Glance at the grindstone

Evaluate by Andreas F. Borkenstein, MD

Improved processes for getting rid of residual cortical materials adjacent to the posterior capsular bag for the duration of cataract surgical procedure with no the have to have for added machines are risk-free and really effective in the initially circumstance in which it was carried out. Looks to be. Personal opening in Graz, Austria.

Borkenstein introduced the information at the 2022 Yearly Meeting of the American Society of Cataract and Refractive Medical procedures in Washington, DC. The co-authors of this analyze are Boris Malyugin, MD, PhD, Professor of Ophthalmology and Deputy Chief Cabinet Secretary of the S. Fyodorov Eye Microsurgery Federal Point out Institute in Moscow.

Borkenstein claimed that the ways to take out cortical debris and principal capsular fibrosis are crucial in cataract surgical treatment for the reason that of the prospective for harm to the posterior capsule. This method acknowledges the “superb” potential to take out major capsular fibrosis without having detrimental the highly viscous cohesive ophthalmic mucus surgical product (OVD) (Pe-Ha-Luron F 2.2% Albomed Germany). It was born two several years ago. Rear capsule with irrigation / suction cannula when carrying out mechanical capsule sprucing steps.

Typical spraying through the treatment often leaves a residue and the stress of the jet stream can destroy the capsule. The next 12 months, Volkenstein sought an ophthalmologist with a surgical and scientific background. This led him to Marugin, an internationally acknowledged qualified in difficult situations of cataract surgery and the inventor of handy devices.

Borkenstein located that the concept of ​​cleaning capsules utilizing a fluid stream from an irrigation cannula hooked up to a balanced salt option (BSS) syringe was harmless and safe in the late 1990s (Steven Arshinoff, MD, Thomas Neuhann, MD). I discussed that it goes back again to effectiveness. The technique has been reported.1,2

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The distinction involving the verified method and the technique under dialogue is that the latter does not use BSS streams, but takes advantage of OVD bolus. This method seeks to prevent excessive collateral irrigation trauma to the delicate corneal endothelium and posterior capsule.

Combination OVDs are great for this solution because they have high molecular weights and floor tensions and are created up of huge molecules. In addition, they are best for protecting the anterior chamber, serving to to make a cystic incision, and making area. The superior surface tension will make it effortless to remove, Borkenstein stated.

Step by stage

Borkenstein gave an overview of the a few-step system. First, fill the capsule bag to about one-3rd of its capability with a highly cohesive, substantial-viscosity OVD to build a bolus.

Second, the surgeon introduces a 27-gauge or 30-gauge cannula hooked up to the syringe to boost the BSS jet stream by directing it to the posterior capsule, which is slightly in contact with the OVD bolus. Eventually, the OVD bolus starts to rotate, generating some kind of “grinding stone”.

Volkenstein defined that this can be detected when a thick viscoelastic wire commences to rotate rapidly inside of the capsule as a ball with a relatively tough surface area that shatters cortical content. The jet stream stays in the exact situation (that is, it touches the posterior capsule).

Bubbles in the anterior chamber remain in the same place, indicating that fluid or shear forces do not attain the anterior chamber or endothelium / cornea.3

Initially OVD situation

Bokenstein pointed out that the very first 62 cases have been profitable. No intraoperative or postoperative problems ended up detected. No corneal edema or hypertension happened on the initially day after operation. The normal finest corrected visible acuity was –0.01 ± .11 logarithm of the least resolution angle.

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This treatment looks protected as there is no extra irrigation trauma and no strain, mechanical force, or sharp objects are utilized to the capsule. “OVD stays in the capsule because of its molecular fat, so the anterior chamber and corneal endothelium are also protected,” he reported.

This new method additional only 30-60 seconds to the time of typical cataract surgical procedure4. A significant advantage in tough instances is that the threat of building posterior capsule opacity (PCO) soon after operation may well be lowered. No additional surgical devices were being wanted. It truly is safe and sound and simple — suitable for difficult situations like traumatic posterior eye, pseudoexfoliation syndrome, or floppy iris syndrome, he claimed.

In addition, it is interesting for Borkenstein to see in the extended run whether this technique will lessen PCO fees, and if it can cut down intraoperative complication charges, more surgeons all-around the globe will use this strategy. I stated that you will be working.

Additional multicenter collaborative reports are planned to assess prolonged-term outcomes for PCO fees and endothelial cell numbers in extra patients. In addition, Volkenstein wants to display the grindstone effect in a lab review utilizing “Miyake-Apple Backward Video Examination Technological know-how” and is trying to find even more collaboration.

Andreas F Volkenstein, MD


This posting is primarily based on Borkenstein’s presentation at the Once-a-year Conference of the American Modern society of Cataract and Refractive Medical procedures in Washington, DC. He has no monetary curiosity in any aspect of this report.


1 Liu Z, Cao Q, Qu B, and so forth. Fluid jet system for polishing posterior capsule for lens phacoemulsification: Efficacy and safety evaluation. J Cataract Refraction Operation.. 2020 46 (11): 1508-1514. doi: 10.1097 / j.jcrs.0000000000000319

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2 Arshinoff SA, Neuhann T. Feedback: Fluid jet procedure for sharpening posterior capsule for lens phacoemulsification: Efficacy and security evaluation. J Cataract Refraction Surgical procedures.. 2021 47 (8): 1103. doi: 10.1097 / j.jcrs.0000000000000714

3 Borkenstein AF, Borkenstein EM, Malyugin B. Removal of residual cortical materials during cataract operation: Visco polishing and grindstone results as new surgical procedures. Eur J Ophthalmol.. 2021 32 (3): 1817-1820. doi: 10.1177 / 11206721211059909

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