May 24, 2013
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Ultrasonic knife allows prechop of dense lenses

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MILAN — The use of an ultrasonic knife attached to a standard phaco handpiece allows safe and efficient prechop of dense lenses, according to one surgeon.

"With very dense nuclei, I can’t prechop using a standard instrument because I cannot get it inside the nucleus," Jeffrey D. Horn, MD, said at the annual joint meeting of Ocular Surgery News and the Italian Society of Ophthalmology.

Jeffrey D. Horn, MD

Jeffrey D. Horn

The Ultrachopper, invented by Luis Escaf, MD, is produced and distributed by Alcon for use with the Infiniti system. It is 3 mm long and 1 mm high. It is used with the Ultra Sleeve, which goes easily thorough a 2.2-mm incision, and scores dense nuclei, allowing breakup of the lens, Horn explained.

One case of complicated cataract surgery in a patient with glaucoma was shown on video. The patient had elevated pressure and loose zonules, was on Flomax (tamsulosin, Boehringer Ingelheim) and had a small pupil that did not dilate well.

"The Ultrachopper allowed me to go through the dense lens and do the rest of the procedure very efficiently without stretching the zonule and using a reduced amount of phaco energy," Horn said.

What was potentially a complicated case became a nearly routine case. The following day, the cornea was clear and vision was 20/25 uncorrected.

Horn said that this device is "a wonderful tool for cases of loose zonules, where you don’t want to be disrupting the lens very much within the capsule and is excellent for pseudoexfoliation for the same reason."

Disclosure: Horn does clinical research for Alcon.