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New technology improves clinical performance of 2001 Alcon Legacy
The designer of several innovations for the Legacy 20000 describes recent changes and additions.
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Recent additions to the Alcon Legacy have increased both the safety and efficiency of the phacoemulsification procedure. These beneficial changes have come in the form of both new hardware and software capacity.
Flare Tip
Straight or angulated, and available in small and standard dimensions (0.9- mm and 1.1-mm port sizes), the Flare Tip is emerging as a great addition to the armamentarium of the cataract surgeon. A short list of its benefits include more rapid sculpting of the lens due to the increased width of the tip, marked increase in efficiency when sculpting a dense nucleus due to both the greater width and also increased cavitation, and dramatic improvement in fluidics that permit the use of aspiration flow and vacuum levels as high as 60 cc/min and 600 mm Hg.
The use of these parameters permits routine aspiration of grade 1 nuclear cataracts without the use of any ultrasonic energy, and grade 2 lenses require only one or two momentary bursts of ultrasound, which emit insignificant energy into the eye.
The increased width of the Flare Tip design is also beneficial when the “non-impale” technique of phaco chop is used for softer nuclei. The increased tip diameter results in greater stability of the nucleus, against which the tip is pressed during the chop.
With this technique, the chop is performed with the foot pedal in either position 0 or 1. For lenses with substantial nuclear density, I prefer to impale the nucleus (vacuum 250 mm Hg) with a short burst of ultrasound, then return the foot pedal to position 2 to maintain nucleus fixation during the chopping maneuver.
The advantages of the Flare Tip have been achieved without the need to enlarge the surgical incision. I currently insert the 0.9 Mackool ABS Flare Tip (straight or angulated) through an incision of 2.6 mm; the 1.1 flare requires a 2.75-mm incision. This results in a sealed incision that does not leak during the phaco procedure.
The combination of the Mackool and ABS technologies provide protection against elevation of incision temperature. I have performed more than 10,000 procedures with either the Mackool or Mackool ABS technology without a single case of even a minor incision burn.
New software
The AdvanTec software changes introduced this year enable the surgeon to combine machine functions in a manner that reduces the amount of ultrasound required and limits its emission to the most favorable portions of the procedure. For example, the system can be programmed to automatically deliver ultrasound in a short pulse mode (my preferred mode) when the actual vacuum level achieved reaches 90% of the preset maximum. The tip then vibrates 25% of the time (60 msec on, then 180 msec off, etc).
This limits the application of ultrasound to those periods of time when the nucleus is at the tip and occluding the port. Essentially all of the energy thus emitted will be absorbed by the nucleus, dramatically reducing the amount of US used for the procedure.
Lastly, NeoSoniX offers the interesting ability to combine oscillatory tip movement with ultrasound. One potential benefit of this is my finding that the combination of these technologies causes the position of the nucleus to constantly vary at the tip. This prevents penetration/impaling of the nucleus and, therefore, the need to use a second instrument to reposition it prior to continuing the removal process. This would appear to be beneficial for those surgeons who favor a one-handed technique for phacoemulsification.
For Your Information:
- Richard J. Mackool, MD, can be reached at the Mackool Eye Institute, 31-27 41st St., Astoria, NY 11103; (718) 728-3400; fax: (718) 728-4882; e-mail: mackooleye@aol.com. Dr. Mackool has a direct financial interest in the Flare Tip and the Mackool System. He is a paid consultant for Alcon.
- Alcon Surgical can be reached at 6201 South Freeway, Fort Worth, TX 76134; (800) 826-5266; fax: (817) 241-0677.