Surgical support app tracks safety, efficiency variables for physicians

August 30, 2019
Lynda Charters

Analysis may help surgeons track performance, create standardized metrics

Separate studies have reviewed the eyeTELLIGENCE icloud platform, a component of Bausch & Lomb’s Stellaris Elite vision enhancement system, which provides data to analyze cataract surgeries with the goal of improved efficiency and safety.

Reviewed by Mitchell Shultz, MD

A key aspect of any practice is securing platforms that provide the best possible outcome for its patients. Two comparative studies have reviewed the eyeTELLIGENCE icloud platform, a component of Bausch + Lomb’s Stellaris Elite vision enhancement system, which provides data to analyze surgeries with the goal of improved efficiency and safety, according to Mitchell Shultz, MD, and Valeri Kolesnitchenko, MD. The first case series is the dual-linear venturi phacoemulsification with an adaptive fluidics system used during FLACS versus traditional horizontal chop.

In this series, one surgeon performed all procedures at one site using the Stellaris Elite system. A total of 164 patients were included, 30% of whom underwent FLACS and 70% a traditional chop procedure. The following parameters were used: a maximal vacuum of 600 mm Hg (50- 400-600 mm Hg), 8 milliseconds of phaco energy in burst mode (duty cycle of 1–75%); phaco energy in pulse mode at 30 pulses/second (duty cycle 60%, power 2–50, front-loaded). Most patients had cataract densities that ranged from 2–2.5 (38%) and 3–3.5+ (56%).

The phaco energy usage was (p = 0.0085) higher in the traditional group compared with the FLACS group in 21.6% and 18.2%, respectively, compared with cases with densities of 2–2.5+ and 27.4% and 22.4%, respectively, in cases with densities of 3–3.5+, according to Dr. Shultz, who is in private practice in Northridge, CA.
The absolute phaco times were (p = 0.0016) lower by more than half of those in the FLACS group compared with the traditional group with both nuclear densities; in the 2–2.5+ group, the respective times were 2.21 versus 4.64 seconds and in the 3–3.5+ group, 5.23 and 13.41 seconds.

The effective phaco times in the two nuclear groups also were significantly (p = 0.0000) lower in the FLACS group compared with the traditional group, in the 2-2.5+ group, 0.36 versus 0.94 seconds and in the 3-3.5+ group 1.06 versus 3.82 seconds.

The total fluid volume used in the 2–2.5+ nuclear density group in the FLACS group compared with the traditional group were, respectively, 51.57 and 48.61 milliliters and in the 3–3.5+ group, 68.33 and 58.27 milliliters. The second series is the dual-linear venturi phacoemulsification with a new adaptive fluidics system in traditional phacoemulsification across various nuclear densitie, in which investigators compared the same surgical parameters during traditional emulsification in patients with varying nuclear densities.

One surgeon performed 136 cataract surgeries using the Stellaris Elite at one site. The nuclear densities were determined preoperatively. Thirty-seven patients had 2+ nuclear densities, 65 3+, and 34 over 3+.

In patients with 2+ and 3+ nuclear densities, vacuum levels up to 600 mm Hg (75-450-600) were used; in the 2+ group, 6 milliseconds, 12% ultrasound, and duty cycle 1–55%, and in the 3+ group, 8 milliseconds, 20% ultrasound, and duty cycle 1-75% were used. Analysis of the average ultrasound power used showed that the respective average power levels used in the three groups were 12.18%, 13.27%, and 18.74%.

The respective average absolute phaco times in the three groups were 2.80, 6.17, and 24.02 seconds (p = 0.00); the average effective phaco times were 0.35, 0.82, and 4.72 seconds (p = 0.00). The average total fluid amounts used were 47.81, 51.46, and 62.88 milliliters (p = 0.0001). Dr. Shultz said dual linear vacuum enabled lens material to flows to the phaco tip without the need to chase fragments.

Disclosures:

Mitchell Shultz, MD
E: izapeyes@gmail.com
Dr. Shultz is a paid consultant and lecturer with Bausch + Lomb. Dr. Kolesnitchenko is an employee of Bausch + Lomb.

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