TORSIONAL AND MICRO-COAXIAL TECHNOLOGY: New Efficiencies in Challenging Cases

I would like to present our experiences with torsional and micro-coaxial technology on behalf of our French research group. My goal is to demonstrate to surgeons the transition from performing phacoemulsification with traditional longitudinal ultrasound to a micro-coaxial procedure using torsional technology. The impetus for the development of micro-incisional phacoemulsification was to provide a lens removal technique that is less traumatic and truly affords astigmatically neutral cataract surgery. Compared with 1.0-to 1.5-mm bi-manual micro-incisional phaco emulsi fication, the micro-coaxial approach offers several advantages. Whereas bi-manual micro-inci-sional phacoemulsification requires use of an ultra-thin capsulorhexis forceps or a cystome for capsulorhexis creation, 2.2-to 2.4-mm micro-coaxial surgery allows the surgeon to create the anterior capsu-lar opening without any special instru-mentation. In addition, the infusion rate is preserved with micro-coaxial pha-coemulsification so that fluidic balance is more naturally achieved using lower bottle heights than with bi-manual tech-2 Torsional ultrasound virtually eliminates repulsive forces and increases followability to provide phenomenal cutting efficacy. Torsional ultrasound performed with the INFINITI Vision System ® (Alcon Laboratories) using the OZil ® Torsional Handpiece (Alcon Laboratories) became commercially available in July, 2006. Torsional ultrasound offers many advantages compared with traditional longitudinal ul-trasound and is considered a revolution in ultrasound technology. Torsional ultrasound virtually eliminates repulsive forces and increases followability to provide phenomenal cutting efficacy and rapid nucleus evacuation. These benefits are achieved with lower flu-idics settings and minimal heat generation so that the safety of the lens removal procedure is enhanced. Moreover, torsional ultrasound is a perfect partner with a micro-coaxial approach in all eyes and particularly in challenging cases where the advantages of each combine to enable controlled, safe, and efficient surgery. At a symposium held during the XXV Congress of the ESCRS in Stockholm, a distinguished faculty of renowned cataract surgeons presented their experiences with micro-coaxial phacoemulsification using torsional ultrasound. Using impressive videos recorded intraoperatively and including some particularly challenging cases with very advanced cataracts, they demonstrated the features of the micro-coaxial approach and torsional ul-trasound and contrasted the benefits of these techniques with the drawbacks of bi-manual micro-incisional phacoemulsification and traditional longitudinal ultrasound. The information they presented is summarized in this supplement and has relevance to all surgeons as we continually strive to deliver higher quality surgery and better outcomes for our patients.