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Dual pump feature increases control and efficiency
To remove cataracts safely, surgeons must maintain exceptional fluidic control throughout surgery. The WhiteStar Signature System with Fusion Fluidics (Advanced Medical Optics [AMO]) provides significant improvements in phacoemulsification technology and offers enhanced fluidics and innovative pump technology.
Pump technology
 Y. Ralph Chu |
Surgeons are familiar with two kinds of pump technology, peristaltic and venturi. Each pump is beneficial in certain situations. Peristaltic pumps maintain good control, whereas venturi pumps speed the removal of fragments from the eye. Because they operate at a faster rate, however, venturi pumps can be more difficult to control. The peristaltic system is excellent for removing the nucleus, but the venturi system is superior for removing cortex once the nucleus is removed and when performing a vitrectomy. The WhiteStar Signature System is the first phaco platform that makes both pumps available to the surgeon on-the-fly without changing packs. This feature enhances safety and chamber stability while increasing control and efficiency.
Having used the Infiniti (Alcon), Sovereign (AMO), Millennium (Bausch & Lomb), and Accurus phaco systems (Alcon), I am familiar with both venturi and peristaltic bases systems. The WhiteStar Signature System features a peristaltic pump with advanced fluidic control that is similarly efficient to a venturi system. The added safety measures also make the procedure more efficient. The machine provides increased control of nuclear fragments through a variety of techniques such as a phaco chop, phaco flip, and divide and conquer. I have used this system on patients using tamsulosin (Flomax, Boehringer) therapy and patients with traumatic cataracts or zonular dialysis. The pump technology provided impressive control and safety. The interface makes the system easier to use for the surgeon, technicians, and staff.
Standard flow and vacuum rates differ for the peristaltic and venturi pump systems. I use a standard flow rate of 36 mL/min and a vacuum rate of 200 to 250 mm Hg when using a phaco flip technique on the WhiteStar Signature System. On a venturi system, my vacuum rate is about 150 mm Hg for phaco flip.
Cortical cleanup
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Achieving good cortical cleanup at the time of cataract surgery is becoming increasingly important as the field continues to view cataract surgery as refractive surgery with lens implantation. Many new lens technologies demand excellent cortical cleanup, and having a phaco system capable of removing cortex efficiently and cleanly without damaging the capsule is important. Whether a surgeon uses single-handed irrigation and aspiration (I&A) or bimanual I&A, it is critical to have exceptional pump control and proper fluidics. Using the WhiteStar Signature System, surgeons can achieve higher vacuum levels and clean the cortex better and more efficiently than with previous units. In the past, increasing vacuum led to higher safety risks. WhiteStar Signature technology can eliminate postocclusion surge and achieve a stable anterior chamber and minimal bounce of the posterior capsule. With these new systems, surgeons can use higher vacuum and achieve more efficient cleanup, and still maintain a higher level of safety than they could with previous technologies.
Challenging cases
New-generation peristaltic machines such as the WhiteStar Signature System allow surgeons to use low flow rates, which is useful when operating on patients taking Flomax. More patients are taking Flomax for prostate treatment, causing a floppy iris or small pupils at the time of surgery. Use of low flow, for example, 20- to 24-mL per min, and a vacuum in the range of 100 to 150 mm Hg slows the procedure and allows excellent removal of the nucleus with very little turbulence inside the anterior chamber. This makes complicated cases easier for the surgeon to perform.
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Low flow settings can also be useful for patients with endothelial dystrophy, such as Fuch’s corneal dystrophy. These patients are prone to corneal edema and impeded recovery. Minimizing turbulence in the eye helps reduce the risk of developing pseudophakic bullous keratopathy or corneal decompensation after surgery. If a patient develops corneal decompensation, he or she may need a corneal transplant. Therefore, being capable of carrying out that procedure safely is a major advantage.
Maintaining a stable chamber
Maintaining a stable anterior chamber environment free of trampolining of the posterior capsule improves safety during phacoemulsification. Creating a wound of proper size and architecture, ensuring that paracentesis sites are not leaking, and maintaining the bottle at the appropriate height are all important factors to monitor. A machine with good balance in the pump control and a good software package is also ideal. The WhiteStar Signature System provides constant monitoring of the pressure and intraocular fluid environment to maintain the most stable chamber possible. This is a safe and efficient machine for removing cataracts of all types. This machine makes surgery easier and less stressful for surgeons and technicians, and provides more options for treating difficult condition.
Dr. Chu is founder and medical director of Chu Vision Institute in Edina, MN, an adjunct assistant professor of ophthalmology at the University of Minnesota, and an assistant professor of ophthalmology at the University of Utah.