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A new capsule polisher can efficiently polish and sweep debris from the entire anterior capsule.
Take-home message: A new capsule polisher can efficiently polish and sweep debris from the entire anterior capsule.
By Nancy Groves; Reviewed by Jared R. Younger, MD
Fountain Valley, CA-A new capsule polisher is designed to polish both the anterior and posterior chambers and eliminate the need to use two instruments to remove capsular debris.
Jared R. Younger, MD, in private practice in Fountain Valley, CA, developed the instrument (Younger 360°) in coordination with Rhein Medical.
The 360° capsule polisher is a modification of a previously designed instrument by John R. Shepherd, MD, who developed dual right- and left-sided capsule polishers, each with a 90° bend, to be used in sequence.
“This always worked well,” Dr. Younger said. “However, this modified polisher completes the step without having to switch instruments.”
Currently available polishers have required either switching between a right and a left instrument or using one instrument that can go separately through the main incision and then a different instrument through the side port incision.
Various techniques can be used to clean the posterior capsule-a step many surgeons perform to prevent complications that could interfere with the patient’s quality of vision, such as capsular opacification or contraction. After cataract surgery, the anterior lens epithelial cells can undergo metaplasia, which may cause the capsule to shrink or develop fibrosis or phimosis and increasing the risk of decentration or tilt of the IOL.
Studies have shown the rate of anterior capsular opacification and phimosis is reduced with capsular polishing, according to Dr. Younger.
“Knowing that, I always clean and polish the capsule,” he said. “However, like most surgeons, I use a single irrigation and aspiration tip for cortex removal, which can be used to polish some of the capsule, but it has a limited polishing range of approximately 180°. The option then has been to use one or two different instruments to polish the entire capsules.”
Dr. Younger’s modification addresses this phase of polishing.
“After cortex removal, you use the 360° capsule polisher with viscoelastic in the capsular bag to clean the under the right side and then continue on with the beveled bend of the instrument to polish the left side of the capsule and reach under the incision,” Dr. Younger explained.
This maneuver saves time since it can polish 360° of the capsule quickly, including the subincisional capsule, and the angle of the shaft, along with the beveled left side, allows for an efficient polishing maneuver, he noted.
The technique separates a significant amount of material from the capsular rim, and cortical strands or debris can be removed from the posterior capsule surface. This may reduce immediate postoperative inflammation since irrigation and aspiration will have removed the liberated capsular debris.
Advances in cataract removal techniques and lens implants have not eliminated the need for capsule polishing and may make it even more essential. Dr. Younger, like others, has augmented his surgical protocol with aberrometry and a femtosecond laser, slightly increasing the time per procedure.
“Any step I can do that produces less inflammation and saves time is valuable,” he said. “Also, the fewer times you have to enter and exit the eye, the less chance of incision trauma, especially with bent instruments.
“With refractive cataract surgery, our goal is an excellent visual outcome with a happy patient,” Dr. Younger said. “This requires precise surgical techniques and minimal inflammation, and I find the 360° polisher to fit in nicely.”
Jared R. Younger, MD, MPH
Dr. Younger has a financial interest with Rhein Medical regarding this instrument.