In our current age of refractive cataract surgery, surgical outcomes are more important than ever, and achieving a low complication rate is critical. Among the most dreaded of surgical complications is rupture of the posterior capsule, as this may lead to a host of problems and compromise the patient's vision.

For most cataract surgeons, there is a greater risk of capsule rupture during cortex removal versus during emulsification of the nucleus. Once the nucleus has been removed, there is very little protection of the posterior capsule, which can be as thin as 4 µm centrally. The high vacuum forces created during I/A of the cortex may damage the posterior capsule if it enters the I/A tip.

I/A Tips
Traditional. Such I/A tips are metal; this can pose a problem. With repeated use of these metal tips and with manipulation via other instruments, it is possible to develop an irregular and sharp edge to the metal I/A tip (Figure 1). When a metal I/A tip with a small burr is exposed directly to the posterior capsule, it will likely result in immediate rupture of the posterior capsule and prolapse of vitreous.

Silicone-coated soft I/A. Because these tips are coated with silicone, there is never an opportunity for metal to contact the posterior capsule, thereby decreasing the likelihood of capsule rupture and vitreous loss (Figure 2). Additionally, the flexible silicone covering may be adjusted to allow larger or smaller port openings, depending on the surgeon's preference. Even if a second instrument is used during I/A (ie, to push or force cataract material into the I/A tip), there will be no metal-to-metal contact.

Advantages of the Silicone-Coated Soft I/A Tip
While the most important advantage is the increased safety to the posterior capsule during cortex removal, there are other advantages to the silicone-coated soft I/A tip. This new I/A tip—made of silicone with a grip surface—may be used for intraocular manipulations of cataractous material and the IOL implant.

This grip surface may be used to flip an epinuclear plate out of the capsular bag, to ball-up subincisional cortex material, and to even polish the posterior capsule without the use of vacuum. The surface may also be used to (1) tilt the IOL, facilitating viscoelastic removal, (2) dial the IOL into the capsular bag, and (3) further position the IOL in the center of the visual axis.

I have used the silicone-coated soft I/A tips in hundreds of cases with no complications related to capsule rupture during cortex removal. It has significantly improved my surgical technique and given me increased confidence when working in close proximity to the posterior capsule. Use of this tip has become routine in my own practice, and I believe that it will become the standard in the ophthalmology community.

Uday Devgan, MD, FACS, is in private practice at the Maloney Vision Institute, in Los Angeles, and Acting Chief of Ophthalmology, Olive View UCLA Medical Center, and Assistant Clinical Professor, Jules Stein Eye Institute, UCLA School of Medicine, in Los Angeles. Dr. Devgan may be reached at +1 310 208 3937; Devgan@ucla.edu; or www.maloneyvision.com.