Comparison of Efficiency of Phacoemulsification Settings, Handpieces and Software

1
Comparison of Efficiency of Phacoemulsification
Settings, Handpieces and Software

• Pasta, J.

Department of Ophthalmology, 1st Medical Faculty
of Charles University and Central Military
Hospital, Prague, Czech Republic
2
Statement of Financial Interest

• The presenting author has no financial interest
  in the subject matter of following presentation.

3
Method

• Three different machines, i.e. BL Millennium,
  Alcon Infinity and AMO Sovereign were used for
  phacoemulsifications in everyday cataract
  surgery.
• The 20 patients for each group of nucleus
  hardness 2 and 4 and each setting were treated by
  mentioned machines with different settings from
  October 2006 to February 2007.
• Mostly used phacoemulsification technique was
  stop and chop for initial dividing and halves
  were then cracked into smaller parts.
• Description of specific settings for each machine
  and specific grades of cataract density follows.
• The results were taken from recorded overlay
  statistics (BL Millennium and Alcon Infinity) or
  from printed statistics (AMO Sovereign) and
  compared.

4
Millennium Settings Cataract Grade 2 and 4

• Settings M 2 and 4/1 Superotemporal Corneal
  Tunnel 2,65 mm, Microflow needle, BL sleeve, CCS
  1and 4
• Settings M 2 and 4/2 Superotemporal Corneal
  Tunnel 2.2 mm, Microflow needle, Alcon 1,1 Ultra
  sleeve, CCS 1 and 4
• Settings M 2 and 4/3 Superotemporal Corneal
  Tunnel 2.2 mm, Stableflow 19G needle, Alcon 0,9
  Ultra sleeve or Medicel Triflow Sleeve, CCS-MICS
• Settings M 2 and 4/4 90º upper corneal tunnels
  1,5 mm (superonasal) and 1.7mm (superotemporal),
  Stableflow 19G needle, irrigating chopper,
  CCS-MICS

5
Infinity Settings Cataract Grade 2 and 4

• Settings I 2 and 4 Supero-temporal Corneal
  Tunnel 2,3 mm, 0,9 mm Flared ABS Tip, Alcon
  Micro-Coaxial 0,9 Ultra sleeve, Micro-Coax Neo
  mode 2 and 4
• Settings I 2 and 4 Superotemporal Corneal Tunnel
  2,3 mm, 0,9mm Tapered ABS Tip, Alcon 0,9 Ultra
  sleeve, Micro-Coax OZil mode 2,3mm 2 and 4

6
AMO Sovereign Settings Cataract Grade 2 and 4

• Settings A 2 and 4 Superotemporal Corneal Tunnel
  2,2 mm, 0,9 mm Standard Micro Tip, AMO 0,9
  Microsleeve, White Star Ice (Version 7.10) 2 and
  4

7
Settings M 2
8
Settings M 4
9
Settings I 2
10
Settings I 4
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Settings I Neo 2 and 4
Neo 2.  (Soft cataract, nucleus grade 2). Sculpt
Smart pulse longitudinal linear energy, 35 US
Power, hyperpulse 30 pps, torsional energy 60,
DC 10ms off, Vacuum 120mmHg, asp. 35ml/min, DR
0 Chop - Micro Burst longitudinal linear energy
up to 35 US Power, torsional energy up to 60,
DC time on 40ms, time off 10ms, Vacuum 330 mmHg,
asp. 35ml/min, DR 1-2 I/A max. - 550mm Hg, asp.
50ml/min IV pole - 110cm Neo 4.  (Hard cataract, 
nucleus grade 4). Sculpt Smart pulse
longitudinal linear energy, 45 US Power,
hyperpulse 30 pps, torsional energy 80, DC 10ms
off, Vacuum 120mmHg, asp. 35ml/min, DR 0 Chop -
continual energy up to 40 US Power, torsional
energy up to 80, Longitudinal regimen 20 of
time, torsional regimen 80 of time. Vacuum 330
mmHg, asp. 35ml/min, DR 1-2 I/A max. - 550mm Hg,
asp. 50ml/min IV pole - 110cm
12
Settings I OZil 2 and 4
OZil 2.  (Soft cataract, nucleus grade
2). Sculpt Smart pulse longitudinal linear
energy, 35 US Power, hyperpulse 30 pps,
torsional energy 60, DC 10ms off, Vacuum
120mmHg, asp. 35ml/min, DR 0 Chop - Micro Burst
longitudinal linear energy up to 35 US Power,
torsional energy up to 60, DC time on 40ms, time
off 10ms, Vacuum 330 mmHg, asp. 35ml/min, DR
1-2 I/A max. - 550mm Hg, asp. 50ml/min IV pole -
110cm OZil 4.  (Hard cataract,  nucleus grade
4). Sculpt Smart pulse longitudinal linear
energy, 45 US Power, hyperpulse 30 pps,
torsional energy 80, DC 10ms off, Vacuum
120mmHg, asp. 35ml/min, DR 0 Chop - continual
energy do 40 US Power, torsional energy up to
80, Longitudal regime 20 of time, torsional
regimen 80 of time. Vacuum 330 mmHg, asp.
35ml/min, DR 1-2 I/A max. - 550mm Hg, asp.
50ml/min IV pole - 110cm
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Settings A 2 and 4
A 2. (Soft cataract, nucleus grade 2) OCCLUSION
MODE OFF POWER SET 50 PULSE
SHAPING PARAMETER RANGES Unoccl Pwr
0 - 0 Unoccl Kick
0 0 POWER USED 50 POWER MODE
MB WS DF MAX VAC 400
mmHg VAC NEVER gt 400 mmHg ASP RATE
36 cc/min IV POLE HT
76 cm EPT
0004.66 U/S
0056
A 4. (Hard cataract,  nucleus grade 4) OCCLUSION
MODE OFF POWER SET 30 PULSE
SHAPING PARAMETER RANGES Unoccl Pwr
0 - 0 Unoccl Kick
0 0 POWER USED 30 POWER MODE
SB WS CF MAX VAC 300
mmHg VAC NEVER gt 113 mmHg ASP RATE
22 cc/min IV POLE HT
76 cm EPT
0000.02 U/S
0000 TOTAL EPT 0016.06 TOTAL
U/S 0219 AVG POWER
11,5
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Video Shot of Phacoemulsification
15
Handpieces
Infinity NeoSonics
Infinity OZil
Millennium
Sovereign
16
Handpieces Comparison

• Sovereign and OZil handpieces are lightweight,
  handy, agreeable.
• Millennium handpiece is slightly greater, but
  lightweight and agreeable.
• NeoSonics handpiece is big, heavier and vibrates
  during phacoemulsification.

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Infinity Panels Software Options
18
Infinity Panels Software Options
19
Custom Control Software (CCS) and MICS
Specifications
Linear Power 0 100 Duty Cycle 10
90 Pulse Rate 0 120 PPS

• Enhanced Phaco Modulation Options
• Pulse Mode
• PPS (Pulses Per Second) setting range increased
  from 0 to 20 PPS to now allow 0 to 120 PPS.
• Duty Cycle (Ultrasound On-Time) setting range
  increased from 50 (not programmable) to now
  allow 10 to 90 duty cycle.
• With rise time 2 Provide waveform modulation.
• Fixed Burst Mode
• New mode alternate method of programming a
  pulse mode by directly entering burst duration (4
  to 600 msec) and interval (4 to 600 msec).
• With rise time 2 Provide waveform modulation.

Pulse Mode
20
Custom Control Software (CCS) and MICS
Specifications
Fixed Power 0 100 Pulse Duration 4 600
ms Duty Cycle 50 100
Multiple Burst Mode

• Enhanced Phaco Modulation Options
• Multiple Burst Mode
• Burst Duration setting range expanded from 80 to
  600 msec to now allow 4 to 600 msec.
• Added a maximum duty cycle settings. Allows phaco
  on time at full pedal travel to range from 50 to
  100.

Multiple Burst Mode
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CCS and MICS Specifications

• 3. Enables Simpler Method of Selecting Various
  Phaco Modulations
• Ultrasound SubModes
• Each ultrasound mode may have up to three sets of
  phaco settings.
• Current modulation is selected with on screen
  tool window or optionally with inward yaw foot
  pedal activation.
• Each submode share the same vac, bottle height
  and other settings. Only phaco mode, power and
  modulation is programmable.

Settings 50PPS, 50 DC
Waveform OFF
Waveform modulation
Waveform ON
5s
22
SovereignTM

• WHITESTARTM ICE
• Setup Mode
• Occlusion ModeTM Phaco
• CASE Chamber Stabilisation Enviroment

23
Softwares Comparison

• After my opinion, Millennium CCS or MICS
  softwares as so as Infinity and AMO WhiteStar ICE
  hyperpulse softwares are able to fully satisfy
  requirements of modern phacoemulsification
  techniques and gives uncountable number of
  variances of different settings to every cataract
  surgeon.

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Results Millennium, Cataract Grade 2 and 4
25
Results Infinity, Cataract Grade 2 and 4
NST NeoSonics Time TT Torsional Time
ANP Average NeoSonics Power ATAmp Average
Torsional Amplitude
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ResultsSovereign, Cataract Grade 2 and 4
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Conclusions

• Millennium phacoemulsification
• Generally it is the fastest procedure, from the
  reason of dual linear mode mainly.
• In mentioned settings it is very safe procedure.
• With smaller tip channel diameter rises duration
  of the procedure in soft cataract surgery.
• The duration of hard cataract surgery procedure
  is comparable with Stableflow needle soft
  cataract procedures.
• The duration of Stableflow needle hard cataract
  procedures is only slightly higher then classical
  and microcoaxial procedures.

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Conclusions

• Infinity phacoemulsification
• Generally it is larger procedure.
• In mentioned settings it is very safe procedure.
• OZil accelerates phacoemulsification and makes it
  easier.
• The duration of hard cataract surgery procedures
  is much longer then soft ones.
• Effective phacotimes are short.

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Conclusions

• Sovereign phacoemulsification
• In mentioned settings it is very safe procedure.
• Stability of anterior chamber during
  phacoemulsification is excellent.
• The duration of hard cataract surgery procedures
  is markedly higher then soft ones.
• Effective phacotimes are comparable with
  Millennium ones.

30
Conclusions

• It is possible to compare phacoemulsification
  regimes with the same parameters and settings
  only.
• The settings of all three machines discussed
  arent fully equivalent but they were set upped
  from the point of view of requirements of one
  super high volume phacosurgeon.
• The results verify advancements of
  phacoinstruments, phacohardwares as so as
  phacosoftwares which facilitates modern
  microphacosurgery.