Dr. Rajendra Prasad, Dr. ANURAG BADHANI
Keywords:
Dispersive Force, T Soft and Wedge tool
Purpose:
To describe a new technique T Soft, the equatorial chop for soft cataract with some brittleness utilizing a specially designed device “Terminator” the wedge tool and a unique surgical mechanics, to break and split the soft nuclei into two complete segments with much ease and minimal manipulation for safe and swift emulsification of soft cataract.
Methods:
In this technique a low to mod vacuum with very low phaco power is used to impale and hold the soft nucleus at the equator then initiate full thickness nuclear fracture with the help of terminator the wide angled wedge tool which does not cut through the soft nucleus easily. Wide angled wedge tool when pushed or driven into the soft nuclear substance generates inside out dispersive mechanical force and causes them to crack and split in tension. Lateral separation of both the instrument’s propagate the initial crack splitting the entire soft nucleus into two complete halves. Each half of the nucleus, then very simply flipped out and emulsified with high vacuum and low phaco power settings.
Technique:
T- soft the new surgical technique utilizes a unique mechanical force, to break and split the soft nuclei into two complete segments with much ease and minimal manipulation.In this technique a low to Mod vacuum with very low or no phaco power is used to impale and hold the soft nucleus at the equator. Full thickness nuclear crack is then initiated at the open edge equator, by generating a dispersive fracture force with the help of a specially designed blunt olive tip chopper the Terminator, which does not cut through the soft nucleus easily. Low vacuum and low power is very important as the phaco needle can rapidly move through the soft lens material into the capsule with out any hold on the nucleus. Using too much of vacuum and power will likely cause the lens to jump into the tip and create a hole in the lens, “Swiss cheesing” the lens. The idea is to use the phaco needle with low power and low vacuum to hold and support the soft nucleus while blunt chopper with wedge inner edge and broad posterior surface is used to stabilize and initiate the crack and split the nucleus into two complete segments.
Results:
T- Soft represent a simple, safe and easy strategy for controlled nuclear division, mobilization and emulsification, within the capsular bag in cases of soft cataract, especially for beginning surgeons. T Soft technique can be used successfully for removal of adult soft cataract with good reproducibility. T Soft ensures a complete nuclear segmentation including the posterior plate from equator to equator through the centre in first attempt, in 100% 0f attempted cases. Wide angled wedge tool when driven through the soft nucleus induces transversal splitting force without making cheese wire effect resulting into complete division of nucleus.200 cases underwent prospective study results TBD.
Conclusion:
With cataract surgery slowly but surely moving towards refractive lens surgery, ophthalmologists are going to see more and more soft lenses slated for removal in the next few years. Effective planning and choice of the proper surgical technique help the surgeon to avoid any unnecessary intraoperative complications when faced with a soft cataract.
Authors
Rajendra Prasad, MD (Presenting Author)
Disclosures
Rajendra Prasad, MD (Presenting Author): No Relevant Financial Interests
SYNOPSIS:
Whilst much attention is rightly paid to handling dense, rock hard nuclei, quite often, softer cataracts also present a challenge. Soft nuclei are quite sticky gelatinous and adherent to capsular bag and lack sufficient brittleness. It’s really difficult to separate, rotate, grip and crack these soft nuclei. Current chopping and cracking techniques are often ineffective. High vacuum and high power settings to hold the nucleus for chopping in soft cataract results in the soft lens material aspirating into the phaco probe with resultant loss of suction. Sharp choppers and the phaco probe cheese wire through the soft lens and make it difficult to hold and crack the nucleus. There is also the risk of the phaco tip going rapidly through the soft lens material and through the capsular bag, resulting in a posterior capsule rupture. We aim to describe T- Soft a new surgical technique, which utilizes a unique mechanical force, with the help of specially designed chopper named as terminator to break and split the soft nuclei into two complete segments with much ease and minimal manipulation.
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