EW
SHOW DAILY
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P
hacoemulsification
settings can occasionally
vex even the most sea-
soned cataract surgeons,
which is why EyeWorld
held
a symposium on the topic
"Phaco Fundamentals: Device Set-
tings and Best Practices for Routine
to Complex Phacoemulsification."
An online survey of the
audience found a mix of both
newer surgeons in attendance as
well as some with 15 years or more
of experience. The material in the
session
would help surgeons at any
level, said moderator David Chang,
MD, Los Altos, Calif.
The use of peristaltic versus
Venturi pumps was the focus of
the initial talk from Bonnie An
Henderson, MD, Boston. She
reviewed the basics of fluidics, in-
cluding flow, vacuum, and the pros
and cons of the different kinds of
pumps. Dr. Henderson also gave ad-
vice on how to control surge, such
as by having a higher bottle height,
using a lower aspiration flow rate,
and having a lower vacuum preset.
"We want to optimize our
settings for enough power and to
prevent surge," she said. "Surge is
a five-letter word in phaco."
Lisa Park, MD, New York,
discussed device settings and best
practices, reviewing the power mod-
ulation categories of direction—in-
cluding longitudinal, torsional, and
transversal—and the timing settings
of pulse, burst, and hyperpulse.
A presentation from Kenneth L.
Cohen, MD, Chapel Hill, N.C.,
covered what a peristaltic pump
does during cataract surgery and
how phaco settings should facilitate
followability and emulsification
while minimizing surge.
The panelists further explained
how they alter phaco settings
during specific cases, using videos to
demonstrate their ideas. They then
discussed how they change phaco
settings for complicated cases such
as soft lenses, dense lenses, and
weak zonules.
Dr. Henderson shared with
attendees her Stellaris (Bausch +
Lomb, Rochester, N.Y.) segment
removal settings. For the average
lens, she uses a bottle height of 135
cm, a power of 40, a vacuum of 275,
30 pulses per second, and a 40%
duty cycle. In a dense lens, her
bottle height remains 135 cm but
she increases power to 60. Her
vacuum with a dense lens is 290,
she uses 70 pulses per second, and
her duty cycle is 60%.
For further information
on phaco fundamentals, Dr.
Chang recommended the website
phaco.ascrs.org, which provides more
comprehensive phaco education.
EW
Editors' note: This event was supported
by unrestricted educational grants
from Alcon (Fort Worth, Texas) and
Bausch + Lomb.
ASCRS•ASOA SYMPOSIUM & CONGRESS, BOSTON 2014
EyeWorld session covers phaco's fundamentals
by Vanessa Caceres EyeWorld Contributing Writer
