FP427 : Automated pulse delivery of Visco in complicated Phaco – An innovative Technique

Dr. Santosh Agrawal,

Introduction : –

Visco has become indispensable tools in protecting corneal endothelium & maintaining adquate space for difficult & delicate intraocular manipulations. No single OVD is ideal to do all the desirable tasks. Hence cohesive & dispersive  OVD’s are used in combination many a times to have ideal surgical enviornment to preclude damage. Still it is noted that repeated injection of OVD’s are required at different stages of surgery through main incision which spend a lot of time, enormous amount of OVD’s & many sustain inadvertant damage to intraocular structures while both hands are engaged during phacoemulcification.

The new technique has been introduced in order to have pulsed inoculation of visco through specially designed AC maintainer in anterior chamber. It is automized & can be controlled by footpedal as the tubings are attached to vitrectomy or silicon port on the console & lowest cut rate was resorted to.

Aim and Objective : –

To prove safety of automated Puled delivery of visco in phacoemulsification an innovative  technique.

Material and Methods : –

• Prospective study
• Total cases = 440
• Duration of study 2011-2016
• Age Ranging from 60 to 85 yrs. – 418, Pediatric cataract – 22.
• Male – 332, Female – 208
• Type of cataract

– Gr. IV & V                         –  172

– Gr. II & III                         –  180

– Post subcap cataract     –  66

– Pediatric cataract          –   22

– Cases lost to follow up two weeks of surgery – 5

Material and Methods { Contd… } : –

— Visco – , HPMC 2%, AC maintainer, Scalp vein set, Adapter, Vitrectomy Machine, Tubings,

Silicon injection system.

— AC maintainer is applied at the start to have firm eyeball imparting ease during incision.

— Tubings, infusion pump, adapter are attached sequentially & lastly to vitrectomy port or silicon port on console.

— Lowestcut rate – about 60 is maintained.

— As soon as footpedal is depressed, the forceful air impact through tubing is transferred to the injector & visco

is poured in AC in small doses. Left leg was used to operate it through foot pedal .

— One can ues visco as per the requirement during different stages of phacoemulsification. which will ensure

CCC, maintain deep AC during phaco and to protect corneal endothelium as well.

Parameters studied : –

Preoperative :-

– Corneal endothelial count & pachymetry

During Phaco :-

– CCC escape

– PC rent & vitrous loss

– Pupillary dilatation

– Trauma to different structures.

Post Phaco :-

– Corneal edema, striate keratopathy

– AC Reaction & iritis – flare & cells

– IOP

– Corneal endothelial count by specular microscope & pachymetry { At glass appointment i.e. 1 mth. }

– BCVA

Results :-

During Phacoemulsification

 

	Paed. Cat.	Others
CCC escape	1/22 ( 06.25% )	3/418 ( 0.83 % )
PC Rent & vitreous loss	NIL	3/418 ( 0.83 % )

Post – Phacoemusification :

Corneal edema / SK	110/440 ( 25 % )
Corneal endothelial loss	05.0 %
Pachymetry ( at 1 mth )	0.3 % high
BCVA ( 6/18 )	91.4 %

• The ease of surgery & patient comfort were excellent.

Discussion : –

Comparison of complications during phaco

	Jeng et al	Present study
CCC escape	53.3 %                                                  10 % ( Haelon + Viscoat )                                    ( Haelon 5)	1.25 %

 

	Fishkind et al	Saraf et al	Holz et al	Present study
PC Rent & Vitreous loss	0.8 – 1.25 %	1.7 %	2.0 – 5.0 %	0.83 %

 

	Bastiet al	Abrar Ali et al	Present study
Corneal edema & SK	11.6 – 59.0 %	53.0 %	25.0 %

 

	Nayak et al	Miyata et al	Kim et al	Holz et al	Present study
Corneal endothelial loss	7.4 %	6.4 % ( Soft shell) 16.3 % ( Healon alone )	12.2 % ( Viscoat + Hyal 2000) 20 %(Viscoat alone)	6.2 % ( Healon 5) 15.4 % ( Viscoat )	5.0 %

 

	Nayak et al	Oshika et al	Present study
Pachymetry ( % Increased)	0.51 %	0.51 %	0.30 %

 

	Gogte et al	Present study
BCVA ≤ 6/18	81.08 %	91.40 %

Excellent results can be attributed to : –

• Excellent C. endothelial protection throughout the procedure.
• Adequate space for manipulations during surgery, so least trauma & postop, inflamation ( No Surge)
• Amazing PC protection as it is kept away from phaco tip.
• Use of ample visco during different stages of surgery with ease.
• During PC Rent , no burn hand reflex owing to extra pouring of visco immediately through AC maintainer in AC.

Shortcoming : –

– This innovative technology still needs many more modifications to refine it & ensure technical alteration in the phaco machines.

Conclusion : –

It is indeed a revolution to have such a automated pulse delivery of Visco for the great safety of phacoemulsification which have reflected in more promising & predictable outcome, especialy to curtail down the risk factors associated with complicated phaco.