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EW CATARACT 41 by Ellen Stodola EyeWorld Staff Writer Anti-blockage technique could prevent intraoperative capsular block syndrome Dr. Escaf works with the Clinica Oftalmologica del Caribe and the Fundacion Oftalmologica del Caribe, which are 2 separate institutions that share a common operating room. With this technique, capsular block complications have not been seen. Dr. Escaf said the anti-blockage technique is particularly helpful for surgeons in training. EW References 1. Vasavada VA, et al. Real-Time Intraocular Pressure (IOP) Measurement During Phacoemulsific tion: Randomized, Clinical Trial. AJOC. 2010; 4–6. 2. Fine H, et al. Intraocular pressure during phacoemulsific tion. J Cataract Refract Surg. 2006; 32. 3. Davison JA. Capsular bag distension after endophacoemulsific tion and posterior chamber intraocular lens implantation. J Cataract Refract Surg. 1990; 16: 99–108. 4. Miyake K, Ota I, Ichihashi S, et al. New classific tion of capsular block syndrome. J Cataract Refract Surg. 1998; 24: 1230–1234. 5. Durak I, Özbek Z, Ferliel ST, et al. Early postoperative capsular block syndrome. J Cataract Refract Surg. 2001; 27: 555–559. 6. Shah N, Goulstine DB. Capsular block syndrome presenting with a hyperopic shift. J Cataract Refract Surg. 2006; 32: 1974–1976. 7. Yepez JB, Cedeño de Yepez J, Arevalo JF. Intraoperative peripheral anterior capsulotomy to prevent early postoperative capsular block syndrome. J Cataract Refract Surg. 2004; 30: 1840–1842. Editors' note: Dr. Escaf has financial interests with Alcon. Contact information Escaf: escaff@gmail.com fragments, where it flows upward to discharge into the anterior chamber. This creates a new pathway for fluid circulation so that there is no ac- cumulation in the posterior, which would produce distension of the posterior capsule and could in turn lead to posterior capsule rupture. Dr. Escaf said that one way to verify that the infusion fluid is ci - culating through this newly created route is to stain with trypan blue solution, and the route of the solu- tion through the halves will become evident. Finally, the surgeon should spin the 2 halves and complete the fracture with the UltraChopper and perform phaco. The UltraChopper is the ideal tool for this technique because it can cut the cataract in a clear, precise, and safe way, Dr. Escaf said. With the UltraChopper, the cataract is divided into 2 fragments, which facilitates safer hydrodissection. Results Dr. Escaf has seen hundreds of cases using this method in which no intraoperative capsular block syndrome presented. He highlighted 669 cases where he obtained positive results and no intraoperative capsular block syndrome. These cases included eyes with posterior subcapsular cataracts, polar cataracts, and small pupils. Dr. Escaf recommended using the technique in cases such as those with small pupils, posterior polar cataracts, small to medium capsulor- hexis cases, IFIS, posterior subcapsu- lar cataracts, and pseudoexfoliation. iris prolapse, shallowing of the ante- rior chamber, and increase in ocular pressure. Dr. Escaf said one goal is to find a technique to prevent this. Intraoperative capsular block syn- drome can be especially troublesome if the surgery continues without the surgeon realizing it is happening. Dr. Escaf said that before the anti-blockage technique, there were ways to try to prevent capsular block syndrome. One way is to make a wide capsulorhexis. The hydrodis- section injection should be made very slowly, softly, and gently, without abrupt saline, he said. How the anti-blockage technique works The experience of the surgeon is key to prevent intraoperative capsular block syndrome from happening, Dr. Escaf said. His technique creates a "lock" to block the problem from occurring. For the technique, Dr. Escaf uses topical anesthesia with a self-sealing incision. He then creates a capsulor- hexis that is generally between 5.0 and 5.5 mm in diameter. After performing the continuous circular capsulorhexis, Dr. Escaf will make a deep cataract incision with the UltraChopper, and immediately after the central groove is obtained, the fracture is completed with the nucleus divider or mechanical prechopper. When the 2 halves of the cata- ract are created, he continues with hydrodissection, and the infusion fluid should flow through the spac created between the 2 cataract By performing hydrodissection in a different way, this complication could be prevented D espite high success and safety, phacoemulsific - tion can still have some complications, one of which is intraoperative capsular block syndrome. Luis Escaf, MD, Clinica Oftalmologica del Caribe, Barranquilla, Colombia, has developed a surgical technique to prevent this, which he calls the "anti-blockage technique," and he utilizes his UltraChopper (Alcon, Fort Worth, Texas) in this technique. Intraoperative capsular block syndrome A report by Dr. Escaf describes intra- operative capsular block syndrome as "a condition characterized by the accumulation of fluid in front of the posterior capsule and behind the epinucleus in the maneuver of hydrodissection during cataract surgery with phacoemulsification technique." When hydrodissection is per- formed abruptly, this can cause the injected liquid to move the cataract nucleus forward so that it is block- ing the capsulorhexis, and this could produce a distension and possible rupture in the posterior capsule. Additional signs to look for in this syndrome are viscoelastic outflo , Using the anti-blockage technique with the UltraChopper, a central groove in the cataract follows the CCC. The incision turns into a groove to obtain two halves, communicating the anterior chamber with the posterior chamber. During hydrodissection, the fluid flows in between the two halves, releasing the tension over the posterior capsule and avoiding the blocking of the capsulorhexis rim. Source (all): Luis Escaf, MD October 2014