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 JoVE Clinical and Translational Medicine

A Novel Capsulorhexis Technique Using Shearing Forces with Cystotome

1, 2, 3

1Department of Ophthalmology, Hairmyres Hospital, NHS Lanarkshire, 2Royal Devon and Exeter NHS Foundation Trust, Department of Ophthalmology, 3Department of Ophthalmology, South Devon Healthcare NHS Trust

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    Summary

    This video demonstrates a novel capsulorhexis technique in modern cataract surgery. Capsulorhexis is the most difficult and important part of phacoemulsification surgery.

    Date Published: 5/15/2010, Issue 39; doi: 10.3791/1962

    Cite this Article

    Karim, S. M. R., Ong, C. T., Sleep, T. J. A Novel Capsulorhexis Technique Using Shearing Forces with Cystotome. J. Vis. Exp. (39), e1962, doi:10.3791/1962 (2010).

    Abstract

    Purpose:

    To demonstrate a capsulorhexis technique using predominantly shearing forces with a cystotome on a virtual reality simulator and on a human eye.

    Method:

    Our technique involves creating the initial anterior capsular tear with a cystotome to raise a flap. The flap left unfolded on the lens surface. The cystotome tip is tilted horizontally and is engaged on the flap near the leading edge of the tear. The cystotome is moved in a circular fashion to direct the vector forces. The loose flap is constantly swept towards the centre so that it does not obscure the view on the tearing edge.

    Results:

    Our technique has the advantage of reducing corneal wound distortion and subsequent anterior chamber collapse. The capsulorhexis flap is moved away from the tear leading edge allowing better visualisation of the direction of tear. This technique offers superior control of the capsulorhexis by allowing the surgeon to change the direction of the tear to achieve the desired capsulorhexis size.

    Conclusions:

    The EYESI Surgical Simulator is a realistic training platform for surgeons to practice complex capsulorhexis techniques. The shearing forces technique is a suitable alternative and in some cases a far better technique in achieving the desired capsulorhexis.

    Protocol

    Part 1 : Purpose:

    To demonstrate a capsulorhexis technique using predominantly shearing forces with a cystotome on a virtual reality simulator and on a human eye.

    Part 2 : Method:

    Steps:

    1. Our technique involves creating the initial anterior capsular tear with a cystotome to raise a flap.
    2. The flap is then left unfolded on the lens surface.
    3. The cystotome tip is tilted horizontally and is engaged on the flap near the leading edge of the tear.
    4. The cystotome is moved in a circular fashion to direct the vector forces.
    5. The loose flap is constantly swept towards the centre so that it does not obscure the view on the tearing edge.
    6. Re-engage the needle to the tearing edge frequently to create a suitably sized continuous curvilinear capsulorhexis.

    Part 3 : Results:

    Our technique has the advantage of reducing corneal wound distortion and subsequent anterior chamber collapse. The capsulorhexis flap is moved away from the tear leading edge allowing better visualisation of the direction of tear. This technique offers superior control of the capsulorhexis by allowing the surgeon to change the direction of the tear to achieve the desired capsulorhexis size.

    Discussion

    The EYESI Surgical Simulator is a realistic training platform for surgeons to practice complex capsulorhexis techniques. Capsulorhexis is the most important and complex part of phacoemulsification procedure. A successful cataract surgery mostly depends on a good capsuporhexis. The shearing forces technique is a suitable alternative and in some cases a far better technique in achieving the desired capsulorhexis.

    Disclosures

    No conflicts of interest declared.

    Acknowledgements

    We would like to thank Dr Clemens Wagner from VR magic for his support. We also like to thank Dr Nail Modi for helping out with the video recording.

    Materials

    Name Company Catalog Number Comments
    0.06% Trypan Blue DORC International NEC0010(Clinic cat.)
    EyeSi Cataract surgery simulator VRMagic

    References

    1. Neuhann, T. Theorie und Operationstechnik der Kapsulorhexis. Klin Monatsbl Augenheilkd. 190, 542-545 (1987).
    2. Gimbel, H. V., Neuhann, T. Development advantages and methods of the continuous circular capsulorhexis technique. J Cataract Refract Surg. 16, 31-37 (1990).
    3. Gimbel, H. V., Neuhann, T. Continuous curvilinear capsulorhexis. letter) J Cataract Refract Sur. 17, 110-111 (1991).
    4. Gimbel, H. V. Evolving techniques of cataract surgery: continuous curvilinear capsulorhexis, down-slope sculpting, and nucleofractis. Semin Ophthalmol. 7, 193-207 (1992).

    Comments

    2 Comments

    Excellent topics, unique and good way they performed, I am couragiously supporting their description and video they have shown step-by-steps. I think eysi surgical simulator is another wonderful machine to practice on for novice surgeon before they perfom surgeries.
    Reply

    Posted by: Andres A.May 17, 2010, 10:43 AM

    This is a nice video demonstrating the EYESi's utility in allowing surgeons to rehearse techniques new to them for use in the OR. However, the cystotome technique for capsulorhexis is not new, it dates back to the early 1990's....
    Reply

    Posted by: AnonymousSeptember 16, 2010, 5:06 AM

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