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Small infusion sleeve assists with ultrasmall-incision coaxial technique
The Alcon Ultra sleeve allows coaxial phaco with an incision size of 2.3 mm to 2.5 mm, surgeon says.
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With an ultrasmall infusion sleeve and the Alcon Infiniti Vision System fluidic design, surgeons can perform coaxial phacoemulsification through a smaller incision than a normal phaco sleeve allows, according to a surgeon who has used the device.
Richard J. Mackool, MD, spoke about use of the Alcon Ultra sleeve with the Infiniti system at the American Society of Cataract and Refractive Surgery meeting earlier this year. He said the Ultra sleeve on a standard, 1.1-mm flared tip allows reduction of the incision size in coaxial phaco, without the extra equipment and the learning curve required for bimanual phaco.
“Coaxial phaco using a 2.1-mm incision is now possible with the Alcon Infiniti and the Ultra sleeve,” Dr. Mackool said. “After the injection of the IOL with a Monarch C cartridge, the incision will be between 2.3 mm and 2.5 mm.”
He said the key to the technique is the smaller infusion sleeve combined with the Infiniti fluidics.
“Everything else is the same when we do phaco,” Dr. Mackool said. “With the flared tip, we can use tiny incision sleeves, and instead of using an incision of 2.75 mm, which I typically use with the high-flow infusion sleeve, we can use the Ultrasleeve through a 2.1-mm incision.”
The parameters that Dr. Mackool uses can be used with the Ultra sleeve include an infusion bottle height of 130 cm, flow rate of 40 cc/minute and vacuum of more than 400 mm Hg, he said.
Phaco chop
Dr. Mackool said he uses a phaco chop procedure with the Ultra sleeve. Nucleus removal begins with chopping, and the segments are removed using 250 mm Hg of vacuum. He said not a great deal of vacuum is needed to impale the lens in this stage. He advised surgeons to hold the lens still with the phaco tip during the chopping stage.
Once the segments are created, the vacuum is increased to 400 mm Hg, with a flow rate of 50 cc/minute. Dr. Mackool recommended that surgeons beginning to learn the technique use 40 cc/minute. Segments, even dense ones, can be removed quickly, he said.
Dr. Mackool said he found that the procedure with the Ultra sleeve took slightly longer to perform that his normal phaco time. It required about 1:30 minutes, while it typically takes him about 50 to 60 seconds to remove a nucleus using a standard sleeve.
“It takes about 30 seconds longer because I can’t use the extremely high vacuum and flow levels that I typically use,” he said.
The incision
After the nucleus is removed, the IOL is inserted through the incision, which is 2.1 mm when created.
Dr. Mackool said he uses a Monarch C cartridge. The inserter cannot fit into the incision, as the barrel is too big, but the tip can be fit into the lip of the tunnel and the lens inserted from that position, he said. It is likely that many surgeons use this technique to get IOL through an ultrasmall incision, Dr. Mackool said.
“After insertion of the IOL through the 2.1-mm incision with today’s technology, the incision, in his experience, will be between 2.3 mm and 2.5 mm,” he said.
For Your Information:
- Richard J. Mackool, MD can be reached at Mackool Eye Institute, 31-27 41st St. Astoria, NY 11103; 718-728-3400; fax: 718-728-4882; e-mail: mackooleye@aol.com.
- Erin L. Boyle is an OSN Staff Writer who covers all aspects of ophthalmology.