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New phaco tips are the key to surgical efficiency
These tips ensure a technique that is highly reproducible, uses a minimal number of instruments and steps, and flows smoothly with no mental stress.
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Surgical efficiency can be defined in a number of ways — time, cost, effort, reproducibility. As phaco surgeons, we all wish to remove the cataract in the least amount of time while not sacrificing safety. I believe the way to achieve this is through a technique that is highly reproducible, uses a minimal number of instruments and steps, and flows smoothly with no mental stress. I have been able to achieve this goal for myself using the new flared ABS (Aspiration Bypass System) tips from Alcon in combination with the Legacy 20,000 unit and its Burst and Bimodal software programs.
Flared tips
The new flared tips come in two sizes — 0.9 mm (“the microflare”) and 1.1 mm. Each of these tips essentially doubles the port area at the edge of the tip compared to standard tips; hence, there is a larger surface area for purchasing lens fragments. The Aspiration Bypass System (ABS) is a small hole in the microshaft just below the flare of the tip. There is little or no flow through this port when the tip is unoccluded. As the tip becomes occluded and vacuum builds, more irrigation fluid is drawn through the ABS port, helping prevent any post-occlusion surge and anterior chamber collapse. Thus, high vacuum levels of more than 500 mm Hg are safely achievable. In addition, the extra fluid flowing through and around the tip (via the loosely fitting irrigation sleeve) allows extra cooling of the tip, helping prevent corneal burns.
Now, consider the formula: Port area × vacuum = holding force factor. Because the port are is doubled with these flared tips, and because higher vacuum levels are a safely achievable (almost double previous levels), there is thus a four-fold increase in holding force. This is the key to the surgical efficiency provided by these new tips.
Burst and Bimodal software
---Flared ABS Tip.
Notice the port area at the entrance of the tip is double the size of the
standard tip. Note also the small ABS hole just behind the flare.
The Burst and Bimodal software programs allow this new technology to be
even more effectively used. In the Burst setting, the surgeon can linearly
control the frequency of ultrasound bursts with the foot pedal in position 3.
This allows quick and easy emulsification of even the hardest nuclei. The
Bimodal setting allows linear control aspiration in foot position 2 and linear
control of ultrasound power in position 3. This allows for very efficient
epinucleus and cortical removal.
Using these modalities together has made a significant difference in my surgical procedure. I perform a single groove with two to four passes, crack the nucleus into two, then attack each piece with the flared tip using burst. I no longer need to groove further, and I can, if necessary, use a single spatula to crack the heminucleus with mild counterpressure. This is made possible by the improved holding force provided by the flared tip. After nucleus removal, I switch to Bimodal for quick epinucleus removal.
In a series of 154 consecutive cases, I was able to use no more than 20% phaco power and less than 3 minutes of surgical time for the hardest of nuclei. The 1.1-mm flared tip was 20% more efficient time-wise compared to the 0.9-mm tip. However, some may prefer the slight increased visibility and maneuverability provided by the microflare tip.
In summary, no matter what one’s technique, I believe these new modalities can provide the phaco surgeon with a powerful tool for increased surgical efficiency.
For Your Information:
- Henry M. Haley Jr., MD, can reached at the Eye Surgery Center of Louisiana, New Orleans, LA. Ocular Surgery News could not confirm whether or not Dr. Haley has a direct financial interest in any of the products or if he is a paid consultant for any companies mentioned in this article.