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Figure 4.10E

Figure 4.10F

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Figure 4.10G

Figure 4.10H

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Figure 4.10I

Figure 4.10J

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Figure 4.10K

Figure 4.10L

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Figure 4.10M

Figure 4.10N

Figures 4.10A to N: Microphakonit (700 micron cataract surgery).

(A) 0.7 mm phaco tip (microphakonit) as compared to a 0.9 mm

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phaco tip (phakonit); (B) 0.7 mm irrigating chopper;

(C) Illustration showing normal anterior chamber when case is started. Air pump is not used; (D) Illustration showing surge and chamber collapse when nucleus is being removed. Air pump is not used. Note the chamber depth has come down. When we use the air pump this problem does not occur; (E) 0.7 mm irrigation probe used for bimanual I/A compared to the 0.9 mm irrigation probe; (F) 0.7 mm aspiration probe used for bimanual I/A compared to the 0.9 mm aspiration probe; (G) Microphakonit started. 0.7 mm irrigating chopper and 0.7 mm phako tip without the sleeve inside the eye. All instruments are made by MST, USA. The assistant continuously irrigates the phaco probe area from outside to prevent corneal burns; (H to K) Illustration showing the nucleus removal; (L) Microphakonit completed. The nucleus has been removed; (M) Bimanual irrigation aspiration started with the 0.7 mm set; (N) Bimanual irrigation aspiration completed

On May 21st 2005, for the first time a 0.7 mm phaco needle tip with a 0.7 mm irrigating chopper was used by the author (Amar Agarwal) to remove cataracts through the smallest incision possible as of now. This is called microphakonit.

When we wanted to go for a 0.7 mm phaco needle the point which we wondered was whether the needle would be able to hold the energy of the ultrasound. We gave this problem to Larry Laks from MST, USA to work on. He then made this special 0.7 mm phaco needle (Figures 10 A to N). As you will understand if we go smaller

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thought we would be able to balance the entry and exit of fluid into the anterior chamber and that is what happened.

Bimanual irrigation aspiration is done with the bimanual irrigation aspiration instruments. These instruments are also designed by Microsurgical Technology (USA). The previous set we used was the 0.9 mm set. Now with microphakonit we use the new 0.7 mm bimanual I/A set so that after the nucleus removal we need not enlarge the incision.

INDEX

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