Arka Polar Kataraktta Torsiyonel Ultrason ile Cerrahi Sonuçları

1. 1Baskent University Medical Faculty, Department Of Ophthalmology, Adana, Turkey
2. 2Baskent Üniversitesi Adana Arastirma Ve Uygulama Merkezi Göz Hastaliklari Bölümü, Adana, Türkiye

Sorumlu Yazar: Numerous modifications have been reported for posterior polar cataract surgery, which is still one of the challenging cases for anterior segment surgeons. Avoiding over-inflation of the anterior chamber, avoiding hydro-dissection, low-energy surgery which includes low bottle height, reduced vacuum and US power all carry the common philosophy to maintain the integrity of the posterior capsule and the plug; since broken integrity of the posterior capsule, which is reported to be 0%to 36%in posterior polar cataract surgery, might lead to devastating complications like loss of nuclear fragments into the vitreous.5,13,14 Even minimal trauma, could result in posterior capsule tear.13 Low-energy phacoemulsification is hypothesized to cause less trauma to ocular structures.7,9,15 A study with a large cohort, reported a decrease in US time and energy with torsional phacoemulsification decreases.10 Thus, Bozkurt and co-workers16 concluded that torsional phacoemulsification reduced the risk of posterior capsule rupture as it is associated with less repulsion of the nuclear fragments and anterior chamber instability. In the current study, of the devastating complications of posterior polar cataract surgery, posterior capsule rupture rate was comparable with the literature (15.4%). The posterior capsule rupture occurred during plaque removal; this was also consistent with previous studies which report this rate to vary between 0% and 36%.14 We used very low levels of vacuum (100 mmHg average), bottle height (50-60 cm), and aspiration flow rate (16-18 mL/min). These parameters were similar to the ones given by Vasavada and co-workers (150-250 mmHg, 50-60 cm, and 16 mL/min, respectively).17 Torsional phacoemulsification is reported to be associated with greater vacuum limit accuracy, less occlusive break surge, less vibration, and improved followability.18,19 Thus, we believe with these enhanced dynamics torsional phacoemulsification can be safely and efficiently used in posterior polar cataracts. However, intelligent phacoemulsification which offers reduced occlusion time, aspiration time, and balanced salt solution use was recently introduced.20,21 Perhaps, this software would reveal enhanced surgical outcome in posterior polar cataract surgery; further studies are required. To the best of our knowledge, this is the first report in the literature that emphasizes the benefit of torsional phacoemulsification in posterior polar cataract. With low complication rates, torsional phacoemulsification is a safe and preferable technique in posterior polar cataract management. Address for Correspondence/Yazisma Adresi: Selçuk Sizmaz MD, Baskent University Medical Faculty, Department of Ophthalmology, Adana, Turkey Gsm: +90 533 338 77 00 E-mail: selcuk.sizmaz@gmail.com Received/Gelis Tarihi: 24.12.2012 Accepted/Kabul Tarihi: 03.05.2013