researchers claimed that their method helps protect the corneal endothelium as the main surgery is done in the capsular bag. Moreover, astigmatism, as a side effect of phacoemulsification, is observed more often in two-handed methods4. Other studies have shown that in contrast to the two-handed cataract surgery, the one-handed method causes less damage to the cornea and improves clinical outcomes.
Safety and Effectiveness of the Procedure So, how safe is the one-handed revolving technique? Even a surgery with a small incision might have its complications. Among those side effects are corneal edema, rupture of the posterior capsule, moderate to severe iritis and endothelial cell loss. However, Dr. Kim and co-authors reported that their method excludes the risk of posterior capsule damage, since the physician is relieved from deep surgical manipulations close to the capsule. Remarkably, the one-handed technique guards endothelial cells in the cornea from harm, as the surgical procedure occupies the capsular bag. In the majority of phacoemulsification techniques, the nucleus is prolapsed into the anterior chamber. In contrast, the one-handed method does not implement the prolapse, and the nucleus is taken out with capsular support. How effective is the reported technique? Well, the successful surgeries speak for themselves. According to Dr. Kim and co-authors, they have performed more than 1,500 surgical operations and did not observe any noticeable complications.
A Welcome Option for Phaco Surgeons Could this method be considered a panacea for any type of cataract? The authors stated that their method is
“
The one-handed surgical method has shown satisfactory results in a large cohort of patients and allowed significant reduction of potential side effects.
”
– Dr. Harvey Uy, M.D., medical director at the Peregrine Eye and Laser Institute in Makati, Philippines primarily suitable for cataracts graded nuclear opalescence or nuclear color 3 or lower, according to the Lens Opacities Classification System III. They pointed out that not only soft, but also moderate and even hard cataracts can be effectively cured by this surgical approach. However, continuous curvilinear capsulorhexis less than 5mm or immobile lens were named as exceptions, which would require a different type of surgical intervention. Are there other advanced phacoemulsification methods that could compete with the reported method? Femtosecond laser-assisted cataract surgery has been shown to be superior to regular phacoemulsification5. In particular, the laser-assisted method has shown better capsular overlap, centration of intraocular lens and has demonstrated shorter effective phaco time.
Dr. Harvey Uy, medical director at Peregrine Eye and Laser Institute in Makati, Philippines, has commented on Dr. Kim and co-authors’ paper: “Their method is a welcome option for phaco surgeons treating less dense nuclei and will benefit those who prefer onehanded, coaxial techniques.” In his opinion, the technique seems easy to learn and has the added advantage of minimizing surgical instrumentation. “Overall, the soft cataract rotation technique appears promising and worth trying out,” concluded Dr. Uy. The development of both effective and safe techniques remains one of the greatest challenges in cataract surgery. Undoubtedly, Dr. Kim and co-authors’ one-handed surgical technique shows highly effective results and has the potential to become the method of choice for soft cataract surgery.
References
Kim BK, Mun SJ, Choi HT, et al. One-handed revolving technique for soft cataract extraction. Clin Ophthalmol. 2018; 12: 2423–2425. 2 Malavazzi GR, Nery RG. Visco-fracture technique for soft lens cataract removal. J Cataract Refract Surg. 2011;37(1):11-12. 3 Fine IH. The chip and flip phacoemulsification technique. J Cataract Refract Surg. 1991;17(3):366-371. 4 Kawahara A, Kurosaka D, Yoshida A. Comparison of surgically induced astigmatism between onehanded and two-handed cataract surgery techniques. Clin Ophthalmol. 2013;7:1967–1972. 5 Mamalis N. Femtosecond laser-assisted cataract surgery: Back to the future. J Cataract Refract Surg. 2019;45(1):1-2. 1
About the Contributing Doctor Dr. Harvey Uy, M.D., is a clinical associate professor of ophthalmology at the University of the Philippines, and medical director at the Peregrine Eye and Laser Institute in Makati, Philippines. He completed fellowships at St. Luke’s Medical Center and the Massachusetts Eye and Ear Infirmary and has been a pioneer in femtosecond cataract surgery, accommodation restoration by lens softening, modular intraocular lenses and intravitreal drugs. He has published over 30 peer reviewed articles and is on the editorial board of American Journal of Ophthalmology Case Reports. He is a former President of the Philippine Academy of Ophthalmology and current council member of the Asia Pacific Vitreo Retina Society. [Email: harveyuy@yahoo.com]
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March/April 2019
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