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Whenever we are faced with a new surgical technique, after overcoming our natural scepticism, two simultaneous questions arise: Why change at all, and if changing is deemed appropriate, how to go about it? Such is the case with bimanual phaco, a new development in cataract surgery that is unfolding with the new millennium.
I believe the question as to how the transition to bimanual phaco can be facilitated for ophthalmologists wishing to carry out microincision surgery to be more pertinent than that searching for reasons to change, as the answer would seem entirely obvious to any practitioner having successfully mastered the transition.
From the very first descriptions onwards, the bimanual nucleofracture technique has been perfected with the development of irrigating choppers that make it possible to achieve nuclear cracking without sculpting. However, for most ophthalmologists performing cataract surgery using the coaxial technique, bimanual phaco requires a more or less long learning curve, followed by another, necessary to master the phacochop technique. In fact, due to reduced mobility of the instruments nuclear fracture is more difficult when performed with a micro-incision of less than 1.5 mm than with a 3.2 mm incision. On the other hand, the difficulties in synchronizing intracameral chopper manoeuvres with those of the ultrasound probe represent a hurdle for many practitioners in allowing themselves to be convinced by bimanual phaco itself.
Today, many authors believe that the bimanual phacochop technique is the most appropriate to limit ultrasound emissions and therefore to perform less invasive microincision phacoemulsification.
These concerns call for a "step by step" approach to bimanual phaco adapted to microincisions, by seeking to identify the essential issues and the pitfalls to avoid. It is with these fundamental objectives in mind that I have written this purposely concise and practical guide intended for all those who would like to learn this new technique, and whose perseverance must be encouraged, for, in the immortal words of Schopenhauer: "All that is new is first rejected and denigrated before being understood and accepted".
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- Last modification : 26-05-2008