A rapid technique for en masse soft cataract phacoemulsification

Figures & data

Figure 1 (A) Surgical video still showing R: rotation of the nucleus with the second instrument. (B) Animation showing R: rotation of the nucleus with the second instrument.

Figure 2 (A) Surgical video still showing A: Alignment of the phaco-tip sideways. (B) Animation showing A: Alignment of the phaco-tip sideways.

Figure 3 (A) Surgical video still showing P: placement of the phaco-tip at the nuclear rim. (B) Animation showing P: placement of the phaco-tip at the nuclear rim.

Figure 4 (A) Surgical video still showing I: impaling of the nuclear rim. (B) Animation showing I: impaling of the nuclear rim.

Figure 5 (A) Surgical video still showing D: devouring of the nucleus. (B) Animation showing D: devouring of the nucleus.

Table 1 RAPID technique – surgical parameters used

Parameters
CDE	1.03 ± 0.61
Fluid used (mL)	10 ± 2.35
Total ultrasound time (Sec)	3.84 ± 3.27
Endothelial cell loss (mean %)	7.05 ± 2.65

Notes: RAPID, a soft cataract phacoemulsification technique, is an acronym-based procedure where R is rotation of nucleus, A is alignment of phacoemulsification tip sideways, P is placement of tip adjacent to the nuclear rim, I is impaling of tip into nuclear rim and D is devouring wherein nucleus is aspirated/emulsified.

Abbreviation: CDE, cumulative dissipated energy.

Table 2 Advantages of RAPID technique

Serial number	Advantages of RAPID technique
1	No cheese wiring as there is no fragmentation
2	En masse removal of the soft cataract
3	No hydrodelineation required
4	Safe zone phacoemulsification
5	Prevents iatrogenic trauma to posterior capsule
6	Prevents endothelial cell loss
7	No special instrumentation/softwares required
8	Decreases surgical time, CDE, and estimated fluid used
9	Multiplanar technique that prevents capsular bag as well as the iris and endothelium
10	Easy to learn and adapt

Notes: RAPID, a soft cataract phacoemulsification technique, is an acronym-based procedure where R is rotation of nucleus, A is alignment of phacoemulsification tip sideways, P is placement of tip adjacent to the nuclear rim, I is impaling of tip into nuclear rim and D is devouring wherein nucleus is aspirated/emulsified.

Abbreviation: CDE, cumulative dissipated energy.

Table 3 Comparaison of non-fragmentation techniques and RAPID technique

Surgical steps	RAPID technique	Traditional carouselling technique	Endocapsular carouselling technique	Phaco-rolling technique	Bowl and Snail technique
Capsulorhexis	5 mm	>5 mm	5 mm	>5 mm	≥5 mm
Hydrodissection	Done	Done	Done	Done	Done
Hydrodelineation	Not required	Required	Required	Required	Required
Sculpting	Not required	Not required	Not required	Not required	Required
Plane of phacoemulsification	Multiplanar	Supracapsular in the anterior chamber	Endocapsular	Endocapsular	Endocapsular
Special tips/instruments	None. Routine Kelman 45 degrees Kelman tip	None	Specialised 20 degrees right bent D shaped phaco-tip with a semicircular opening and a third irrigation port	None	None
Surge preventing softwares	Not required	Required	Required	Required	Required
Fluidics/vacuum	Routine	High fluidics/vacuum	High fluidics/vacuum	High fluidics/vacuum	Low Vacuum

Notes: RAPID, a soft cataract phacoemulsification technique, is an acronym-based procedure where R is rotation of nucleus, A is alignment of phacoemulsification tip sideways, P is placement of tip adjacent to the nuclear rim, I is impaling of tip into nuclear rim and D is devouring wherein nucleus is aspirated/emulsified.

Table 4 Limitations of RAPID technique

Serial number	Limitations of RAPID technique
1	Difficult when capsulorhexis size is small
2	Difficult in older age groups due to increased hardness of the nucleus
3	Feasible in very soft cataracts only

Notes: RAPID, a soft cataract phacoemulsification technique, is an acronym-based procedure where R is rotation of nucleus, A is alignment of phacoemulsification tip sideways, P is placement of tip adjacent to the nuclear rim, I is impaling of tip into nuclear rim and D is devouring wherein nucleus is aspirated/emulsified.