BACKGROUND: Today, phacoemulsification with ultrasound represents the gold standard in cataract surgery. Nevertheless, new technologies for this operation are being developed to reduce the loss of endothelial cells, the heating of the tissue, and the size of the accesses. In addition to bimanual phacoemulsification, laser phacoemulsification, and mechanic phacolysis, the waterjet is discussed as an alternative. MATERIALS AND METHODS: Human soft and hard nuclei of the lens obtained by extracapsular cataract extraction (ECCE) were divided in the water bath with the waterjet, whereby the parameter pressure was varied and the time needed for fragmentation was recorded. RESULTS: In spite of different consistencies, all nuclei could be divided under the direct force of the waterjet. For the emulsification of hard nuclei of the lens, a pressure of no less than 10 bar was necessary. This value was obviously higher than a lens capsule can tolerate. For the fragmentation of soft nuclei of the lens with lower acceptable pressures of 5 bar, comparatively long operating times (in some cases over 5 min) were measured. This means that also in these cases a pressure of 10 bar was required. CONCLUSION: Intraocular use of the waterjet with direct effect of the stream with these pressures is not justifiable. Instruments for waterjet phacoemulsification should be developed which pose no danger to the corneal endothelium and lens capsule.
BACKGROUND: Today, phacoemulsification with ultrasound represents the gold standard in cataract surgery. Nevertheless, new technologies for this operation are being developed to reduce the loss of endothelial cells, the heating of the tissue, and the size of the accesses. In addition to bimanual phacoemulsification, laser phacoemulsification, and mechanic phacolysis, the waterjet is discussed as an alternative. MATERIALS AND METHODS:Human soft and hard nuclei of the lens obtained by extracapsular cataract extraction (ECCE) were divided in the water bath with the waterjet, whereby the parameter pressure was varied and the time needed for fragmentation was recorded. RESULTS: In spite of different consistencies, all nuclei could be divided under the direct force of the waterjet. For the emulsification of hard nuclei of the lens, a pressure of no less than 10 bar was necessary. This value was obviously higher than a lens capsule can tolerate. For the fragmentation of soft nuclei of the lens with lower acceptable pressures of 5 bar, comparatively long operating times (in some cases over 5 min) were measured. This means that also in these cases a pressure of 10 bar was required. CONCLUSION: Intraocular use of the waterjet with direct effect of the stream with these pressures is not justifiable. Instruments for waterjet phacoemulsification should be developed which pose no danger to the corneal endothelium and lens capsule.
Authors: Khalil M Al-Salem; Fawwaz A Al-Sarayra; Mohammad Abu Al-Dabaat; Wisam Shihadeh; Mohammad M Al-Salem; Mahmoud K Al-Salem; Shlomit Schaal Journal: Int J Ophthalmol Date: 2014-10-18 Impact factor: 1.779