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EW NEWS & OPINION 23 drodissection facilitates nucleus ro- tation and allows easier cortical aspi- ration. I prefer to perform phacoemulsi- fication by adhering to the princi- ples of the closed chamber and slow motion techniques, using torsional ultrasound (OZil, Alcon). The closed chamber technique includes making self-sealing valvular incisions, inject- ing OVD before removing any in- strument from the eye, and the use of bimanual irrigation/aspiration. Phacoemulsification is initiated by keeping low bottle height and low aspiration flow rate and phaco power according to the density of the cataract. The parameters that I routinely use for different stages of phacoemulsification are: • Preset torsional power (burst mode): 50-80% • Aspiration flow rate (AFR): 16–18 cc/minute • Vacuum: 40 mm Hg (sculpting) and 300-400 mm Hg (fragment re- moval) • Bottle height: Varying from 60-80 cm of H 2 O Phacoemulsification is initiated by creating a trench. Then step-by- step chop in situ and lateral separa- tion techniques are used to create multiple small fragments, which are removed by using the step-down technique. This allows for safe poste- rior plane emulsification away from the endothelium. Before initiating the fragmental removal, I prefer to inject Viscoat to avoid endothelial injury that could occur from the nu- clear fragments during fragment re- moval. Constant anterior chamber depth is maintained using Provisc before removing any instrument from the eye. The use of torsional ul- trasound increases the followability, thus reducing turbulence and chat- ter and increasing the efficiency of energy delivery. Bimanual irrigation and aspiration (I/A) is subsequently performed for cortex removal. Always watch out for bleb leak- age in eyes that have thin, cystic blebs. Following implantation of an IOL of the surgeon's choice, stromal hydration of all the incisions, in- cluding paracenteses, is advisable at the end of surgery. In case of the slightest doubt of the incision in- tegrity in these eyes, always suture the incision. Post-op considerations Adhering to the above-mentioned principles will ensure consistent suc- cessful post-op outcomes (Figure 2). However, surgeons should always monitor these eyes for an early post- op IOP spike or hypotony. Long- term sequelae following cataract surgery include subconjunctival fi- brosis in the bleb with filtration fail- ure. Therefore, close monitoring is recommended in these patients. EW Editors' note: Dr. Vasavada has no financial interests related to this article. Contact information Vasavada: +91-79-27492303, icirc@abhayvasavada.com DON'T MISS: The Ophthalmology Innovation Showcase 11 Private Device Company CEO Presentations I N N O V A T I O N S U M M I T O P H T H A L M O LO G Y April 19, 2012, Chicago, IL @ A S C R S gy I thalmolo ph he O T t of oph elopmen v de t is deliv en t on eeting c M OIS) @ ASCRS will unit tion Summit ( a v nno gy I , and de ts duc o thalmic pr t of oph ts in academia, industr xper ed e y not ed b er t is deliv e the leaders in the OIS) @ ASCRS will unit . es vic , and de , and healthcar y ts in academia, industr e includes: he audienc T clinical r - e Clinical and pr sicians/Clinicians y h P e the leaders in the . esting v e in , and healthcar e includes: , chers esear clinical r echnology y t ersit , Univ sicians/Clinicians tion contac orma e inf or mor F e P utiv ec , Ex os ak vr ta arissa S C arissa@ibf . 310 or C t x (516) 765-9005 e t: tion contac um, Inc or usiness F tional B erna t , In er oduc r e P om .c es enc er onf onfer c arissa@ibf arissa@ibfc ed B t esen r P . iv r , P ers er oc ansf ansfer oc tr a por or , C es ecutiv x e , and I es tiv ta esen epr r um, Inc : y ed B y ompan ublic c e and P t a iv t elopmen e business dev t a . ors est v n , and I November 2011 Figure 2 Source: Abhay R. Vasavada, M.S., F.R.C.S. EyeWorld factoid The phacoemulsifica- tion complication that occurs most often with inexperienced surgeons is iatrogenic zonular dialysis Source: Phacoemulsification, Volume 2; edited by Sunita Agarwal, Athiya Agarwal, and Amar Agarwal

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