1. How long have you been performing cataract surgery?
I started training as a cataract surgeon in 1995 at Iwata City Hospital in Iwata, Japan. By the time I had been there 1 year, I could perform a routine cataract extraction in 10 minutes.
In 1999, I founded the Kikugawa Eye Clinic in Shizuoka Prefecture, which is in the Chubu region on Honshu Island, Japan. This area is best known as the home of Mt. Fuji, the highest mountain in Japan. After 12 years of practice, I can now perform a routine cataract extraction in 5 minutes.
We have two ORs in our clinic, which allow us to perform an average of 100 cataract surgeries per month. I personally perform 50 to 60 procedures, and my colleague performs approximately 40.
2. What kind of tools have you developed for cataract surgery?
Since 1998, I have designed a series of capsulorrhexis forceps that are available from ASICO (Westmont, Illinois). My first design (AE-4389 Ikeda Capsulorrhexis forceps) was based on a vitrectomy forceps. Over the next 3 years, I refined the design, first by making the tip thinner and shorter and most recently by changing its angle.
ASICO also introduced the AE-4402 Ikeda Nozumi Capsulorrhexis Forceps, so named because the tip resembles the bullet train that runs on Japan's Shinkansen high-speed rail line.
The amount of power with which a surgeon can grasp the capsular surface with a forceps increases as the instrument's tip approaches perpendicularity relative to its shaft. This configuration tends to block the surgeon's view of the area where he wants to make the capsulorrhexis, however, so most forceps are curved or angled. The unique 45° angle of the Nozumi forceps and its broad, serrated tips strike a balance between grasping power and visibility.
3. How can the capsulorrhexis be improved?
I designed an instrument that will create a perfectly circular capsulorrhexis. It looks like a corneal marker, except it is designed to be used inside the anterior chamber. The surgeon could set the instrument to a desired diameter, hold it on the anterior part of the capsule, and create a capsulorrhexis using the instrument's interior edge as a guide.
4. What would be the advantage of a perfectly circular capsulorrhexis?
Within the next 10 to 20 years, I would like to see an IOL that does not have haptics. Instead of inserting the IOL into the capsule through the capsulorrhexis, the surgeon would embed the IOL in the anterior part of the capsule. The margins of the capsulorrhexis would fit into a groove around the IOL's edge and hold the lens in place. A perfectly circular capsulorrhexis would be required. One advantage of this system would be that a surgeon could implant the smaller "hapticless" IOL in the anterior chamber through a smaller incision.
Another technological development that would improve the outcome of cataract surgery would be the introduction of customized IOLs. We could use these lenses to correct each patient's specific refractive errors.
5. Have you invented any tools for bimanual microphacoemulsification?
I designed a dual-hole irrigation chopper that has a unique V-shaped configuration (manufactured by Geuder AG, Heidelberg, Germany). Irrigation choppers that have one hole inflate only one side of the capsular bag, whereas those that have two holes direct fluid toward both sides of the bag and thus inflate it equally. The force of the fluid exiting these holes tends to be too weak, however, to inflate the bag sufficiently. By tapering the irrigating holes in my chopper to emit fluid at an angle, I improved the strength of the individual irrigating streams and my ability to visualize the inside of the capsular bag during phacoemulsification.
