Head-to-head: bimanual vs microincision coaxial phaco

The goal of ophthalmic surgery is to achieve the desired effect with minimal trauma to the eye, as such, creating smaller incisions for clear cornea phacoemulsification continues to garner significant interest because it has been shown to decrease induced astigmatism and the need for suturing.¹ Currently, there are two methods of performing microincisional cataract surgery: bimanual and microincisional coaxial (microcoaxial) phacoemulsification.

Both bimanual and microcoaxial techniques use smaller incision sizes. Here, we will refer to our knowledge of the bimanual and microcoaxial techniques that induce two 1.2 mm and one 2.2 mm incision, respectively. Several firms have, however, recently manufactured surgical instruments that create even smaller incisions with both techniques, though the availability of and experience with these new devices is currently very limited.

Many researchers have reported the advantages of bimanual phaco to include less surgically-induced astigmatism, increased followability of nuclear fragments and the added flexibility of using two incisions, allowing differing angles for the surgical approach,^2,3 whilst disadvantages include anterior chamber instability, potential wound trauma and lower vacuum levels. With regards to microcoaxial phaco, less endothelial cell loss and less Descemet's membrane trauma have been reported,^4,5 however, the disadvantages of the technique have been found to be similar to those encountered in standard coaxial phaco, such as, difficulty in removing the sub-incisional cortex and decreased followability, as irrigation may push nuclear fragments away from the phaco tip.

Bimanual pitched against coaxial & microcoaxial phaco

After completing the simulated phaco cycle, the intraocular pressure (IOP) was cyclically raised and lowered from 0 to 125 mmHg in all eyes for 30 seconds while the wounds were monitored for spontaneous leakage. We processed two corneas from each treatment group for histologic evaluation to determine India ink penetration into the corneal wounds, and performed SEM on one cornea from each treatment group to evaluate Descemet's membrane and the corneal endothelium.