We congratulate Hwang et al.1 on their excellent article regarding combined phacoemulsification and 25-gauge transconjunctival sutureless vitrectomy (TSV25). We would like to report our experience with TSV25 combined with 700 μm microphakonit.
For cataract removal, we modified the instruments used in conventional bimanual phacoemulsification or phakonit.2,3,4 In this technique, we first perform microphakonit using 700 μm instruments. Two clear corneal incisions are made with customized knifes. A capsulorhexis is made with a 26-gauge needle, followed by gentle hydrodissection and nucleus rotation. The nucleus is then emulsified using the 700 μm microphakonit irrigating chopper connected to the infusion line of the phaco machine and the 700 μm sleeveless microphakonit tip connected to the aspiration line. Cortical cleanup is done with the 700 μm bimanual irrigation/aspiration set. Gas-forced infusion with an air pump is used during the entire procedure.5
At the end of surgery, the incisions, which are small and stable, are self-sealing and able to withstand high intravitreal pressures during vitrectomy without leakage, chamber shallowing, or iris prolapse (Figure 1). The problem of reduced globe resistance and wound instability during infusion cannula insertion, which Hwang et al. mentioned, is not encountered with this technique. Therefore, unlike the earlier TSV25 technique, in which the infusion cannula is inserted before phacoemulsification, we can insert the infusion cannula after the completion of surgery. The main-port cataract incision also does not have to be sutured, unlike in conventionally performed combined coaxial phacoemulsification with vitrectomy.
Thus, this combination of microphakonit with TSV25 makes the combined procedure more rapid and minimally invasive and may be a very useful procedure in vitreoretinal pathologies without dense fibrous proliferation.
1. Hwang J-U, Yoon YH, Kim D-S, Kim J-G. Combined phacoemulsification, foldable intraocular lens implantation, and 25-gauge transconjunctival sutureless vitrectomy. J Cataract Refract Surg. 2006;32:727-731.
2. Pandey SK, Werner L, Agarwal A, et al. Phakonit: cataract removal through a sub-1.0 mm incision with implantation of the ThinOptX rollable intraocular lens. J Cataract Refract Surg. 2002;28:1710.
3. Agarwal A, Agarwal A, Agarwal S, et al. Phakonit: phacoemulsification through a 0.9 mm corneal incision. J Cataract Refract Surg. 2001;27:1548-1552.
4. Agarwal A, Agarwal S, Agarwal A, et al. Phakonit with an AcriTec IOL. J Cataract Refract Surg. 2003;29:854-855.
5. Agarwal A, Agarwal S, Agarwal A, et al. Antichamber collapser. J Cataract Refract Surg. 2002;28:1085-1086.