Vision enhancement system facilitates safe phaco with decreased energy

The internal controls and responsiveness to changes in vacuum with a new vision enhancementsystem (Stellaris, Bausch & Lomb) have made high-vacuum, coaxial microincision cataract surgerya safe and efficient procedure, according to Elizabeth Davis, MD. The system also helps todecrease the amount of excess energy added to the eye beyond what is needed to remove acataract.

"With the interest in small-incision cataract surgery, the procedure produces less astigmatism,intraoperative safety is enhanced, and risk of infection is decreased," said Dr. Davis, who isaffiliated with the University of Minnesota, Minneapolis.

Many surgeons prefer to use ultrasound energy for a cataract procedure to avoid the chance ofcatastrophic loss of chamber stability and integrity that can occur when working with extremelyhigh levels of vacuum, she explained.

Dr. Davis and her colleagues evaluated 50 patients (mean age, 67.4 years) who underwentmodified supracapsular, high-vacuum technique with the system's vacuum module performed througha 1.8-mm incision. Next-generation fluidics (EQFluidics, Bausch & Lomb) allow for the use ofsmaller incisions and offer enhanced technology from the previous generation phaco system(Millennium, Bausch & Lomb).

The outcomes indicated that "vacuum up to 600 mm Hg can be used without surge or loss ofanterior chamber stability," Dr. Davis said. "There has been no clogging of the tubing[StableChamber, Bausch & Lomb], and the procedures have been extremely efficient. With vacuumset at 600 mm Hg, average phaco power use ranged from 0% to 4%."

Cataract densities ranged from 1 to 3+. In 94% of patients the mean phaco power was 0%, and in82% of patients the surgical time ranged from 4 to 8 minutes, she reported. The mean phacopower was 0.3% (range, 0 to 9%) and the mean phaco time was 0.22 seconds (range, 0 to 4seconds). The mean surgical time from incision to wound closure was 6.6 minutes (range, 3 to 11minutes). Denser cataracts required a longer surgical time. Corneas in 98% of patients wereclear.

Dr. Davis concluded that the transition to sub-2-mm surgery was accomplished withoutdifficulty, there was no change in surgical efficiency, and the operating room personnel foundthe system easy to use.