Phaco experience maximized

August 15, 2010

Phacoemulsification technology has advanced steadily in the past decade, and the major phaco platforms available in the United States all are refined, highly efficacious systems.

New York-Phacoemulsification technology has advanced steadily in the past decade, and the major phaco platforms available in the United States all are refined, highly efficacious systems. Major evolutionary trends in recent years have included improved power modulations, enhanced behind-the-scenes fluidic sensors and safety controls, and the move to smaller incision size.

A significant advancement has been the introduction of non-longitudinal phaco with the development of torsional ultrasound and transversal ultrasound. With torsional ultrasound, the phaco tip oscillates side-to-side on a bent Kelman needle; whereas in transversal ultrasound, the needle travels in an elliptical motion composed of side-to-side and blended longitudinal movement. These power modulations dramatically decrease nuclear repulsion and heat production, enabling the use of lower and safer fluidics and diminishing thermal injury.

If there is one downside to non-longitudinal phaco, it's the propensity to slow down or clog up with denser nuclei. The introduction of enhanced technology (Ellips FX handpieces and 2.0 software upgrade) for a proprietary phaco platform (Whitestar Signature, Abbott Medical Optics [AMO]) is one option available to eradicate the clogging and maximize the smooth, non-repellant, cutting of transversal ultrasound. Coupled with the ability to choose peristaltic or newly enhanced venturi fluidics (Fusion Fluidics) in each sub-mode, the entire phaco experience is optimized.

Phaco manufacturers have learned a lot about optimizing side-to-side or horizontal phacoemulsification since its introduction.

AMO's enhancements with its Ellips FX handpieces are dramatically improved over its original Ellips 1.0. Cutting ability has been increased by significantly increasing the stroke path of the needle, as well as the frequency of its oscillations. The result is a smooth, powerful phaco with the benefits of side-to-side phaco and the cutting ability of longitudinal phaco. Furthermore, these benefits all are attained with a straight phaco tip.

In the first version of Ellips, frequently a Whitestar hyperpulse setting was overlaid on the transversal ultrasound-with the thought that the two technologies would be additive.

In my experience, the hyperpulse pauses (designed to minimize repulsion in longitudinal ultrasound) only slow the already non-repulsive, side-to-side phaco-so I utilize the new technology in continuous mode, again with great cutting effect even on brunescent lenses.

The new technology also achieves two important phaco attributes: holdability and followability. Followability frequently is alluded to in describing phaco and represents the ability of cataract segments to be regrasped fluidly and emulsified, one after another. Followability was much discussed with the introduction of Whitestar or hyperpulse technology several years back, but is improved even further with the latest technology.

Just as important, holdability, or the lack of nuclear chatter at the tip, has been harder to eradicate with longitudinal ultrasound even with high vacuum levels. This is where the new technology also shines-the optimized elliptical movement so effectively minimizes repulsion that I have yet to experience any chatter with its use. Even dense lens fragments stick to the tip without a shimmer. With less chatter comes less endothelial cell loss and clearer corneas.

Furthermore, with such natural holdability, I have been able to reduce significantly my vacuum settings without loss of efficiency.