New phaco tip enhances wound sealing and helps prevent thermal damage

The tip’s waisted design allows use of a reduced-diameter sleeve that runs almost flush with the tip head, minimizing incision size, surgeon says.

Rupert Menapace

A new phacoemulsification tip is well-suited for mini-incision cataract surgery using peristaltic flow, according to a proponent of the device.

The Oertli easyTip 2.2 mm phaco tip (Oertli Instruments) is safe and easy to use, Rupert Menapace, MD, said in an interview with Ocular Surgery News.

“This high-flow, high-vacuum tip is a true alternative to power modulation or OZI/Ellips technology,” Dr. Menapace said. “It optimizes both followability and holdability, thus tremendously reducing the energy required for emulsification.”

Dr. Menapace said he prefers to use the easyTip in conjunction with the Oertli OS3 phaco system with flow-controlled peristaltic pumping. Currently, the ideal incision size for the easyTip is 2.2 mm to 2.4 mm; an incision of 2.2 mm is optimal when a modified sleeve is introduced, he said.

The easyTip offers better wound sealing and prevents thermal damage to the incision. Its design was derived from the Oertli CO-MICS 2 tip, which allows highly efficient coaxial phacoemulsification through an incision as small as 1.4 mm, particularly when infusion-assisted, Dr. Menapace said.

Features of the tip

Various features make the easyTip safe, user-friendly and effective, Dr. Menapace said.

The transition from an enlarged head to a slim shaft maximizes the projection area of the frontal plane and increases emulsification power by a factor of six. Flow resistance associated with a small aspiration bore allows the surgeon to use high vacuum to optimize flow, he said.

Also, the tip’s waisted design allows use of a reduced-diameter sleeve that runs almost flush with the tip head, further minimizing incision size, Dr. Menapace said.

The design allows for easy insertion into the incision. A wider space between the sleeve and slim shaft increases distance to the tunnel and allows more fluid to pass. This optimizes fluid supply, allows higher flow rates and enhances cooling when emulsification is performed with the tip not fully occluded.

“Due to the slim shaft, the cross-section of the infusion mantle is greater than with a standard tip. This optimizes the infusion supply while the slim shaft of the tip suppresses surge,” he said. “As a result, 45 mL/min flow and 600 mm Hg vacuum can be used at an effective bottle height of 100 cm with the chamber still stable upon occlusion break.”

The design requires higher vacuum energy to produce an adequate flow rate. This provides pre-loaded vacuum at the tip opening, enhancing followability, optimizing tip occlusion and reducing rise time to the pre-set occlusion level, he said.

Augmented inflow of infusion fluid and increased flow resistance in the aspiration channel suppress surge when occlusion breaks, he said.

“Clinical experience and ongoing studies fully support the efficiency of this technically elaborate new phaco tip, which enriches the control provided by a peristaltic pump with a vacuum preload as a widely appreciated feature of the otherwise more aggressive venturi pump,” Dr. Menapace said. – by Matt Hasson

• Rupert Menapace, MD, can be reached at Intraocular Lens Service, Medical University of Vienna, Department of Ophthalmology, Vienna General Hospital, Waehringer Guertel 18-20, A 1090 Vienna, Austria; +43-1-40400-7931; fax: +43-1-40400-6630; e-mail: rupert.menapace@meduniwien.ac.at.

The Oertli easyTip maximizes chamber stability and safety by increasing irrigation capacity and reducing aspiration flow. These effects are produced by narrowing the internal and external proximal diameters of the phaco needle to limit the rate of aspiration flow, eliminate surge and utilize the additional space for irrigation. The trade-off with this design is the potential for increased clogging at the neck of the needle.

– Mark Packer, MD, FACS
Drs. Fine, Hoffman and Packer Ophthalmologists, Eugene, Ore., U.S.A.