Innovations enhance current phacoemulsification systems

ByRoger F. Steinert, MD

Roger F. Steinert

To assess the capabilities of phacoemulsification systems, a surgeon must have considerable experience with a number of cases and cataract densities. Further, because cataracts respond differently to specific settings and programs, surgeons must become familiar with the range of phacoemulsification systems available.

Current phacoemulsification systems incorporate an array of capabilities and features including energy-efficient, computer-modulated, micropulse ultrasound; advanced fluidics systems allowing for high flow and vacuum while maintaining chamber stability; streamlined interfaces; and user-friendly accessories. A reliable phacoemulsification system depends primarily on its ultrasound delivery and fluidics system.

Phacoemulsification systems such as the WhiteStar Signature System with Fusion Fluidics (Advanced Medical Optics [AMO]), the Stellaris Vision Enhancement System (Bausch & Lomb), and the Infiniti Vision System (Alcon) may provide advanced technology to meet the expanding needs of cataract surgeons. The WhiteStar pulse-shaping technology and Fusion Fluidics, for example, are two new features that may help surgeons achieve increased efficiency and safety.

Increased efficiency

In my experience, the WhiteStar pulse-shaping technology increases cutting efficiency, reduces phaco time, and improves magnetic followability. Using the forces of cavitation and jackhammer energy, the phaco tip disassembles the nucleus quickly with minimal ultrasound exposure to the eye and a reduced risk of wound burn. The jackhammer effect occurs on the forward motion of the phaco needle as it impacts the nucleus. However, with WhiteStar, as the needle retracts, cavitation energy is created in which bubbles hit the nucleus and cause it to break apart. The pulse-shaping design aids destructive cavitation energy by separating the nucleus from the tip and creating a pocket where balanced salt solution combines with ultrasound, increasing efficiency.

As the pulse-shaping technology breaks the nucleus into fragments, the Fusion Fluidics pumps help the surgeon maintain anterior chamber stability. Comprising a venturi vacuum-based pump and a peristaltic flow-based pump, this system allows surgeons to switch between the two instantaneously, using a single tubing pack. The dual pump system detects occlusion and proactively adjusts the vacuum level before the occlusion break occurs, in a process otherwise known as preocclusion phaco. Once the nuclear fragments have been aspirated from the eye completely, an occlusion break can occur, causing pressure to drop and threatening the integrity of the chamber. The Fusion Fluidics pump system reduces the vacuum level in as little as 20 ms. Surgeons can therefore use high vacuum and flow during irrigation and aspiration because the pump will sense any fluctuations in anterior chamber volume and respond accordingly.

Setting customization

I find that surgeons using the WhiteStar Signature System for the first time experience no significant learning curve. The system can be customized to accommodate any surgeon’s technique. This feature allows for an individualized approach to surgery and helps surgeons avoid the time consuming process of learning a new technique. In my experience, standard settings can be used to produce good results in the beginning, but as surgeons become more familiar with the platform, they will find settings that complement their technique. I find that the innovations incorporated in this system are flexible and will be able to support both current and future surgical techniques.

Dr. Steinert is a professor of ophthalmology and professor of biomedical engineering at the University of California in Irvine.