Eyeworld Daily News

EW SHOW DAILY 50 Monday, April 20, 2015 by Chiles Aedam R. Samaniego EyeWorld Asia-Pacific Senior Staff Writer placing the preferred settings of members of its faculty in that con- text, thereby hopefully equipping attendees to refine their existing settings. Members of the faculty went over the fundamentals, described their preferred settings for partic- ular phaco platforms, and adapted their settings for complicated cases. Bonnie An Henderson, MD, Bos- ton, reviewed "Peristaltic vs. Venturi Pumps: Differences & Advantages" before going over her preferred settings for the Stellaris phaco system (Bausch + Lomb, Bridgewa- ter, N.J.), and how she adapts her settings for brunescent cataract. Kenneth L. Cohen, MD, Chapel Hill, N.C., focused on "Peristaltic Pump Fluidics: Vacuum & Flow," presenting his standard settings and those for soft posterior polar cataracts on the Whitestar Signature Phacoemulsification System (Abbott Medical Optics, Abbott Park, Ill.). Finally, Lisa Park, MD, New York, reviewed "Ultrasound Power Modulation" and detailed her set- tings for a standard case and a case of IFIS on the Infiniti and Centurion systems (Alcon, Fort Worth, Texas). David F. Chang, MD, summed up the fundamentals underlying their choices as they adjusted their settings progressing from step to step in the phaco procedure—from sculpting, to emulsification or fragment removal, to epinucleus removal. With each step, Dr. Chang said, "priorities change." "When you're sculpting, you don't want a lot of vacuum," he said. "If you have too much vacuum everything starts to rush ... so that's why they turn their vacuum down." You also have to worry about incision burn. "The single most im- portant thing you do is put disper- sive or highly retentive viscoelastic for a brunescent lens," he said. After which, "take the time to just aspirate that cloud of viscoelastic above the lens surface of the brunescent lens [that] gives you some more space with some fluid so you won't clog the tip, which is what causes wound burns." During chopping or quadrant dissection, "that's when we want grip—that's when you want the high vacuum," he said. Particularly with a chop technique, you need to have a high vacuum to have a good grip to separate the pieces. Once the lens is fragmented, the focus shifts from vacuum to power modulation and, as Dr. Park pointed out, the goal is to remove the lens efficiently, using no more power than is necessary. Finally, with the epinucleus, the goal, Dr. Chang said, is for there to be no surge. This is where all the doctors reduced their settings to minimize the risk of surge. Keith A. Walter, MD, Winston- Salem, N.C., and Elizabeth Yeu, MD, Norfolk, Va., rounded out the symposium by discussing Venturi and peristaltic extraction, respec- tively, in the setting of femtosecond laser-assisted cataract surgery. EW Editors' note: This EyeWorld CME Educational Symposium was supported by unrestricted educational grants from Abbott Medical Optics, Alcon, and Bausch + Lomb. Meeting Reporter Phaco fundamentals: The 'incredible power' of small adjustments S ometimes, it's the little things. "I think there's incredible power to very small and intentional ad- justments to your settings in keeping patient satisfaction at that postop visit as high as possible," Berdine M. Burger, MD, Charleston, S.C., said in her talk, "Speaking the Same Language: Update on Phaco Dynamics & Fluidics," that kicked off an EyeWorld CME Educational Symposium, "Phaco Fundamen- tals: How Well Do You Know Your Machine? Optimizing Settings for Routine, Complex, and Femto Phaco Cases." Dr. Burger's talk prefaced the symposium with a discussion of the basic concepts of phaco surgery, discussing phacoemulsification as a combination of power and fluidics. She defined power as stroke length times frequency—the ul- trasound energy delivered at the handpiece tip. She defined fluidics as infusion: flow (attraction to the phaco tip)—and outflow—aspiration (amount of flow through tubing) and vacuum (attachment to phaco tip). Dr. Burger recommended that surgeons who already had platform- specific phaco settings of their own that they were comfortable with not start over; rather, the symposium aimed to present the fundamentals, "Phaco Fundamentals" draws a large crowd on Sunday morning. Dr. Chang summarizes how cataract experts adjust phaco settings as necessary in the context of an understanding of the fundamentals of phacoemulsification.

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