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New phaco tips suit all types of cataract surgery
A common goal is reducing ultrasound time, thus increasing safety and being gentle with the eye.
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Pezzola phaco tip, made in Italy by Optikon 2000, is designed with a 30° angle, and with an internal hourglass-shaped narrowing 1.5 mm above the distal end. This internal diaphragm is designed to prevent turbulence with high flow rates. |
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MILAN – Phaco tips of the newest generation provide a wide variety of options from which surgeons can select the one best suited for their — and their patients’ — individual needs.
“The latest designs have improved all possible features to get the best out of each stage of phacoemulsification,” said Roberto Bellucci, MD, here at the Satelcataract meeting. “A common goal is that of reducing ultrasound time, thus increasing safety and being as gentle as possible with the eye.” New phaco tips of various types were discussed and evaluated by the panel and audience at the meeting, organized by Lucio Buratto, MD. Dr. Bellucci summarized some of their most outstanding features.
High vacuum tips
According to Dr. Bellucci, one of the most interesting products is the Pezzola phaco tip, made in Italy by Optikon 2000. (At present the tip is a prototype, not yet in the Optikon 2000 catalogue.) The tip is designed with a 30° angle, and with an internal hourglass-shaped narrowing 1.5 mm above the distal end. This internal diaphragm is designed to prevent turbulence with high flow rates (figures 1a and 1b).
“This tip allows safe phacoemulsification in high vacuum conditions,” Dr. Bellucci said. “The lens material is captured where the internal diameter of the needle becomes narrower, occludes the tip and creates a fast and high vacuum rise. Following the ultrasound burst, the tip is freed up and the flow starts again more gradually, reducing the risk of surge as much as a microtip would do. Unlike microtips, however, these tips can never get clogged up. You can then have the best of both worlds: same safety of a microtip in high vacuum conditions, same prevention of obstruction that macrotips offer.”
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Aspiration Bypass Stabilizer microtip (Alcon) has a small hole in the side of the tip, covered by the sleeve. A small quantity of liquid can be aspirated through the needle even when the tip port is completely occluded. |
The ABS
Equally effective in preventing obstruction and overheating is the Aspiration Bypass Stabilizer (ABS) microtip by Alcon.
“The ABS is a small hole in the side of the tip, covered by the sleeve,” said Dr. Bellucci. “Thanks to this simple device, a small quantity of liquid can be aspirated through the needle even when the tip port is completely occluded (figure 2). This results in a gentle, continuous flow that keeps the tip cool, avoiding corneal burns. It can be used with vacuum pumps of the venturi type.”
The ABS microtip is particularly indicated in phacoemulsification associated with vitrectomy, when a peristaltic pump is usually not used, he said.
High flow tips
Flared tips, such as the Bausch & Lomb Micro-Flow Plus and those made by Optikon 2000, favor a high flow level. These tips are particularly indicated for medium-hard cataracts, Dr. Bellucci said. Through their larger apertures, more lens material can be captured at a low flow rate and then aspirated at a higher speed when it reaches the narrower segment of the needle (figure 3). The reduced size of the needle inside the sleeve allows increased irrigation flow.
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Flared tips, such as the Bausch & Lomb Micro-Flow Plus and those made by Optikon 2000, favor a high flow level. Through their larger apertures, more lens material can be captured at a low flow rate and then aspirated at a higher speed when it reaches the narrower segment of the needle. |
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“With this kind of tip, aspiration of the lens material is much faster,” said Dr. Bellucci. “They should, however, be used with flow pumps because, in case of obstruction, they need the pressure of a high vacuum level and reduced aspiration.”
One advantage of flared tips is a better cooling system compared with other tips. “In particular, the fluted needles produced by Bausch & Lomb reduce the diameter of metal surface coming into contact with the tissue,” Dr. Bellucci explained. “The grooves allow for a more copious irrigation that cools down the tip and avoid thermal injuries.”
A strong hold
When dealing with hard cataracts, the nuclear and cortical fragments captured by the phaco tip tend to spin during ultrasound emission. “There are tips that have been specifically designed to overcome this problem,” said Dr. Bellucci. One of them is the Optikon 2000 Kawano tip, which has a round section and two claws at the aperture. “It looks and works like a human mouth, grasping and holding the fragments firmly. It is the ideal solution to emulsify hard nuclei, and can be used with a traditional peristaltic pump,” he said.
For Your Information:
- Roberto Bellucci, MD, can be reached at tel./fax +(39) 0365-43678. Dr. Bellucci has no direct financial interest in the products mentioned in this article, nor is he a paid consultant for any companies mentioned.
- Information on Optikon 2000 phaco tips can be found at www.optikon.com.
- Information on the ABS microtip can be found at www.alconlabs.com.
- Information on the Flared Tips can be found at www.bausch.com.