Eyeworld

Optimizing machine settings for routine, complex, and femto phaco cases 6 continued from page 5 Dr. Henderson, who presented a video using the Stellaris PC (Baus- ch + Lomb, Bridgewater, N.J.). "With the venturi system, you will notice that there is good movement of the pieces toward the tip and the pieces will engage before being fully occluded," she said. "The biggest danger I think with working with a venturi sys- tem, especially with the brunes- cent cataracts, is that the pieces are opaque." Therefore, it may be difficult to see the bottom of the phaco tip, and the surgeon could be vacuuming past the lens frag- ment and inadvertently into the posterior capsule, she explained. She recommended keeping a second instrument such as the chopper beneath the probe to protect the posterior capsule. She also changes her viscoelastic for brunescent cataracts. She uses a dispersive viscoelastic with chon- droitin sulfate close to the cornea to protect the endothelium from the additional energy that is used in emulsifying a dense cataract. Soft posterior polar cataract Kenneth L. Cohen, MD, Sterling A. Barrett distinguished professor, Department of Ophthalmology, University of North Carolina at Figure 1. Chopping dense cataract using the Bausch + Lomb Stellaris machine Source: Bonnie An Henderson Figure 2. This is a soft posterior polar cataract, which is best removed using linear control of the aspiration flow rate, vacuum, and phaco power. Only hydrodelineation is performed. Source: Kenneth L. Cohen, MD Chapel Hill, featured cases with soft nuclei performed by residents with the WhiteStar Signature Phacoemulsification System (Abbott Medical Optics, Abbott Park, Ill.) (Figure 2). In one posterior polar cata- ract, the surgeon performed only hydrodelineation. With the sculpt setting in foot position 2, a pocket was created to allow for fluid movement by removing OVD and anterior cortex and epinucleus. "We're creating a pocket so we don't get an incision burn," he said. Then a small groove was cre- ated in the small nucleus. The sur- geon used the epinuclear setting, which provided linear control of vacuum and flow. " One of the recent greater challenges for the cataract surgeon is the floppy iris patient. " Lisa Park, MD "Once you do get occlusion, you can use your foot pedal to control the level of vacuum to ba- sically aspirate this soft cataract," he said. The remaining large, thick epinucleus was removed using the linear function on the foot pedal and foot position 2, with no phaco power, just linear aspira- tion. The linear vacuum trimmed the anterior edge of the epinu- cleus, and the surgeon brought it forward with the Seibel nucleus rotator/horizontal chopper. There was enough room for the posterior polar cataract to rotate and move to another edge. The occlusion mode was also used, which lowers the aspiration flow rate as the vacuum rises, Dr. Cohen explained. He presented a case of posterior subcapsular cataract, for which hydrodissection and hydrodelineation were used. The surgeon removed the OVD and aspirated as much cortex and epinucleus as possible to get to the nucleus. A small groove was sculpted, and using a Drysdale, the lens was rotated. Using the epinuclear setting, set on linear aspiration and linear vacuum, the surgeon removed the anterior rim of the epinucleus until the cataract could be flipped and then removed with occlusion mode phaco, which automatically lowers the aspiration flow rate as the vacuum rises. "Very safe, essentially using no phaco," he said.

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