Phaco rolling technique

Abstract

We thank Güell et al.1 for introducing this unprecedented phacoemulsification technique. The key to success is the free and unrestricted rotatory movement of the nucleus. With this technical prerequisite, this variant of phacoemulsification does not appear to be as surgically simple and safe as other techniques. The feasibility of this technique would be undermined by some cataract problems. First, what would be the surgical strategy in conditions such as zonular dehiscence or dense posterior subcapsular cataract in which rotating the lens is difficult? Second, the usual position of the phaco tip during rotatory movement is at the capsulorhexis edge.1 Theoretically, this has the advantage of curtailing the risk for endothelial and posterior capsule injury. However, the close proximity of the edge of the capsulorhexis to the phaco tip may increase the risk for anterior capsule damage during phacoemulsification. If undetected, an anterior capsule tear may extend across the equator, leading to a dropped nucleus or, later, to IOL decentration.2 This is an important safety issue that should not be overlooked while performing the phaco rolling technique. The authors did not report any anterior capsule injury, and we are interested to learn the precautions for reducing or preventing this risk. David T.L. Liu MRCS Vincent Y.W. Lee FRCS Wai-Man Chan FRCP, FRCS Dennis S.C. Lam MD, FRCOphth Hong Kong, China