EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/276058
EW SECONDARY FEATURE 126 by Ellen Stodola EyeWorld Staff Writer Innovation in phaco tips The invention of a number of tips has helped to further innovation in phacoemulsification S ince the advent and popu- l arization of phacoemulsi- fication, there have been a variety of advancements, including those in phaco tip technologies. These tips have helped to further promote innova- tion in phaco and make it safer and more efficient. Tip-chop Cesar Carriazo, MD, Carriazo Oph- thalmology Center, Barranquilla, Colombia, developed the tip-chop, which is like a conventional phaco tip but has a modification at the end. It has a sharper end that is gradually angled, which helps with hard cataracts, and the other end is less sharp, like a spoon, which is ideal for softer cataracts. "The angulation is available in higher or lower grades," Dr. Carriazo said. The s urgeon can use the sharp or blunt piece for different needs, depending on the hardness of the cataract. "This instrument combines the versatility of a chopper with the functionality of the phaco tip, mak- ing maneuvers into the eye safe and effective, allowing the surgeon to handle the core of the cataract, m inimizing the time required for the ultrasound without the need for another instrument," Dr. Carriazo said. In other words, the instrument is a tip and chop at the same time. Surgeons may consider certain specifications of the tips for different patients. "We have several sizes of tips," Dr. Carriazo said. There is a m ore elongated, acute and sharp tip, which works well for intermediate to hard dense cataracts, and there is a blunt, spoon-shaped tip, which works well for less dense cataracts, phaco refractive surgeries, and femtophaco surgery. He said there are no contraindications for the tip-chop. "The Carriazo tip-chop optimizes back pressure maneuvers obtaining more lenticular tissue, f acilitating the access of the densest part of the core of the nucleus, which can be broken very easily," Dr. Carriazo said. It does this with- out the danger of going to the pe- riphery to find the fragments, which could be a potential risk to the pos- terior capsule. The tip-chop also avoids stress on the zonules. UltraChopper Luis Escaf, MD, Eye Clinic of the Caribbean, Barranquilla, Colombia, created the UltraChopper (Alcon, F ort Worth, Texas), an ultrasonic scalpel that is designed to cut the cataract into several fragments, mak- ing emulsification easier with less phaco energy. The characteristics of the UltraChopper as far as size, design, and dimensions make it safe and effective to cut without damage to other structures of the eye, he said. The UltraChopper measures 2.5 mm long, 1 mm in height and has a lower trough to protect the iris when cutting. Dr. Escaf said that the UltraChopper's length, compared to the thickness of a cataract, makes it impossible to harm the posterior capsule, which is a key factor. "[The] learning curve is short, and [it resembles] the divide and conquer technique normally used by cataract surgeons," Dr. Escaf said. The UltraChopper connects to the phaco machine and is calibrated as any phaco tip using power from 30 to 50 longitudinal, fixed power vacuum 50–100, and bottle height of 90 to 115 cms. The UltraChopper is flat at its distal end and has two lateral holes at the end, Dr. Escaf said. He added that the tip's use is similar to that of a normal phaco tip so the surgeon does not have to change his/her routine to introduce the tip into the anterior chamber. He would highly recommend it for new and inexperienced surgeons. The UltraChopper shortens surgical time and reduces ultrasonic energy, Dr. Escaf said. The tip works for a number of different situations and types of cataracts. Dr. Escaf said that over the past seven years, he and several other surgeons have done more than 20,000 cataract surgeries without complications. Radius Tip Steven Dewey, MD, Colorado S prings, Colo., created the Dewey Radius Tip (MicroSurgical Technolo- gies, Redmond, Wash.), which he said is similar to other phaco tips. "It's only different in that it is safer and after you have some experience with the tip, it is more efficient than a sharp tip," he said. The design difference is very s imple. "The important distinction is it has a radius edge both on the inner surface and the outer surface, so there's no sharp edge coming in contact with tissue." It can be used on any patient, with any phaco machine, without changing settings or techniques. Dr. Dewey said that in his expe- rience using the Radius Tip, it is able to go into the incision easier. "Once inside the eye, it does a wonderful job of dissecting nuclear material," he said. The Radius Tip has helped with efficiency, he said, because there is a "greater zone of safety" to operate and move inside the eye. "That doesn't mean things can't happen," Dr. Dewey said. "It just means they don't happen with the same likeli- hood that they would with a sharp needle." Dr. Dewey had the first proto- type of the Radius Tip in 2004, and the tip has gained popularity as phaco machines have been up- dated. As more surgeons are con- verting to the use of femtosecond laser-assisted cataract surgery, Dr. Dewey said the safety of his needle has attracted a number of people. "In my hands, I don't have any dif- ficulties taking out a dense nucleus with the needle," he said. "It is a lit- tle less efficient than a sharp needle when you're dealing with really dense cataracts." He believes the safety of the Radius Tip is its major advantage. EW Editors' note: Dr. Carriazo has finan- cial interests with the tip-chop. Dr. Escaf has financial interests with Alcon and Novartis (Basel, Switzerland). Dr. Dewey has financial interests with the Radius Tip and Abbott Medical Optics (Santa Ana, Calif.). Contact information Carriazo: ccarriazo@carriazo.com Dewey: deweys@prodigy.net Escaf: escaff@gmail.com February 2011 Phaco innovations March 2014 In this video grab from the operating microscope, the sharp-edged standard phaco needle shows tiny irregularities along the inner margin (gold) in contrast to the highly refined finish of the Dewey Radius Tip (blue). Source: Steven Dewey, MD The size, design, and dimensions of the UltraChopper help ensure that the posterior capsule will not be harmed. Source: Luis Escaf, MD 126-129 2nd Feature_EW March 2014-DL_Layout 1 3/6/14 4:07 PM Page 126