Comment on: Fluid-jet technique to polish the posterior capsule for phacoemulsification surgeries: efficacy and safety evaluation
Bibliographic record
Abstract
We read with great interest the study by Liu et al.1 The authors have presented a well-structured study to demonstrate the efficacy and safety of the fluid-jet technique to polish the posterior capsule for phacoemulsification surgeries. Our interest was piqued because the technique of polishing the posterior capsule with jets of a balanced salt solution was first independently presented in consecutive lectures at the September 1999 Congress of the ESCRS, in Vienna, Austria, by Steve Arshinoff (author) and, then, in the immediately subsequent presentation, by Thomas Neuhann (author). Arshinoff presented this idea first at the April 1999 ASCRS Symposium on Cataract, IOL, and Refractive Surgery in Seattle, Washington, in the presentation “Extending the idea behind the viscoelastic soft-shell technique,” and it was later published, but both of us had devised the technique independently and used it for every case since the late 1980s.2 We made the following points: (1) The cannula should have a polished blunt tip to prevent snagging the posterior capsule. (2) Injection should be uninterrupted when the cannula is in the eye to prevent contacting the posterior capsule, thereby exposing the capsule only to the fluid jet. (3) The method is enhanced if the hockey stick shape of the injection cannula is used to advantage to depress the posterior lip of the incision, causing it to leak as injection is performed, so that the posterior capsule domes forward, thereby causing the injection jet to induce an S curve in the capsule, with the indentation of the S facing the injection stream, facilitating removal of the residual lens fibers. (4) The balanced salt solution–jet technique can also be very helpful to wash out the capsular fornices to remove any residual cortical fibers, which are, otherwise, often unseen, especially if the pupil has constricted during the procedure. We have each performed this technique in more than 30 000 consecutive cases since those presentations. We are convinced of its efficacy in reducing posterior capsular opacification, and Arshinoff has, therefore, taught the technique in ophthalmic viscosurgical device courses given at ASCRS, ESCRS, AAO, and many other meetings globally for almost 30 years. We therefore concur with the authors' findings of reduction of posterior capsule opacification demonstrated in the article and can confirm that that reduction lasts for many more years than the 1 year the study by Liu et al. demonstrated, as we both now have more than 30 years of follow-up of some of those initial patients. Video 1 available at, https://links.lww.com/JRS/A401, made in the 1990s by Arshinoff and shown at the Congress of the ESCRS in 1999, and at many other meetings, shows the original technique.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".