Irrigation and Aspiration in Phacoemulsification
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Irrigation and Aspiration in Phacoemulsification
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Irrigation and Aspiration in Phacoemulsification
- 1. Irrigation and Aspiration Dr. Ashraful Huq (Ridoy) Consultant Bangladesh Eye Hospital & Institute Ltd. dr.ashraf@bdeyehospital.com
- 2. Use of Irrigation and Aspiration For removing soft lens material For removing viscoelastics
- 3. Importance Reduce risk of inflammation Reduce risk of IOP elevation Less chance of PCO
- 4. Types of Instrument Simcoe cannula Co-Axial hand piece Bi-Manual hand piece
- 5. Co-Axial hand piece Straight tip Angled tip J-shaped tip I/A Tip materials Metal Silicone
- 6. Foot Pedal Position-1 : Irrigation Position-2 : Irrigation & Aspiration Phacodynamics Vacuum AFR Irrigation
- 8. Techniques Enter AC with the aspiration port facing up Engage the cortical material under the anterior capsule
- 9. Techniques Hold and sweep tangentially Pull the cortical material to the center with low vacuum Increase vacuum to aspirate the cortex
- 11. Management of sub-incisional cortex Bi-manual I/A Angled I/A tip or J-tip Rotate the IOL after implantation to release residual cortex
- 12. Advantage of using Bi-manual Safer and easier removal of lens cortex Easy to remove the sub-incisional cortex Less risk of wound distortion
- 13. Cortex Removal by Bi-manual
- 14. Capsular Polish Reduced aspiration rate and vacuum Place port on posterior capsule Gentle sweeping Avoid lifting the tip when polishing
- 15. Capsular Polish
- 16. Visco removal
- 19. Take Home Message Use of Bi-manual is safe and easy Hold cortex and move tangentially with low vacuum Aspirate cortex in center with full vacuum Aspiration port always facing up
- 20. Thank You
Editor's Notes
- After we remove the hard nucleus portion of lens we switch to the Irrigation and Aspiration hand piece to remove soft lens material that include Cortex and epinucleus. We also remove viscoelastics.
- So,
- This slide shows various IA instruments. For Phaco we using Co-axial and Bi-manual hand piece.
- Irrigation Aspiration hand piece has 0.25 to 0.3 mm port. Co-axial hand piece tip can be straight or angled 45/90 or J shaped, in addition tip can be metal or silicon. The silicon tip also has less risk of PCT & IOL scratch damage, the port is closed at distal end.
- We also need to think about foot pedal position and we always need to press in FP-1 for continuous irrigation to avoid collapse of anterior chamber.
- This is a parameter which can be used by beginners. Continuous irrigation and Linear vacuum CORTEX – Linear vacuum, so that not aspirate quickly. VISCO -
- Sweep tangentially and then pull to the center. We should not pull cortex material radially.
- Stripping aspirated cortex uses tangential movements with the hurricane technique, rather than radial movements traditionally done with standard techniques. Retro illumination is used to see zonular tension. Note that a tangential aspiration technique minimizes capsular bag distortion.
- Easy to remove the sub-incisional cortex – Aspirating port never needs to turn towards the capsular fornix. It can be kept facing the cornea and away from the posterior capsule virtually at all times. Less maneuvering - Two side ports - Astigmatism:
- Using Bi-mannual is safer and easier. We should keep in mind that Irrigation port will enter eye first and comes out last. Release foot pedal or use reflux when capsule or iris was accidently aspirated.
- To remove lens epithelial cells and fine cortical matters. Residual lens epithelial cells will proliferate and may undergo fibroblastic transformation.
- Aspiration piece is stable in center and we rotate only the irrigation port around. We canTake Irrigation port at the equator & hold, so allow visco comes out from behind lens. We can also Take irrigation port behind the lens, so visco comes out, but we don’t recommend it for beginners. We should keep in mind that all visco materials should be removed before sealing the wounds.
- The most common step for PCT to occur is at cortex removal rather then the phaco part. In IA it is not uncommon to see some stria on posterior capsule. As we see in the right picture, this stria appear appear in radial fasion. PCT occurs when PC aspirated.