Carouseling in the Bag

1.Balamurali K. Ambati
2.Griffin Jardine
3.John Elsnab
4.Gilbert Wong
5.Bruce Gale

1.University of Utah

Purpose: To introduce a novel technique carousel technique within the bag.

Methods: A newly designed phacoemulsification tip was developed with a 20 degree rightward bend in the tip, a semicircular opening and a 3rd irrigation port. Postoperative day 1 & 3 month pachymetry and 3 month endothelial cell counts were performed. A computational fluid dynamics simulation was performed to assess lens equatorial shear.

Results: A retrospective analysis was done of a consecutive series of eight phacoemulsifications performed with the novel endocapsular carousel technique by a single surgeon. All cataracts were graded 3+ or less. Mean preoperative pachymetry increased from 572 ± 39 microns to 596 ± 59 microns at postoperative day 1 and 578 ± 46 microns at 3 months. Mean endothelial cell count declined slightly from 2299 ± 349 cells/sq. mm to 2240 ± 324 at postoperative day 1 and 2190 ± 467 at postoperative month 3. None of these changes were statistically significant (all p's >0.05). For the simulated probe location and boundary conditions, the peak velocity of the peripheral current is 1.3 m/s which induced a maximal shear stress of 32.5 pascals on the equatorial lens surface. This is almost 15 times the peak wall stress of the carotid artery in a normal 60 year old male

Conclusion: By retaining phacoemulsification energy under the anterior capsule, thermal injury is minimized to the cornea. The presence of a third port keeps the peripheral capsule inflated, enhancing safety. This technique improves efficiency for the surgeon, and safeguards for safety.