Cataract surgery in the dog is a highly successful procedure that many owners have chosen for their four-legged friends to regain or improve vision. Cataracts in general and a brief discussion of the preoperative workup and surgery is presented in a prior post that you can peruse if interested titled Cataracts in the Dog. (You can find this older post if you scroll to the bottom of this page and click on Older Entries.) Removal of an opaque, cataractous lens is an elective procedure that is chosen if we feel we can improve our dog’s quality of life by returning his or her vision. This surgery is rewarding for dog, owner and doctor as it can truly bring the “puppy” back in many dogs whose lifestyle had changed with a loss of sight. Nothing beats watching the joy on our client’s faces as their dog ambles back into their arms and makes eye contact after surgery!
The technical aspects of this surgery have evolved over the years with the goal to improve the ultimate success of the procedure. These improvements involve everything from patient selection and timing, pre- and post-operative medical management, surgical technique, quality and type of lens implants, instrumentation and last but not least the science of the cataract surgery machine itself. Veterinary medicine often trails human medicine when it comes to technical advances primarily due to the financial limitations of the very expensive equipment used for diagnosis and treament of many diseases. Here at the AEC, were are proud to introduce an upgrade to the most recent technology for cataract extraction in the dog in the form of a new cataract surgery machine, the Alcon Infiniti, and this post will focus on this machine.
Cataract removal is primarily achieved by what is called phacoemulsification. In general, a small, beveled needle is introduced into the eye through a 3mm incision. While concurrently irrigating with fluid and aspirating it out, the needle will vibrate with ultrasound power to break the cataract into small pieces that are ultimately sucked out through the tip. Very cool! As you can imagine, there are numerous factors that are involved to make this work. How fast do you introduce the fluid? How much suction do you need to suck the fluid and lens pieces out while keeping the eye inflated? How much ultrasound power do you safely use to break up the lens without disrupting the other structures? How do you create a handpiece to deliver this energy inside the eye? How do you minimize the heat and inflammation that is generated in the process? Lot’s of smart people have worked on these and many other issues to help create different machines to maximize success while miniimizing risk.
The main feature that makes the Infiniti and its Ozil handpiece better is the development of torsional or elliptical phaco. Standard phaco, used for the last 30-40 years, is in a longitudinal mode. The action of the needle is in an in-and-out motion that “jackhammers” the lens material into small pieces. The torsional movement this system features adds a side-to-side motion that shears the cataract as well. This combination creates two benefits. It reduces the heat that is created during the process which can affect inflammation and incision quality and it keeps the pieces stuck to the tip to allow faster breakdown and removal.
Other advances with the pump system help add a smoother delivery and removal of the fluid while protecting against “surge” of the fluid that disrupts the evenness of the procedure. I could go into this and other parameters in more detail here but the take home point for us and your pet is that the procedure becomes faster, easier and less traumatic with this new technology. The biggest difference between a human and a dog getting cataract surgery is that dogs generate more inflammation than people with similar ocular trauma. And inflammation after surgery is the linchpin of complication. Thus, if we can decrease our inflammation by utilizing the above upgrades we should see better success. Our pets are thus benefiting from these advances and possibly to a greater degree than people in respect to inflammation. We are excited to have this new machine in our clinic and maybe your dog will see the reason why!