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Reducing vacuum and aspiration rate minimizes post-occlusion surge
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SAN FRANCISCO — There are ways to minimize post-occlusion surge during phacoemulsification, according to a speaker.
"Surge is something we all need to recognize as surgeons. We need to know what it is; we need to know how to manage it," Timothy P. Page, MD, said at the American Society of Cataract and Refractive Surgery meeting here.
Surge occurs after the occlusion breaks on the phaco tip. Irrigation continues during occlusion, causing pressure to rise in the anterior chamber. Meanwhile, vacuum continues to draw, creating negative pressure to build in the tubing.
"This creates a potentially dangerous pressure gradient," Page said. The point at which the pressure drops after occlusion is broken is when the post-occlusion surge occurs. "That’s where we can’t get our foot off the pedal fast enough."
To prevent surge, Page suggested reducing vacuum by about one-third when aspirating the last piece of nucleus and reducing the aspiration rate, as well. Page said that he prefers to perform coaxial microincision cataract surgery with a venturi system, because the vacuum is more responsive than in a peristaltic system. He also suggested using an hour-glass tipped needle on the Stellaris platform (Bausch + Lomb), which provides a forward-facing cavitation area for emulsification so that particles do not clog the 500-µm internal diameter.
Disclosure: Page is a consultant for Bausch + Lomb.