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Kevin M. Miller, MD
Ali H. Aboughaida, MS
Satish Yalamanchili, MBA, MS
David W. Dyk, BScOptom
Omid S. Rohani, PhD
To characterize post occlusion break surge volume (SV) in the Centurion with Active Sentry peristaltic system (CAS), Whitestar Signature Pro peristaltic system (WSP), and Stellaris PC venturi system (SPC) under varying intraocular pressures (IOP), vacuum limits (Vac), and aspiration rates (Asp).
A mechanical eye model that mimics the compliance of human eye was used to model the anterior chamber volume-pressure change behavior. Using this model, the SV of the systems were characterized at Vac of 300 to 600 mmHg, IOP of 30 to 80 mmHg, and Asp of 20 and 40 cc/min (the SPC does not have an Asp setting). Each operating setting was tested on six samples and the SV average and standard deviation (SD) for all the samples was calculated at all given settings [IOP, Vac, Asp].
The CAS SV (SD) was 48.6 (3.1) µL at [50, 500, 20] and 61.8 (4.9) µL at [50, 600, 20]. The corresponding WSP SV (SD) was 70.3 (4.2) µL and 102.6 (5.5) µL while the corresponding SPC SV (SD) was >160 µL and >160 µL. The CAS SV (SD) was 50.9 (3.3) at [40, 500, 20] and 63.6 (5.1) at [40, 600, 20]. The corresponding WSP SV (SD) was 77.3 (6.2) µL and 112.5 (7.4) µL while the corresponding SPC SV (SD) was >160 µL and >160 µL. Wherever SV is reported as >160 µL, the mechanical eye model reached its limitations and therefore was not able to measure a surge volume that was greater than 160 µL.
SV is heavily dependent on the cataract system used and its surgical settings. CAS had a significantly lower surge volume in high Vac and low IOP when compared to WSP and SPC. CAS had a small SD which shows it can provide a higher level of case-to-case consistency. In CAS, surge is mainly a function of Vac and does not greatly vary with IOP.
Santaro Noguchi, MD
To examine how the torsional amplitude, sleeve type, tip type, and IOP settings affect the intraocular perfusion supply.
Using CENTURION®Vision System, the weight of BSS PLUS®500 0.0184% (Alcon) injected during torsional phaco was measured. The weight of BSS injected from the sleeve was measured accurately for 3 seconds (measured 15 times every 200 msec) by weight scale AD-4212C-300. Four measurements were made at each torsional power (TP) setting, and the average value and standard deviation of the perfusion supply rate were calculated. A bent tip (0.9 mm Mini ABS® 45 ° Kelman®; mini tip) and a semi-circular tip (0.9 mm balanced ABS® 45 ° Alcon; balanced tip), and a nano sleeve (Alcon) were used, respectively. The perfusion rate was measured at IOP20mmHg and IOP40mmHg.
In the balanced tip + nano sleeve, the perfusion rate increased 1.18 to 1.27 times at IOP 40 mmHg when compared to IOP 20 mmHg. In both IOPs, perfusion decreased with TP. In the balanced tip + ultra sleeve, there was no significant decrease in perfusion rate with TP in both IOPs. Mini tips + nano sleeves were greatly affected by TP, and perfusion decreased. In the setting of IOP40 mmHg, an increase in perfusion of 1.28 to 1.42 times is recognized. In the mini tip + ultra sleeve, The flow rate decreased more than TP80%. In IOP40 mmHg, a flow rate of 1.39 to 1.58 times was recognized compared to that in IOP20 mmHg.
Except for the balanced tip + ultra sleeve setting, all perfusion flow tended to decrease due to the influence of TP. In particular, in the case of TP with TP 80% or more, the decrease of perfusion rate was remarkable. This suggests the anterior chamber is likely to become unstable in cases requiring TP high power.
Erik L. Mertens, MD
To present on the 1st 100 consecutive eyes where the capsulotomy in routine cataract surgery was performed using a new Selective Laser Capsulotomy (SLC) technique.
SLC is performed with a 590nm orange wavelength laser which is absorbed into a trypan blue stained capsule to create a perfectly sized, centered and circular capsulotomy. The diameter settings are set from 4.5mm to 5.5mm in 0.1mm increments. From initial use the 1st consecutive 100 eyes were treated by the same surgeon and reviewed for size, centration and circularity. The number of free-floating capsular discs and 360° coverage of the IOL optic surface was also observed.
After an initial learning curve observed with the 1st 20 eyes, SLC produced repeatable and accurate capsulotomies in terms of size, centration and circularity. Free floating capsular discs were consistently observed and 360° IOL coverage was achieved in 100% of cases.
The CAPSULaser SLC technique resulted in accurate and consistent capsulotomies easily integrated into the patient workflow. These results shown in our first 100 cases demonstrate the value of this automated capsulotomy device.
David M. Lubeck, MD, ABO
Hang Cheng, MSc
Megan Bourque, PhD
Sarah T Kane, PhD
Daniel Son, MSc
Phacoemulsification (PKE) is the standard of care in cataract surgery. Advances in PKE technology aim to minimize iatrogenic effects, improve patient outcome and optimize procedural efficiencies. A systematic literature review (SLR) was conducted to evaluate recent clinical evidence comparing safety, efficacy and efficiency of different PKE systems
PubMed and EMBASE/MEDLINE databases were searched in March 2019. Observational and randomized controlled trials comparing at minimum two PKE systems were included. Searches were not limited by language and articles published between 2009-2019 were included. Article screening was performed in duplicate. Exclusion criteria encompassed PKE studies involving femtosecond laser-assisted cataract surgery (FLACS), animal or laboratory studies, and non-comparative clinical studies. From all relevant comparative clinical studies, the study and patient characteristics, clinical efficacy, procedural efficiency, and safety outcomes (intraoperative and long-term) were extracted.
A total of 5,895 articles were screened. Data was extracted from 27 relevant articles that included the following PKE systems: Whitestar Signature® PRO, Legacy®, Accurus®, Stellaris®, CENTURION®, and INFINITI®. A total of 6,099 eyes were studied in the 27 articles, the majority of which underwent PKE using CENTURION® (n=2,022 eyes) and INFINITI® (n=3,114 eyes). In the eight studies comparing CENTURION® and INFINITI®, safety outcomes were similar between the two systems; however, CENTURION® outperformed INFINITI® in the following procedural outcomes: estimated fluid usage (EFU, 3/4 studies), total aspiration time (TAT, 3/3 studies) and cumulative dissipated energy (CDE, 8/8 studies).
The CENTURION® and INFINITI® Vision Systems encompassed the majority of comparative clinical data identified in this SLR. The CENTURION® Vision System outperforms the INFINITI® Vision System in EFU, TAT and CDE. Superiority in these efficiency measures may result in reduced ocular trauma, quicker patient recovery, and superior visual outcomes.
Emilie L. Ungricht
Jacob T. Harris
Randall J. Olson, MD
Corneal incision contracture (CIC) can occur due to the ultrasonic movement of the phacoemulsification needle and its generation of heat at the site of incision. This study aims to understand the role of OVD in the heat, specifically at the site of incision, in a scenario where vacuum is present and in a scenario where the vacuum is obstructed.
A thin membrane was placed on top of the chamber containing balanced saline solution (BSS). An AC Ozil hand piece was placed into the chamber, piercing through the membrane. 0.1 mL of BSS, Viscoat, ProVisc, DisCoVisc, or Healon 5 were placed on top of the membrane with the temperature gauge. The gauge recorded the temperature at time zero, 10 seconds, 20 seconds, and 30 seconds. The ultrasound was run for 30 seconds with an IOP of 50 mmHg, a vacuum of 0 mmHg, aspiration of 12 cc/min on a torsional setting at 60% power. 10 trials were obtained for each material being tested. This study was then repeated in entirety with the only alteration being the absence of aspiration and flow.
In the absence of both vacuum and flow each OVD/BSS had an average increase of temperature from baseline to 30 seconds of at least 6.88° C and an average difference of 8.34° C. The temperature change for each OVD is: DisCoVisc (6.88° C ± 2.68) Healon-5 (7.15° C ± 2.75), Provisc (7.31° C ± 2.99), BSS (8.30° C ± 9.8), and Viscoat (12.06° C ± 16.74). In the presence of both vacuum and flow, the each OVD/BSS had an average increase of temperature from baseline to 30 seconds of at least 0.57° C and an average change of 1.10 oC. The temperature change for each OVD is: Viscoat (0.57° C ± 1.27), DisCoVisc (0.66° C ± 1.16), Provisc (0.79° C ± 1.79) Healon-5 (1.22° C ± 0.68), and BSS (2.24° C ± 1.76).
Temperature is able to heat at the simulated site of incision, though no trial exceeded 60° C, the threshold of Corneal incision contracture (CIC). The only OVD in the absence of vacuum and flow which had a final average temperature greater than BSS was Viscoat. In the presence of vacuum and flow, BSS featured the greatest change in temperature.
Barbara Kusa, MD
Matteo Piovella, MD
The new miLOOP (Carl Zeiss Meditec)is a micro interventional device designed to delivery low energy endocapsular lens fragmentation manly in dense cataract and complicated cases Single use device, finger controlled, no phaco energy no cavitation reduced I/A
miLOOP was adopted 53 Eyes with medium/hard cataract to split the nucleus in two part.The metal loop was inserted in the capsular bag and open throught the edge of idrodelineation rime. Once the loop is in the proper vertical position the loop is retracted ti split the nucleus
The nucleus was split in two pieces in all patirents. It is necessary a learning curve adotping the device in simple cases to be confident in the proper use to avoid device related complications In one case the loop did not match the capsular bag and coused mild zonula damage with no significant weak event. In one eye we experienced opening of the posterior capsule due to a lock of experience in adopting the device that was opened and retracted more then one single time
miLOOP adoption in dense cataract and complicated cases riduces phaco energy by 50%, reduces I/A fluid use by 30 % and makes hard nucleus cataract removal more controlled and efficient. A proper learning curve needed.