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Irrigation, aspiration, and polishing cannula
7. 8. 9. lO. 11. 12.
a patient with pre-existing bilateral uveitis. Ophthalmic Surg 1988; 19:475-479 Foster CS, Fong LP, Singh G. Cataract surgery and intraocular lens implantation in patients with uveitis. Ophthalmology 1989; 96:281-287 Kaplan HJ. Discussion (Cataract surgery and intraocular lens implantation in patients with uveitis). Ophthalmology 1989; 96:287-288 Gee SS, Tabbara KF. Extracapsular cataract extraction in Fuchs' heterochromic iridocyclitis. Am J Ophthalmo11989; lO8:31O-314 Michelson JB, Friedlaender M, Nozik R. Lens implant surgery and pars planitis. Ophthalmology 1989; 96(SuppI9):83 Lichter PRo Editorial. Intraocular lenses in uveitis patients. Ophthalmology 1989; 96:279-280 Wolter JR. Posterior chamber IOLs inside or outside the capsular bag: a cytopathologic comparison of two eyes in one patient. Ophthalmic Surg 1987; 18:745-750
Irrigation, aspiration, and polishing cannula Elie Dahan, M.D. Liaquat Allarakhia, M.D.
ABSTRACT Aspiration of the lens cortex and capsule polishing are two important aspects of modern extracapsular cataract surgery. In this report we describe simple but useful modifications to the widely used Simcoe irrigation/aspiration cannula. The modifications consist of enlarging the aspiration port diameter from 0.3 mm to 0.4 mm and altering the terminal segment of the cannula to a sandblasted capsule polisher. The 0.4 mm diameter aspiration port reduces the incidence of capsular entrapment and allows a more efficient aspiration of cortex of varying textures. The modifications eliminate the need for a separate capsule polishing instrument and allow simultaneous lens material aspiration and capsular cleanup. These modifications can be used for any irrigation! aspiration cannula whether manually or machine operated. Key Words: aspiration port, capsule polishing, cortex aspiration,extracapsular cat· aract extraction, irrigation/aspira,., tion cannula
The Simcoe irrigation/aspiration (IIA) cannula l is a versatile instrument that is widely used throughout the world. In this report we describe simple modifications which we believe improve the instrument's performance. From St. John's Eye Hospital and the Department of Ophthalmology, University of the Witwatersrand, Johannesburg, South Africa (Dahan), and the Department of Research and Development, Visitec Company, Sarasota, Florida (Allarakhia). The instrument described in this report with all its modifications is available from Visitec Company, Sarasota, Florida. The authors have no financial interest in the instrument described. Reprint requests to Liaquat Allarakhia, M.D., 7575 Commerce Court, Sarasota, Florida 34243.
J CATARACT REFRACT
SURG-VOL
n
JANUARY 1991
97
Fig. 1.
(Dahan) The modified irrigation, aspiration, and polishing cannula.
Capsular opacification is a problem that ophthalmologists have addressed since the advent of modern extracapsular cataract surgery, but no satisfactory practical method of preventing it has been reported. Thorough aspiration of cortical material and meticulous capsule polishing with roughened instruments remains the method of choice for delaying or reducing its incidence. 2 ,3 We have modified the regular Simcoe II A cannula to facilitate cortical aspiration and capsule polishing (Figure 1). A mildly abrasive, sandblasted, polishing surface is added to the terminal segment of the cannula and the aspiration port diameter is enlarged to 0.4 mm (Figure 2). The cannula dimensions are identical to the original Simcoe design; however, the terminal 3 mm of the cannula has a roughened and abrasive surface which includes segments of both the irrigation and aspiration tubes, intervening solder areas, and the irrigation and aspiration ports. The sandblasting grade is such that the abrasive surface is adequate for a safe and thorough capsule polishing. We have noted that the rough surface in the vicinity of the aspiration port helps dislodge adherent lens fibers from the capsule fornices and improves cortical aspiration. The capsule polishing and lens epithelium cleanup can be done with or without simultaneous vacuuming, depending on the surgeon's judgment. At the termination of cortical aspiration, the cannula does not have to be replaced with a capsule polisher so the procedure is not interrupted. To enhance cortical aspiration we have changed the aspiration port diameter size from 0.3 mm to 0.4 mm since we believe that a 0.4 mm size is better for handling cortex of varying textures and consistencies. Both fine lens fibers and coarse epinucleus lens material can be engaged and aspirated through a 0.4 mm port, whereas a 0.3 mm port is often 98
Fig. 2.
(Dahan) Magnified view of the modified cannula end showing the roughened, sandblasted surfaces and the enlarged (0.4 mm) aspiration port.
Fig. 3.
(Dahan) Schematic representation of the cannula in use for irrigation/aspiration and capsule polishing.
insufficient for coarse cortical material. The slightly enlarged aspiration port allows safer capsular epithelial cell cleanup because it slides easily on the capsule, reducing the incidence of capsular entrapment. It does not jeopardize capsular integrity but rather enhances capsular polishing and vacuuming (Figure 3). The modifications we describe can be made to other types of IIA cannulas, whether side by side or coaxial. We believe these modifications facilitate thorough cortical aspiration and capsular polishing.
REFERENCES 1. Simcoe CWo Double-barreled irrigation/aspiration unit. Am Intra-Ocular Implant Soc J 1981; 7:380 2. Nishi O. Incidence of posterior capsule opacification in eyes with and without posterior chamber intraocular lenses. J Cataract Refract Surg 1986; 12:519-522 3. Moisseiev J, Bartov E, Schochat A, Blumenthal M. Longterm study of the prevalence of capsular opacification following extracapsular cataract extraction. J Cataract Refract Surg 1989; 15:531-533
J CATARACT REFRACT SURG-VOL 17, JANUARY 1991
a patient with pre-existing bilateral uveitis. Ophthalmic Surg 1988; 19:475-479 Foster CS, Fong LP, Singh G. Cataract surgery and intraocular lens implantation in patients with uveitis. Ophthalmology 1989; 96:281-287 Kaplan HJ. Discussion (Cataract surgery and intraocular lens implantation in patients with uveitis). Ophthalmology 1989; 96:287-288 Gee SS, Tabbara KF. Extracapsular cataract extraction in Fuchs' heterochromic iridocyclitis. Am J Ophthalmo11989; lO8:31O-314 Michelson JB, Friedlaender M, Nozik R. Lens implant surgery and pars planitis. Ophthalmology 1989; 96(SuppI9):83 Lichter PRo Editorial. Intraocular lenses in uveitis patients. Ophthalmology 1989; 96:279-280 Wolter JR. Posterior chamber IOLs inside or outside the capsular bag: a cytopathologic comparison of two eyes in one patient. Ophthalmic Surg 1987; 18:745-750
Irrigation, aspiration, and polishing cannula Elie Dahan, M.D. Liaquat Allarakhia, M.D.
ABSTRACT Aspiration of the lens cortex and capsule polishing are two important aspects of modern extracapsular cataract surgery. In this report we describe simple but useful modifications to the widely used Simcoe irrigation/aspiration cannula. The modifications consist of enlarging the aspiration port diameter from 0.3 mm to 0.4 mm and altering the terminal segment of the cannula to a sandblasted capsule polisher. The 0.4 mm diameter aspiration port reduces the incidence of capsular entrapment and allows a more efficient aspiration of cortex of varying textures. The modifications eliminate the need for a separate capsule polishing instrument and allow simultaneous lens material aspiration and capsular cleanup. These modifications can be used for any irrigation! aspiration cannula whether manually or machine operated. Key Words: aspiration port, capsule polishing, cortex aspiration,extracapsular cat· aract extraction, irrigation/aspira,., tion cannula
The Simcoe irrigation/aspiration (IIA) cannula l is a versatile instrument that is widely used throughout the world. In this report we describe simple modifications which we believe improve the instrument's performance. From St. John's Eye Hospital and the Department of Ophthalmology, University of the Witwatersrand, Johannesburg, South Africa (Dahan), and the Department of Research and Development, Visitec Company, Sarasota, Florida (Allarakhia). The instrument described in this report with all its modifications is available from Visitec Company, Sarasota, Florida. The authors have no financial interest in the instrument described. Reprint requests to Liaquat Allarakhia, M.D., 7575 Commerce Court, Sarasota, Florida 34243.
J CATARACT REFRACT
SURG-VOL
n
JANUARY 1991
97
Fig. 1.
(Dahan) The modified irrigation, aspiration, and polishing cannula.
Capsular opacification is a problem that ophthalmologists have addressed since the advent of modern extracapsular cataract surgery, but no satisfactory practical method of preventing it has been reported. Thorough aspiration of cortical material and meticulous capsule polishing with roughened instruments remains the method of choice for delaying or reducing its incidence. 2 ,3 We have modified the regular Simcoe II A cannula to facilitate cortical aspiration and capsule polishing (Figure 1). A mildly abrasive, sandblasted, polishing surface is added to the terminal segment of the cannula and the aspiration port diameter is enlarged to 0.4 mm (Figure 2). The cannula dimensions are identical to the original Simcoe design; however, the terminal 3 mm of the cannula has a roughened and abrasive surface which includes segments of both the irrigation and aspiration tubes, intervening solder areas, and the irrigation and aspiration ports. The sandblasting grade is such that the abrasive surface is adequate for a safe and thorough capsule polishing. We have noted that the rough surface in the vicinity of the aspiration port helps dislodge adherent lens fibers from the capsule fornices and improves cortical aspiration. The capsule polishing and lens epithelium cleanup can be done with or without simultaneous vacuuming, depending on the surgeon's judgment. At the termination of cortical aspiration, the cannula does not have to be replaced with a capsule polisher so the procedure is not interrupted. To enhance cortical aspiration we have changed the aspiration port diameter size from 0.3 mm to 0.4 mm since we believe that a 0.4 mm size is better for handling cortex of varying textures and consistencies. Both fine lens fibers and coarse epinucleus lens material can be engaged and aspirated through a 0.4 mm port, whereas a 0.3 mm port is often 98
Fig. 2.
(Dahan) Magnified view of the modified cannula end showing the roughened, sandblasted surfaces and the enlarged (0.4 mm) aspiration port.
Fig. 3.
(Dahan) Schematic representation of the cannula in use for irrigation/aspiration and capsule polishing.
insufficient for coarse cortical material. The slightly enlarged aspiration port allows safer capsular epithelial cell cleanup because it slides easily on the capsule, reducing the incidence of capsular entrapment. It does not jeopardize capsular integrity but rather enhances capsular polishing and vacuuming (Figure 3). The modifications we describe can be made to other types of IIA cannulas, whether side by side or coaxial. We believe these modifications facilitate thorough cortical aspiration and capsular polishing.
REFERENCES 1. Simcoe CWo Double-barreled irrigation/aspiration unit. Am Intra-Ocular Implant Soc J 1981; 7:380 2. Nishi O. Incidence of posterior capsule opacification in eyes with and without posterior chamber intraocular lenses. J Cataract Refract Surg 1986; 12:519-522 3. Moisseiev J, Bartov E, Schochat A, Blumenthal M. Longterm study of the prevalence of capsular opacification following extracapsular cataract extraction. J Cataract Refract Surg 1989; 15:531-533
J CATARACT REFRACT SURG-VOL 17, JANUARY 1991