1531: what happened to bimanual phaco?

Many of our surgeons use bimanual irrigation/aspiration during cataract surgery and certainly all retina surgeons perform bimanual vitrectomy, so what about bimanual phaco? About 15 years ago, bimanual phaco was gaining in popularity. The idea is to separate the infusion from the aspiration, to have better control of the fluidics while using smaller incisions. This became possible because of phaco power modulations which allowed better cooling of the phaco needle by using a lower duty cycle, burst mode, and other modalities. The phaco needle is placed into the corneal incision without a silicone sleeve which means less insulation to protect against a corneal wound burn. There were even specialized instruments such as irrigating choppers. I performed a few hundred of these procedures before switching back to coaxial phaco. This video explains why.

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