Time(EPT)

• Olson RJ2 - Mean EPT 1.4s 1.3 (SD)
  APP 2.4 0.9
  (SD)
• Alio Jl 3 Mean EPT No Difference
• APP - Reduced
  From
• 19.2 10.98 W To 5.28
  3.91 W 73
• Fishkind W.4 Mean EPT 6.67s8.2s(SD)
• Assaf A.5 Mean EPT 4.3s ,APP 5.7
• Our Study Showed Reduction of EPT 20.

2.Olson RJ. Clinical experience with 21-gauge
manual microphacoemulsification using Soveregion
Whitestar Technology in eyes with dense cataract.
J Cataract Refract Surg .2004Jan30(1) 168-72
3.Jorge Alio, Rose Luis, Rodrigues Prats, Ahmed
Galal. Micro Incision Cataract Surgery, In
Textbook Step by step Minimally Invasive
Cataract Surgery, Jaypee Brothers ,India 2005,pp
161-184 4.Fishkind W., Bakewell B,Donnefeid
ED,Rose AD,Watkin LA,Olson RJ, J Cataract Refract
Surg .2006Jan32(1) 45-9 5. Asaf
A,El-Montassen,Kotb AM, Eye2006 May 5
10
Endothelial Cell Loss

• Alio Jl 6,7- Coaxial 15.65
• - Bimanual 11.37
• Tseunoka et al 8 - Bimanual
• 3.0 14.2 Ordinary Hard Cataract
• 9.8 18.4 Extreme Hard Cataract
• Our Study Coaxial 8.7
• - Bimanual 8.1

6.Alio JL,Microincision cataract surgery may be
more efficient with phaco system. 2004 Sept.
Ophthalmoly Times 7.Alio JL , Rodriguez-Prats JL
, Galal A Micro incision cataract surgery.
Highlights of Ophthalmology international, Miami
USA 2004. 8.Tseunoka H, Shiba T, Takahashi Y,
Feasibility Ultrasound Cataract surgery with a
1.4 mm incision clinical results . J.Cat and
Refractive surgery 20022881-86.
11
Uncorrected Visual Acuity Pod 1

• Olson RJ 9 6/9 Or Better 7 Out Of 18 Cases
  Bimanual Hard Cataract
• Fine IH et al10 UCVA 20/40 Or Better 100 -
  Bimanual Staar Sonic
• Our Study 6/12Or Better 73 in bimanual
• 
  77 in coaxial

9.Olson RJ. Clinical experience with 21-gauge
manual microphacoemulsification using Soveregion
Whitestar Technology in eyes with dense cataract.
J Cataract Refract Surg .2004Jan30(1)
168-72 10.I. Howard Fine, Richard Hoffman, Mark
Packer, Minimally Invasive Cataract Surgery (
Bimanual Phaco),Instrumentation and technique .
In Textbook Minimally Invasive Cataract Surgery,
Jaypee Brothers, India 2005,pp 63-82
12
Conclusion

• Significant Reduction Of EPT , comparable
  Endothelial Cell Loss UCVA In Bimanual Phaco
  compared to coaxial phacoemulsification in
  brunescent hard cataract with Soverign Whitestar
  ICE
• Better Fluidics
• Bimanual -Irrigation One End
• -Aspiration Other End
• Closed System No Shallowing Of AC
• Nuclear Fragmentation Totally In The Bag
• Less Fluid In The Eye ,Insignificant Leakage
  
• Increased Followability
• Better Use Of Power Modulation
• Based On Our Study 20g Bimanual
  Microphacoemulsification Is as Efficient as
  Coaxial Phacoemulsification in brunescent hard
  cataract with Soverign Whitestar ICE