Minimize phaco power with high-vacuum venturi settings

THOROFARE, N.J. — Modern phacoemulsifiers allow surgeons to use low amounts of phaco power, making cataract surgery safer, according to one surgeon. Phaco power can be minimized by using other functions of the machine and designing maneuvers that facilitate fracture and lens removal.

Eric Mertens, MD, has developed a technique with a venturi-type phaco machine that he says allows him to use a high vacuum level to minimize use of phaco power.

Venturi pump systems allow the surgeon to directly control aspiration, Dr. Mertens explains in the May print version of Ocular Surgery News Europe/Asia-Pacific Edition. He uses the Bausch & Lomb Millennium system, which allows the surgeon to individually control both vacuum and phaco power with its dual-linear foot pedal.

Dr. Mertens begins his procedure by making a temporal, astigmatically neutral, 3.2-mm stepped clear corneal incision at the steepest axis of the cornea. For sculpting, Dr. Mertens uses about 20 mm Hg of vacuum, a 100 cm bottle height and maximum phaco power of 50%. He then raises the bottle to 130 cm, which automatically sets the phaco power to a maximum of 10%. If the lens material is very hard, he uses slightly higher phaco power, up to 20%.

With the foot pedal all the way down, at a maximum vacuum of 300 mm Hg, the anterior chamber remains stable and will not collapse because the bottle is up high, Dr. Mertens says.

“With this technique, my absolute phaco time is less than 5 seconds in more than 85% of patients,” Dr. Mertens adds.