Bimanual Microincision Cataract Surgery with Stellaris Advanced Flow Module

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Bimanual Microincision Cataract Surgery with
Stellaris Advanced Flow Module

• Mark Packer, MD, FACS
• Clinical Associate Professor
• Oregon Health Science University

Financial Interest Consultant-Advanced Medical
Optics, Inc. Advanced Vision Science, Inc.
Bausch Lomb, Inc. Carl Zeiss Meditec, Inc.
Carl Zeiss Surgical GmbH Celgene Corporation
Gerson Lehman Group, Inc. Ista Pharmaceuticals,
Inc.i-Therapeutix, Inc. Johnson Johnson
Vision Care, Inc. Leerink Swann Company
Sirion Therapeutics, Inc. Transcend Medical,
Inc. Visiogen, Inc. VisionCare, Inc. WaveTec
Vision Systems. Travel Honoraria Endo Optiks,
Inc
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Purpose

• To assess facility of use, safety and efficacy of
  the Stellaris Vision Enhancement System for
  bimanual microincision cataract surgery

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Method

• 30 unselected eyes of 26 patients presented for
  cataract surgery
• Pre-existing pathology other than cataract
• Pseudoexfoliation glaucoma 1
• Strabismus/amblyopia 2
• Epiretinal membrane 2
• Pigment dispersion syndrome 1
• Previous ocular surgery
• S/P LASIK 4

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Patient Profile

• 13 women, 13 men
• Mean age 64.2 8.3 years
• Mean nucleus 1.4 NS

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Technique

• Bimanual microincision cataract surgery
• Temporal clear corneal incisions, 1.4 mm
• Trapezoidal diamond blade
• 20 g irrigating chopper, 30º straight phaco tip
• LRIs performed prior to IOL insertion
• 90 depth, 10 mm OZ, Nichamin nomogram
• IOL implanted via 3rd incision, 2.2 2.8 mm

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Machine Parameters Phaco Phaco IA Cortex IA Viscoelastic Removal Vit Vit
Chop Flip IA BI/COAX Hi speed Regular (pneum)
Power 20 Linear (waveform not enabled) 20 Linear Cut rate 1500 cpm Cut rate 600 cpm
Mode 30 pps Fixed burst Duration 10 msec Interval 30 msec (yaw to turn cutter on/off)
Duty cycle 30 25
Vac (yaw for max) 125-325 250-325 500 linear 500 fixed 150 linear 150 linear
Flow NA 30 fixed NA 30 30 fixed 25 fixed
Vacuum response 2 2
Bottle ht 140 140 140 140/80 75 50
In programs Linear vac ACF Fixed flow Linear vac Linear vac Linear flow Fixed vac
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IOL Selection Astigmatism

• 40 Presbyopia correcting IOLs
• 45 ReZoom
• 36 crystalens
• 18 ReStor
• 53 Cornea customized aspheric IOLs
• 56Tecnis
• 25 IQ
• 19 AO
• 30 Limbal relaxing incisions

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Intra-Op Outcomes

• Mean surgery time start to end 19.7 5.5 min
• Mean effective phaco time 0.77 1.58 sec
• Average phaco power 2.04 2.25

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Post-Op Outcomes

• 20/30 mean uncorrected acuity 2 24 hours
  post-op
• Excluding eyes with pre-existing pathology and
  prior surgery
• 75 20/40 or better 63 20/30 or better
  
  53 20/25 or better 32 20/20
  or better
• No complications 

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Summary

• 30 consecutive eyes operated with the
  Stellaris,10/4/07 to 2/14/08.
• Mean age 64 years.
• Average nucleus 1.4 NS. 
• 40 had presbyopia correcting IOLs (45 ReZoom,
  36 crystalens, 18 ReStor)
• 30 had LRIs
• 53 has corneal-customized aspheric IOLs
  (56Tecnis, 25 IQ, 19 AO)      

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Conclusion

• Stellaris with advanced flow module is efficient,
  safe and effective for bimanual microincision
  cataract surgery