Adaptive fluidics is a pressurized fluid delivery system that modulates fluid pressure in response to the aspiration vacuum the surgeon commands. The higher the vacuum commanded, the higher the source pressure, creating more fluid flow.
“In the past, the surgeon would set the infusion bottle height to account for the highest vacuum they might command with the foot control during surgery,” said Brian McCary, director of innovation and design, Bausch + Lomb. He heads the team that developed Adaptive Fluidics.
“That meant that when they were commanding lower aspiration rates, they would have more pressure in the eye than they needed,” he noted.
Adaptive fluidics provides increased fluid flow to the eye only when the surgeon steps fully down on the foot pedal to command the maximum amount of potential aspiration when the phaco needle is occluded. When the occlusion breaks, there is higher infusion to keep the eye stable during the break.
Dr. Shultz compared the Elite platform using conventional gravity feed and adaptive fluidics with the Centurion Active Infusion. When using gravity feed, the Elite machine allowed a post-occlusion surge of 47.7 mm Hg, similar to the Active Infusion 48.4 mm Hg. When using adaptive fluidics, the Elite post-occlusion surge was 22.5 mm Hg.
Adaptive fluidics also gives the surgeon the option of increasing IOP as high as 150 mm Hg during surgery. The higher pressure can help expand eyes with shallow anterior chambers or chamber subject to high posterior pressure as is commonly seen in obese patients. Expanding the capsule facilitates cortical cleanup in these patients as well as in patients with flaccid capsules.
Higher IOP also improves the efficiency of phaco. In his initial case series of 27 patients, Dr. Shultz needed less phaco energy in cases with up to 3+ nuclear sclerosis. He reported a mean effective phaco time of 0.54 seconds compared with an expected mean of 2.48 seconds. Absolute phaco time (APT) was 3.29 seconds compared with conventional APT of 12.65 seconds. Most cases used between 35 and 60 ml of fluid.
“The less fluid you use, the less trauma to the endothelium,” he said. “Less phaco energy and less fluid used translate into better corneal clarity the day after surgery.”
The manufacturer is also finalizing a cloud-based system that will let users manage data flow and communicate with company support staff on demand. The feature is not yet released, McCary said, but will function like a help button and provide other benefits in development, such as remote diagnostics and real-time interaction.