Eyeworld

PHACO FUNDAMENTALS 2026 continued from previous page Another feature of the Stellaris Elite system is the foot pedal's ability to not only adjust in pitch to allow for irrigation, aspiration, and ultrasound control, but it can also yaw to the right on a sculpt setting to add ultrasound, Dr. Khandelwal explained. On her segment setting, yawing the foot pedal to the right adds vacuum. Part 2: What Parameters/Methods Do I Modify for Complex Cases Complex cases—small pupils, zonulopathy, white cataracts, and the rock hard variety—require some modifications. Panelists shared how they handle the parameters and phaco methods to achieve success in these cases. Dr. Park said small pupil/intraoperative floppy iris syn- drome (IFIS), if not addressed properly in cataract surgery, can result in iris trauma or loss of vitreous. She shared the pharmaceuticals and features that can contribute to IFIS. While alpha blockers for treatment of benign prostatic hy- pertrophy are well known, other categories of medications that may cause IFIS include some tricyclic antidepressants. Patients with light blue or green irides also carry a higher risk of IFIS during surgery. Techniques for addressing IFIS include the use of Omid- ria (phenylephrine and ketorolac, Rayner), which is infused into the irrigating fluid. Other standard means of dilating the pupil include the use of iris hooks and iris rings. Dr. Park also described the use of a novel instrument, an illuminated chopper, the iChopper (Oculight), which received FDA approval in 2021. "Often it is not the size of the pupil that's bothersome, it's the ability to ignore the bil- lowing iris tissue to visualize and get that nucleus out," she said, showing a video with the overhead coaxial microscope light turned off with the only illumination coming from the chopper inside the eye, allowing the surgeon to directly visualize and focus on the lens material itself. detection sensor and technology that can modulate that temperature, if needed. Dr. Khandelwal described the features and capabilities of the Stellaris Elite Vision Enhancement System (Bausch + Lomb), a vacuum-based technology. She said traditional infusion systems have the pressure in the eye going down as the vacuum increases, causing challenges with chamber sta- bility. Newer machines are proactive with chamber stability; as vacuum rises, infusion increases, allowing stable IOP. With the Stellaris Elite system specifically, Dr. Khandel- wal said there is a difference with phaco efficiency. "Here it's very simple in that this is all longitudinal. It has very good cutting," she said, noting that with highly efficient cutting, energy and thus temperature is kept lower. "We don't see wound burns because we're not actively hitting 3 when we first go in," Dr. Khandelwal explained. "We're going on 2 and the pieces start coming to us, but what comes first if you have an eye full of viscoelastic? It's the viscoelastic first, then the pieces will start moving." Sumitra Khandelwal, MD Professor, Department of Ophthalmology Cornea Fellowship Director Baylor College of Medicine Houston, Texas Lisa Park, MD Professor, Department of Ophthalmology Division Director Comprehensive Ophthalmology Columbia University Medical Center New York, New York Rohit Om Parkash, MBBS, MS Dr. Om Parkash Eye Institute Punjab, India Jeff Pettey, MD Chair John A. Moran Eye Center and Department of Ophthalmology and Visual Sciences Salt Lake City, Utah about the physicians 1. Parkash RO, et al. A rapid technique for en masse soft cataract phacoemulsification. Clin Ophthalmol. 2019;13:755–762. 2. Om Parkash T, et al. Oblique chop: a novel hook and lock technique for single step nuclear fracture in cataract surgery. Clin Ophthalmol. 2026;20:595548. references Khandelwal: AbbVie, Bausch + Lomb, BioTissue, BrightStar, BVI, Dompé, Glaukos, Johnson & Johnson Vision, Kala, Nordic Pharma, Ocular Therapeutix, Tarsus, Zeiss Park: Oculight Parkash: None Pettey: None relevant disclosures Khandelwal: Sumitra.Khandelwal@bcm.edu Park: lisa.park@columbia.edu Parkash: drrohitop@gmail.com Pettey: jeff.pettey@hsc.utah.edu contact Dr. Park turns off the overhead coaxial light and uses an illuminated chopper, which allows her to focus on the lens material itself, rather than a billowing iris. Source: Lisa Park, MD

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