5 0 S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E A P R I L 2 0 1 5
H
ere's how to remove cataracts without
the use of phaco-
emulsification.
• Step 1: I use the laser to make the capsu-
lorhexis in the anterior capsule and to fragment
the diseased lens if it is dense, chopping it into
small pieces that remain intact — similar to the look
of a cracked sheet of ice. The procedure then takes
a fundamental turn away from conventional laser
cataract surgery when I float the fragmented lens
through the capsulorhexis and into the anterior
chamber. That's where I use 2 choppers in oppos-
ing 180-degree action to pinch and squeeze the
lens fragments until they break apart.
• Step 2: The phaco tip is set to irrigation/aspi-
ration to remove the fragmented lens pieces.
When larger fragments approach the phaco tip
held in my right hand, I jam them into the port
using the chopper in my left hand
In summary: I use the laser to fragment the lens
in the capsular bag for a hardened nucleus, and float it into
the anterior chamber. Because the fragmented lens sits far
away from the posterior capsule, I can use 2 instruments in
opposing action to fragment it.
What's new about this technique? Most surgeons frag-
ment the lens in the capsular bag, because you can't use
phaco's ultrasonic energy in the anterior chamber for fear of
damaging the cornea. Using the top-down or lateral action
is not as powerful as the opposing 180-dregree action
achieved by placing choppers in front of and behind the
lens. But with the lens still in the capsular bag, surgeons
aren't able to maneuver the choppers to achieve the
desired opposing action, because an instrument placed
behind the bag would practically touch the posterior cap-
sule, increasing the risk of breaking it.
— Ming Wang, MD, PhD
CLINICAL PEARLS
2 Steps to No More Phaco
z STEP 2 Applying a chopper and the phaco tip
in an opposing manner removes lens fragments.
z STEP 1 Using opposing choppers in the anterior chamber
breaks apart the lens that's been fragmented by the laser.
Ming
Wang,
MD,
PhD
