Nucleus fragmentation in a scleral pocket for small incision extracapsular cataract extraction

Abstract

We present a technique for planned manual extracapsular cataract extraction (ECCE) incorporating a modification of mini-nuc ECCE in which the scleral tunnel is made wide enough to allow a nucleus of any size to settle in the tunnel. A 5.0 mm, inverted-V chevron incision is used in which the exposed part of the nucleus lodged in the scleral pocket can be manually picked and fragmented until it is small enough to be removed through the incision. The chevron incision is flexible enough to allow a medium-sized nucleus to be extracted without fragmentation and implantation of a rigid 6.0 mm poly(methyl methacrylate) lens. Vector analysis of preoperative and 3 month postoperative keratometric results in 30 patients showed that the surgically induced vector was 0.54 diopter (D) +/- 0.58 (SD). Mean reduction in astigmatism was 0.08 +/- 0.39 D. The sutureless technique is fast and safe, allows a nucleus of any size to be extracted through a constant size 5.0 mm incision, and results in minimal postoperative astigmatism.

Mature cataracts increase risk of capsular complications in manual small-incision cataract surgery of pseudoexfoliative eyes

“…[16][17] In recent years, manual small tunnel incision ECCE has been described as a different surgical technique in cataract surgery. [18][19][20][21] To our knowledge, there are no reports in the literature on the results of this type of surgery on eyes with XFS. Because we have been using manual small-incision cataract surgery for some years, the aim of our study was to evaluate the rate of intraoperative posterior capsule complications in eyes with and without XFS.…”

Surgical outcome of phacofragmentation and phacoemulsification in senile white mature cataract

“…[5][6][7] Hence, manual techniques such as mininuc, phacosandwich and phacofrag-mentation techniques, were then developed to achieve benefits similar to the phacomulsification. 6,8,11,12,15 If ECCE is performed using a small self sealing incision, post-operative visual recovery and stability could rival that of phacoemulsification.…”

“…The aim of phacofragmentation technique is to reduce the size of a hard and big nucleus in senile mature cataract, thus it can be extracted through a small incision by cutting the nucleus into small pieces. 7,8,10,12,16 The aim of this study is to compare the safety and the effectiveness of phacofrag-mentation and phacoemulsification techniques. Pre-operatively, both groups were tested to ensure that the groups had no significant difference statistically.…”

“…[6][7][8][9] Although some literatures reported a successful result of manual small incision cataract surgery techniques, a comparative analysis between phacoemulsification and phacofragmentation has not been reported. 4,8,12,13 There is still a question whether phacofragmentation and phacoemulsification in senile white mature cataract will give similar results.…”

Nucleus management with irrigating vectis

“…Another option is to remove the nucleus through a smaller wound by fragmentation at the scleral pocket. [5] The remaining nucleus is then pushed into the anterior chamber, longitudinally oriented to the tunnel and removed using the irrigating vectis.…”