New ultrasound delivery system enhances phaco efficiency and safety, surgeon says

Increased cutting speed leads to 50% ultrasound reduction, nuclear fragment control and minimal endothelial damage.

Matteo Piovella

A new ultrasound delivery system, along with existing technology, maximizes the platform’s functionality, making phacoemulsification easier and safer, according to one surgeon.

“[The Ellips FX Transversal Ultrasound system] is the result of continuous upgrading of the WhiteStar [Signature] technology (Abbott Medical Optics), representing the highest standard of sixth-generation phaco machines. Never before have we achieved such a high-quality performance in terms of cutting efficiency, followability, energy management and anterior chamber control,” Matteo Piovella, MD, said in an interview with Ocular Surgery News.

The existing Fusion Fluidics technology offers both venturi and peristaltic modality in a single cassette. The surgeon can switch from one pump to the other during a single operation, exploiting the instantaneous vacuum and holding power of the venturi pump and the control of the flow-based peristaltic at key steps of the procedure.

“Venturi and peristaltic lead to two different styles of cataract surgery. I thought I’d die as a peristaltic user, but this system gave me the opportunity to expand my skills and use both. I would never give up this chance of being more versatile and flexible in my surgery now,” Dr. Piovella said.

Technology advancements

The Ellips FX technology, available since February 2010, has introduced several advancements on the previous Ellips ultrasound, introduced in 2007.

“The basic idea was to provide simultaneous blend of longitudinal and transversal motion. The upgraded Ellips FX has increased cutting frequency and a larger stroke path for more efficient, smoother cutting. You can use it with any phaco tip, straight or curved. You don’t need to change your technique and you can deal effectively with all nuclei, soft or hard,” Dr. Piovella said.

Increased cutting efficiency leads to a significant reduction in ultrasound use.

“We manage down ultrasound power by as much as 50%. Endothelial safety is enhanced proportionally,” Dr. Piovella said.

In addition, the followability of the Ellips FX technology allows good control of nucleus fragmentation, greatly reducing the risk of small particles flying off and bouncing, potentially threatening endothelial integrity.

“Nucleus fragments are held very close to the tip. There is no ping-pong effect, and the fragments are aspirated almost instantaneously,” he said.

Study results

In a study, Dr. Piovella compared the outcomes of two groups of patients in which traditional phaco with peristaltic pump and phaco with the Ellips FX and venturi pump were used.

“Ultrasound power was reduced by 50% in the Ellips FX group. At 6 months, we were able to see that endothelial cell loss was also greatly reduced. It was 1.43%, compared to the 4.22% of the group treated with traditional phaco,” he said.

Dr. Piovella started using the White-Star Signature with a dual pump and Ellips system in 2008. In his high-volume practice he now uses this system routinely, in all his cataract patients.

“Once you have tried it, you can no longer leave it,” he said. “Innovation never ends, and any new product, when it is launched, is just at the start of its development. The full expression of a product’s potential is the result of progressive enhancements and upgrading. With the Ellips FX technology, not only the WhiteStar system but phaco in general has been capable of a further step forward in terms of efficiency, ease of surgical management and safety.”

The rate of complications in cataract surgery is approximately 3%, according to Dr. Piovella.

“Statistically, this is a very good result for a surgical procedure,” he said. “However, if we get down to reality, 3% of the 500,000 cataract procedures that are performed annually still accounts for 15,000 unhappy patients. Enhancing safety and reducing complication rate is still a primary goal of cataract surgery.” – by Michela Cimberle

• Matteo Piovella, MD, can be reached at Centro Microchirurgia Ambulatoriale, Via Donizetti 24, 20052 Monza, Italy; +39-039-389498; fax: +39-039-2300964; email: piovella@piovella.com.
• Disclosure: Dr. Piovella is a consultant to Abbott Medical Optics.

Lateral motion is a crucial advancement in [phacoemulsification] technology. Standard back-and-forth longitudinal movements are known to cause repulsion of lens fragments. This in turn produces a chattering effect that needs to be compensated by increased flow rate. The transversal component of the elliptical stroke path in the Ellips FX system greatly reduces repulsion of lens material and improves followability and cutting efficiency.

With reduced chatter, we are able to exploit flow and vacuum to better control the whole phaco procedure. In addition, the ability to switch from the peristaltic to venturi enables us to customize the fluidics at each surgical step.

The Ellips FX transversal phaco system is a very promising innovation in phacoemulsification. Understanding stroke dynamics will clarify the enormous advantages of this technology in terms of safety and efficacy.

— Daniele Tognetto, MD
Associate Professor, University of Trieste, Italy
Disclosure: Dr. Tognetto has no direct financial interest in the products discussed in this article,
nor is Dr. Tognetto a paid consultant for any companies mentioned.