Clinical Ophthalmology (Apr 2019)
A rapid technique for en masse soft cataract phacoemulsification
Abstract
Rohit Om Parkash,1 Shruti Mahajan,1 Tushya Om Parkash,1 Rasik B Vajpayee,2 Tushar Om Parkash31Ophthalmology, Department of Cataract and Refractive Surgery, Dr Om Parkash Eye Institute, Amritsar, Punjab, India; 2Ophthalmology, FRCS, FRANZCO, Vision Eye Institute, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, VIC, Australia; 3Department of Ophthalmology, Vydehi Institute of Medical Sciences and Research, Bangalore, Karnataka, IndiaPurpose: To describe a new, en masse, stepwise technique for purely soft cataracts.Methods: RAPID, a soft cataract phacoemulsification technique, is an acronym-based procedure where R is rotation of nucleus, A is alignment of phacoemulsification tip sideways, P is placement of tip adjacent to the nuclear rim, I is impaling of tip into nuclear rim and D is devouring wherein nucleus is aspirated/emulsified. RAPID technique was performed in 54 eyes of 54 patients (31 males and 23 females; mean age 46.35±3.95 years). The soft nucleus was emulsified, after performing hydrodissection, in a stepwise manner in the safe zone away from posterior capsule and corneal endothelium. Centurion/Infiniti Phacoemulsification system (Alcon Laboratories, Inc.) was used with vacuum parameters at 475 mm Hg and an aspiration flow rate of 0–45 mL/min in linear mode. The primary outcome measures were cumulative dissipated energy (CDE), ultrasound time (UST), amount of fluid used, surgical complications and mean endothelial cell loss.Results: Phacoemulsification with IOL implantation was performed successfully in all patients without any intraoperative complications. CDE was 1.03±0.61. Total UST for nuclear emulsification was 3.84±3.27 seconds and fluid used was 10±2.35 milliliters. Postoperative follow-up examinations were done on 1, 4, 14, 30 and 90 days. Mean percentage of endothelial cell loss was 7.05±2.65% (mean endothelial cell counts were 2383.75±105.21 cells/mm2 preoperatively and 2215.78±114.9 cells/mm2 3 months postoperatively).Conclusion: RAPID is an en masse non-fragmentation technique for purely soft cataracts. This technique requires neither any specialized instrumentations nor the use of high vacuum with complimenting surge preventing software. Simple stepwise multi-planer approach of RAPID technique allows easy and fast emulsification of soft cataracts with simultaneous safeguarding of posterior capsule and corneal endothelium.Keywords: soft cataract phacoemulsification, RAPID en masse phacoemulsification technique, soft cataract
