Eyeworld

EW CATARACT/IOL 50 March 2011 by Rich Daly EyeWorld Contributing Editor Software, handpiece upgrades mark latest phaco improvements Surgeons have found advantages and some drawbacks in software and hardware upgrades for phaco systems S everal clinical outcomes were improved for cataract patients after surgeons opted for newer hardware and software upgrades available for phacoemulsification systems. But their experiences also indicate surgeons should exercise caution with some upgrades. Among the newest phaco inno- vations is the Ellips FX handpiece, which is an upgraded version of the Ellips non-longitudinal handpiece for the Whitestar Signature pha- coemulsification system (Abbott Medical Optics, AMO, Santa Ana, Calif.). Although the manufacturer notes its high cutting efficacy and low power use, surgeons who have used it tout the FX's ability to pro- vide 100% elliptical phaco. "This improved handpiece com- bined with new phaco settings has allowed the most efficient, con- trolled, and safe removal of all types of cataracts that I have experi- enced," said Y. Ralph Chu, M.D., adjunct associate professor of oph- thalmology, University of Min- nesota, Minneapolis, and clinical professor of ophthalmology, Univer- sity of Utah, Salt Lake City. Richard S. Hoffman, M.D., clinical associate professor of oph- thalmology, Casey Eye Institute, Oregon Health & Science University, Portland, recently added the FX handpiece to his system and found the power increased from 27 KHz in earlier generation Ellips handpieces to 40 KHz speeds in the FX. Addi- tionally, cutting and followability improved with the FX, Dr. Hoffman noted. Despite these advantages, Dr. Hoffman was concerned to discover that the corneas of patients treated with the FX look less "pristine" than those treated with the earlier hand- pieces. "I found that when I switched to the new FX handpieces I had to adjust my aspiration and power set- tings down due to enhanced cutting and what appeared to be faster movement of fluid in the eye," Dr. Hoffman said. Another concern he found with the FX handpiece is that the surgeon is not able to turn off the elliptical setting, as was allowed in previous handpieces. "When we are chopping, we want the phaco needle to be buried into the endonucleus, and the ellip- tical movement makes this more dif- ficult," Dr. Hoffman said. "For chopping I prefer to turn off ellipti- cal movement and just use longitu- dinal phaco. When the quadrants are consumed I will use the combi- nation of longitudinal and ellipti- cal." Unfortunately, he found the ef- fect left the new handpiece less effi- cient in chopping. The software and hardware in- teractions important for another new handpiece are the Infiniti (Alcon, Fort Worth, Texas) system's OZil, which is partnered with Intelli- gent Phaco (IP) software. "I believe the IP addition to OZil has helped as it addresses the situa- tion where the tip gets clogged," said William Trattler, M.D., volun- teer assistant professor of ophthal- mology, Bascom Palmer Eye Institute, University of Miami. "I have been happy with this upgrade." The combined OZil and IP soft- ware package enhance safety and ef- ficiency during lens removal, agreed Terry Kim, M.D., associate professor of ophthalmology, Duke University School of Medicine, Durham, N.C. This is especially true for complex cases such as dense cataracts, small and/or floppy pupils, and compro- mised zonules. "OZil IP is a seamless and intelli- gent phaco energy management sys- tem that enhances OZil torsional emulsification by keeping the lens material at the ideal shearing plane, resulting in increased followability by not allowing maximum vacuum to be achieved, as well as by creating a more stable anterior chamber to reduce IOP fluctuations in the eye," Dr. Kim said. The combination's efficacy is achieved by its ability to automati- cally add pre-programmable and customized short pulses of longitu- dinal ultrasound to the OZil hand- piece when a set vacuum threshold is met, according to Dr. Kim. Similar efficacy was noted in re- cent research. A comparison of pha- coemulsification performed with the OZil handpiece both with and with- out IP found that the IP-assisted pro- cedures resulted in lower cumulative dissipated energy and shorter total ultrasound phaco times. 1 A separate software upgrade is the Chamber Stabilization Environ- ment (CASE) for the Whitestar sys- tem. The software upgrade aims to improve the system's safety by deliv- ering less phaco power to the ante- rior chamber to allow for greater surgical control, and it "virtually eliminates wound burn," Dr. Chu said. "Dense cataracts can be chopped and removed with ease," Dr. Chu said. "The anterior chamber maintains stability in low flow set- tings as in floppy iris cases as well as high flow and vacuum cases." Additionally, the system's ellip- tical phaco does not clog at the phaco tip, in Dr. Chu's experience, because it offers combined side-to- side and longitudinal movement. EW Reference 1. Titiyal JS, Ghatak U, Sharma N. Comparison of phacoemulsification using torsional ultra- sound (OZil) with and without Intelligent Pha- coemulsification. Poster presented at the American Academy of Ophthalmology Annual Meeting; October 18, 2010; Chicago, Ill. Editors' note: Dr. Chu has financial in- terests with AMO and Bausch & Lomb (Rochester, N.Y.). Dr. Hoffman has no financial interests related to his com- ments. Dr. Kim has financial interests with Alcon. Dr. Trattler has financial interests with AMO. Contact information Chu: 952-835-0965, yrchu@chuvision.com Hoffman: 541-687-2110, rshoffman@finemd.com Kim: 919-681-3568, kim00006@mc.duke.edu Trattler: 305-598-2020, wtrattler@gmail.com The Whitestar Signature system Source: AMO The Infiniti system Source: Alcon

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