1. Phaco-drainage Phacosection Amporn techniqueby
Amporn Jongsareejit M.D.
Thai Cataract & Refractive Surgery Society (TCRS)

2. No financial interest of
this presentation.

3. Manual Small Incision Cataract Surgery (MSICS)
- > 70 years after the innovation of IOL
- from suture to sutureless surgery
- from anaesthesia to no anaesthesia
- from phaco-machine to no phaco-machine

4. - each cataract surgery has its adventages and disadvantages
- because of logistical or financial reasons
> suturelesss surgery
> less astigmatism
> early mobility
> cost - effectiveness
Nonphaco sutureless
cataract surgery

5. Surgical technique the hardness of N. ♦ Hard Nucleus Amporn tech.
Phacosection
♦ Mod. Nucleus
♦ Soft Nucleus
Phaco-drainage

6. Amporn techniques for hard nucleus (Black & White cataract)

7. Phacosection
for
Moderate hard Nucleus

8. Concept of Phacosection
1) Crack the nucleus into two pieces in the capsular bag ) Remove the pieces of nucleus through mm. length scleral wound

9. Crack 1/3 of nucleus

10. Separate the nucleus by Mcpherson forceps

11. Phacosection for moderate nucleus
Advantages
1. Short wound
2. Use basic instrument
3. Decrease the corneal endothelium trauma

12. Phaco-drainage technique
for soft nucleus

13. Amporn Jongsareejit , M.D. ampornj@gmail.com

14. Patients and Methods
40 eyes of 37 patients with age-related cataract divided into groups : Group 1 Phacoemulsification 20 eyes Group 2 Phaco-drainage eyes All patients were randomization

15. Exclusion criteria
- Glaucoma & ocular hypertension - Pseudoexfoliation syndrome - Corneal scar & corneal disease - Chronic or recurrent inflammatory dis Proliferative diabetic retinopathy - Endothelial cell count < 1500 cells/mm Dislocated and subluxated lens

16. Pre-operative assessment
Complete ocular examination Nucleus grading Endothelial cell counts Intraocular pressure (IOP)

17. Table 1. Patient’s characteristics.
Characteristic Group(Mean  SD) Phacoemulsification Phaco-drainage Age (mean±SD) ± ± Male Female Right eye Left eye Pre-op VA( Decimal)

18. All surgeries were performed by one surgeon. Group 1
All surgeries were performed by one surgeon. Group 1.phacoemulsification topical anasthesia(2%Xylocaine) clear cornea incision(3.2 mm.) phaco quick-chop technique acrylic foldable IOLs was implantation.

19. Group 2. Phaco-drainage
Sub Tenon’s anathesia Clear cornea incision (3.2 mm.) Phaco-drainage technique Acrylic foldable IOLs was implantation.

20. Three special instruments
1) Anterior chamber maintainer
2) Aspiration cannula
3) Nucleus removal tube
(Amporn tube)

21. Continuous Curvilinear Capsulorhexis
under viscoelastic substance
under balance salt solution
under anterior chamber maintainer

22. Idea concept of Phaco-drainage
1) Crack the nucleus into small pieces in the capsular bag ) Remove the pieces of nucleus through mm. length corneal wound by tube ) Use passive-aspiration force to remove the pieces of nucleus

23. Principle of Phaco-chop
> ½ Depth of the nuclear thickness

24. Prechop by Utatar forceps

25. Results
First post-operative day: ♦ Central cornea  clear ♦ C/F  trace ♦ Postoperative IOP & keratometry not difference in both groups

26. Intraoperative characteristics of phaco-drainage
Average viscoelastic (ml.) ±0.2 Average irrigating fliud (ml.) ±13 Average time to manage nucleus(min.) 6.85±1.77 Average operation time(min.) ±8.6

27. Postoperative BSCVA (at 3 months)
Follow-up Gr. 1 PE Gr. 2 Phaco-drainage week ± ± month ± ± months ± ±0.11

28. Postoperative endothelial cell count and loss Endothelial cells Gr
Postoperative endothelial cell count and loss Endothelial cells Gr.1 PE Gr.2 Phaco-drainage
Pre-op(cell/mm2) ± ± Post-op(cell/mm2) month ± ± months ± ± Mean loss (%) month ± ±3.59 (p< 0.05) months ± ±2.36 (p< 0.05)

29. Complications
No serious complications: capsular tear, vitreous loss, dropped nucleus in both groups mild iris trauma cases corneal wound edema 2 cases

30. Discussion
Advantages of Phaco-drainage 1. Less induced astigmatism (depend on wound length) 2. Faster visual rehabilitation 3. Cost-effectiveness

31. 300 eyes of phaco-drainage surgery
Corneal wound edema eyes
Iris trauma eyes
Descement membrane detactment 2 eyes
Corneal decompensation -> not found
Endophthalmitis > not found

32. In conclusion:
- MSICS is appropriate for cataract surgery in developing countries - We can perform sutureless cataract surgery without phaco-machine. - Phaco-drainage is the cataract surgery method that reduced the wound length until can insert foldable IOLs

33. Dr.Apple et al. in their editorial in Ophthalmology (1999) mention
“ some unfinished tasks that remain of which to deliver primary surgery to huge backlog of cataract blind in the underprivileged world
(25 million blind) is of paramount importance”

34. Thank you
for
your attention