Transcript Microcoaxial phaco using 1.8mm incisions: comparison of

Microcoaxial phaco using
1.8mm incisions:
comparison of two machines
and IOL systems
Richard Packard Windsor England
Consultant for Alcon, AMO and Bausch and Lomb
Reasons for making incisions
smaller
• Less leakage and therefore better
controlled surgery
• Minimal if any induced astigmatism
• Faster rehabilitation visually for the
patient
• Safer more rapidly healing wounds
• Because we can!
Induced astigmatism from temporal wounds
0.5
0.50
0.45
0.40
0.35
0.25
0.30
0.25
0.20
0.12
0.15
0.10
0
0.05
0.00
3.2mm
2.5mm
2.2mm
1.8mm
Microincisions with coaxial give:
• Protected wounds due to sleeve
• Less changes in technique and
equipment than B-MICS
• Ability to use established IOL
technology
• Minimal astigmatism
What do we need for C-MICS
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Wounds and therefore knives that match instrumentation
Microsurgical capsulorhexis forceps
New sleeves that are thin and allow enough fluid passage
Thinner phaco tips?
Understanding hydrodissection with microincisions
No change in cataract removal techniques
Phaco machines with appropriate power modulation and
excellent fluidics
• IOLs capable of being injected with wound assistance
through unopened Co-MICS incisions
Incisions for 1.8mm C-MICS
Capsulorhexis and hydrosteps and tip insertion
for 1.8mm C-MICS
Stellaris System
Overview
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EQ Fluidics equalises fluidic dynamics for solid chamber
stability in vacuum or flow modes
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Ergonomic six crystal handpiece and tubing for efficient
cutting and smooth removal of the nucleus in all
techniques
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CustomControl™ Software II for customisable power
modulation for all cataract grades
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Wireless Dual Linear foot pedal for instantaneous surgeon
control of aspiration and ultrasound
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Sleek and ergonomically designed for operating room
efficiency
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Modular design customisable to both EQ Fluidics options,
the Advanced Flow Module or Vacuum Fluidics Module,
plus all future upgrades
Stellaris EQ Fluidics Management Technology
EQualising aspiration and
irrigation for unsurpassed
safety, efficiency and
predictability in either flow or
vacuum modes for solid
chamber stability throughout
the procedure
EQ
EQ
Advanced Flow
Module (AFM)
Vacuum Fluidics
Module (VFM)
Single module allows surgeons to
toggle intra-operatively between flow
and vacuum modes; flow for
sculpting, vacuum for capsule
polishing and I/A
Latest generation vacuum
fluidics with StableChamber
tubing delivers exceptional
accuracy and efficiency for
MICS
INFINITITM Vision System
• Tri-modal
– AquaLaseTM
– Ozil
TM
– Improved Traditional
Ultrasound
• Fluidics
• User Interface
• Ergonomics
Fluidic Management System
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Pump roller interface
Vent valve interface
Irrigation pinch valve
Infusion pressure
membrane
• Vacuum Pressure
Sensor
• IntrepidTM low
compression tubing
MICS tip and sleeve for
1.8mm surgery with B and L
Stellaris
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Straight MICS tip
30 degree bevel
0.9mm at widest
0.5mm internal
diameter
Mini-flared tip and Nano
sleeve for 1.8mm surgery with
Alcon Infiniti
• Curved 45 degree
mini-flared tip
• 0.9mm at widest
• 0.57mm internal
diameter
Stellaris Handpiece efficient cutting
• Increased stroke length for efficient
cutting of the nucleus
• Tighter, more focused and consistent
delivery of stroke
• CustomControl™ II Software for
customisable, programmable wavefront
power modulations for all techniques
OzilTM technology
Torsional (side) stroke at tip end (action)
-oscillations occur at tip/hub/horn junction
-distal end of Kelman tip exhibits a “side to side”
displacement due to tip geometry
More Efficient Cutting with 32KHz
Torsional induces (“shearing” stress )
vs.
Longitudinal u/s (“compression stress”)
Longitudinal cuts on the “forward” stroke
Torsional cuts both “right or left” = efficiency
Translates = about 1/3 of thermal dissipation
Now that we have removed
the nucleus which IOL can we
use?
Akreos Microincision Lens
Optimised for MICS
Akreos Microincision Lens: Akreos MI60
• Implantable through a 1.8 mm incision using a
wound-assisted injection
• Biocompatible hydrophilic material with a
proven record of safety, used in 2 million
implantations since its introduction in 1998
• The innovative haptic design ensures excellent
3-Dimensional stability of the IOL
AcrySof IQ* Aspheric Natural IOL
(Alcon model SN60WF)
• Thinner aspheric optic design for
1.8mm insertion with wound
assistance and D-cartridge
• Blue Light-Filtration
• AcrySof Single-Piece Platform
• Low PCO
*IQ (Image Quality)
• Material with 17years track
record
So how do they really
compare?
• Both deliver 1.8mm surgery with early
visual rehabilitation due to no induced
astigmatism
• Both require specific knives, capsulorhexis
forceps, phaco tips and sleeves
• Wound assisted insertion is mandatory
• Time will tell how the IOLs perform in the
long term as far as PCO is concerned
Thank you