Eyeworld

SUMMER 2024 | EYEWORLD | 35 C by Ellen Stodola Editorial Co-Director About the physicians Cristos Ifantides, MD, MBA Tyson Eye Cape Coral, Florida Rom Kandavel, MD Colvard-Kandavel Eye Center Encino, California about ease of use for the technicians. "The out- comes are very good, I can get access to every- thing I need, and I think it's faster," he said. For routine cases and when pupil size and dilation are good, coaxial is best, Dr. Ifantides thinks. Dr. Kandavel said he would choose to use coaxial I/A in some cases, specifically if he was averse to creating a second paracentesis. "There are not a lot of scenarios where you can't fit a second paracentesis, but it could happen if the paracentesis was near a preexisting trabeculec- tomy or you have a large LRI," he said. It also depends on surgeon preference, and some surgeons don't want to have another step. However, the time savings in not creating a second paracentesis could be made up by saving time during cortical cleanup, he said. Advantages of bimanual I/A "I think the single biggest advantage is the dex- terity and reach that bimanual I/A can afford for cortical cleanup and the chamber stabili- ty," Dr. Kandavel said. "Removing the residual cortex after the lens has been put in and getting into the sulcus of the bag as well as 360 degrees around the posterior surface of the anterior capsule is a crucial step in modern refractive T he choice between using bimanual or coaxial I/A depends on a number of factors, including physician preference and the type of case. Rom Kandavel, MD, and Cristos Ifantides, MD, MBA, discussed what they use and what may be bene- ficial in certain cases. Dr. Kandavel said that he has been in practice for 18 years, and initially, he began by using a mixture of bimanual and coaxial I/A. He came out of training primarily doing coaxial. In practice, his partner was primarily using biman- ual. "After a period of acclimation, I switched over after I was convinced of the benefits of the technique. "I will certainly use coaxial when I teach at different institutions, and there are hybrid models," he said. Dr. Ifantides uses both bimanual and coaxial I/A. "Very rarely will you find one instrument or technique that will work in every situation better than any other thing," he said. "There's no perfect technique or tool. We have to adapt to the scenario." Advantages of coaxial I/A Dr. Ifantides said currently, his preference is to use coaxial I/A for several reasons. One is that other surgeons in his practice use this, so it's Comparing bimanual and coaxial I/A continued on page 36 Bimanual I/A is shown here. Source: Cristos Ifantides, MD, MBA Coaxial I/A is shown here. Source: Cristos Ifantides, MD, MBA

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