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Microinterventional endocapsular nucleus disassembly for phacoemulsification-free full-thickness fragmentation.

Tsontcho Ianchulev1, David F Chang1, Edward Koo1

  • 1From the New York Eye and Ear Infirmary (Ianchulev), Icahn School of Medicine, Mount Sinai, New York, New York, Department of Ophthalmology (Chang, Koo), UCSF School of Medicine, San Francisco, California, and Department of Ophthalmology (MacDonald), Tufts School of Medicine, Medford, Massachusetts, USA.

Journal of Cataract and Refractive Surgery
|August 18, 2018
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Summary

A novel microinterventional technique uses a nitinol microfilament loop for cataract surgery nucleus disassembly. This phacoemulsification-free approach fragments the lens without ultrasound or laser energy.

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Area of Science:

  • Ophthalmology
  • Surgical Technology
  • Biomaterials

Background:

  • Cataract surgery commonly uses phacoemulsification for nucleus disassembly.
  • Phacoemulsification relies on ultrasonic energy, which can cause thermal damage.
  • Femtosecond lasers offer an alternative but require specialized equipment.

Purpose of the Study:

  • To introduce and describe a new microinterventional technique for nucleus disassembly in cataract surgery.
  • To evaluate the feasibility of using a nitinol microfilament loop for endocapsular lens fragmentation.
  • To demonstrate a phacoemulsification-free and femtosecond-laser-free method for nucleus disassembly.

Main Methods:

  • A microinterventional approach utilizing a superelastic memory-shaped nickel and titanium (nitinol) microfilament (miLOOP) was employed.
  • The miLOOP was inserted through a 2.3 mm clear corneal incision after standard capsulorhexis and hydrodissection.
  • The microloop was actuated to unfold, glide horizontally, expand, rotate vertically, encircle the nucleus, and then mechanically retracted for segmentation.

Main Results:

  • The technique successfully achieved full-thickness centripetal segmentation of the nucleus.
  • Multiple lens segments (4 or more) were created by repeating the loop cuts.
  • The method was effective regardless of cataract grade and eliminated the need for phacoemulsification or femtosecond energy.

Conclusions:

  • The described microinterventional nucleus disassembly technique using the miLOOP is a novel, phacoemulsification-free approach.
  • This method offers a safe and effective alternative for lens fragmentation in cataract surgery.
  • The nitinol microfilament loop technology provides a versatile tool for nucleus disassembly, independent of cataract density.