Priya Narang, MS, focuses her blog on complex cataract surgery cases, new techniques and innovations, along with unique case reports.

BLOG: Trocar ACM — New device for infusion

Maintenance of globe stability and wound architecture is an essential prerequisite in intraocular surgeries. Under such circumstances, viscoelastic and fluid infusion play a very important role. An anterior chamber maintainer, or ACM, and trocar cannula system are commonly employed by anterior and posterior segment surgeons, respectively.

Encompassing the advantages of a trocar cannula into an anterior chamber maintainer, a new device has been designed by Dr. Amar Agarwal called the trocar ACM. As compared with conventional trocars, the overall length of the newly designed trocar ACM has been decreased to 6 mm so that it can be conveniently used by anterior segment surgeons without the fear of damaging intraocular structures.

The advantage of using the trocar ACM is that it prevents overcrowding of the cornea, making greater surgical space available for the surgeon, and it also obviates the need for making a corneal side-port incision. The chance of spontaneous extrusion of an ACM is nullified with the use of the trocar ACM. It can also be used for air-fluid exchange in endothelial keratoplasty procedures without any distortion of the corneal wound.

The video showcases the application of the new trocar ACM for fluid infusion in a case of a subluxated one-piece IOL. Two partial-thickness scleral flaps are made at 90° opposite to each other, and a scleral tunnel is made followed by introduction of the trocar ACM for infusion in the eye. The scleral tunnel is enlarged, and the IOL is explanted followed by introduction of a three-piece IOL and the performance of a glued IOL procedure. After the surgical procedure, the trocar ACM is pulled out, and because the incision size is 25 gauge, the sclerotomy is self-sealing, although a suture can always be taken in case of wound leakage.