Chapter-18 Advances in Microphakonit: 700 micron Cataract Surgery

Abstract

We describe the smallest incision cataract removal technique, Microphakonit, in which bimanual phacoemulsification can be performed with a 0.7 mm phaco tip and 0.7 mm irrigating chopper. Cortical removal is done using 22 gauge or 0.7 mm irrigation/aspiration instruments. The technique was used for 25 adult human eyes with grade 2 nuclear sclerosis and 5 adult human eyes with grade 3 nuclear sclerosis. None of these patients were noted to have intraoperative complications. One eye with grade 3 nuclear sclerosis had mild, central striate keratopathy postoperatively. Six months after surgery, 92% of the patients had a best corrected visual acuity (BCVA) of 20/20 and 96% had ≥20/25.

In vivo analysis of wound architecture in 700 μm microphakonit cataract surgery

“…In addition, smaller incisions tend to heal early (Figure 7), which further decreases the risk for entrance of microbes via the wound. Although there is There is less postoperative leakage and anterior chamber shallowing with microphakonit wounds [4][5][6] which, combined with the properties of early wound apposition and healing, decreases the incidence of postoperative infection. This is also an advantage when combined phacoemulsification and vitrectomy 6 is indicated.…”

“…The reason might be that the range of IOP in our patients was 8 to 18 mm Hg and that we did not measure the immediate (30-minute) postoperative IOP. 28 Moreover, the incisions used for microphakonit [4][5][6] are so small and self-seal so well that the chance of their opening as a result of lid or ocular movements is negligible. This makes the postoperative entry of periocular bacteria into the eye a remote possibility.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13] The smallest cataract incisions reported using 700 mm cataract surgical instruments are created with the microphakonit technique, [4][5][6] a term created to differentiate the method from 0.9 mm phakonit. [1][2][3]12,13 Recently, there have been variable reports of the risk for endophthalmitis [14][15][16][17][18][19][20] with different types of cataract incisions.…”

Safety and efficacy of gas-forced infusion (air pump) in coaxial phacoemulsification

“…[5][6][7][8][9] In the method, a gas-forced infusion system is connected through Q 2010 ASCRS and ESCRS Published by Elsevier Inc.…”

“…3(p102), 4 One of us (S.A.) developed a new method for decreasing surge while performing bimanual microincision cataract surgery (MICS) and subsequently 700 mm cataract surgery (microphakonit). [5][6][7][8][9] In the method, a gas-forced infusion system is connected through a nitrocellulose membrane air filter (Millipore) to the infusion fluid bottle. This creates a positive pressure head above the fluid in the bottle, significantly increasing the amount of fluid entering the eye and balancing the excess outflow occurring on break of occlusion (Figures 1 and 2).…”