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EW SHOW DAILY 76 by Vanessa Caceres EyeWorld Contributing Writer She reviewed the goals of ultrasound power, such as providing enough cutting power and efficiency to effectively disassemble the nucleus and decrease turbulence. Longitudi- nal ultrasound helps to increase cut- ting efficiency, but it also has more energy expenditure. Longitudinal is ideal for chopping and purchase. Torsional ultrasound provides side- to-side oscillating cutting energy and is ideal for segment removal or sculpting. The right use of ultrasound is important because too much can lead to wound burn, turbulence, corneal edema, and endothelial cell loss. However, with not enough ultrasound, the surgeon cannot dis- assemble the nucleus, and zonular stress occurs, along with the use of too much fluid. Panelists shared some ma- chine-specific pearls in terms of managing dense cataracts. For instance, with the Stellaris (Bausch + Lomb, Bridgewater, New Jersey), Dr. Dhaliwal recommending using the machine's "rock" setting. When you have a new phaco machine, your manufacturer's rep should help you titrate it to your surgical preferences, she said. For the WhiteStar pha- co machine (Johnson & Johnson Vision, Santa Ana, California), Dr. Basti noted that more phaco power and higher vacuum settings are needed. With the Centurion system (Alcon, Fort Worth, Texas), the Ac- tive Fluidics option helps to reduce the risk for surge. Panelists also discussed some phaco fundamentals when per- forming femtosecond laser-assisted cataract surgery. For additional practice and learning, the ASCRS website (www. ascrs.org) has a Phaco Fundamentals Classroom, Dr. Chang said. EW Editors' note: This event was sponsored by the ASCRS Young Eye Surgeons Clinical Committee and supported by educational grants from Johnson & Johnson Vision, Alcon, and Bausch + Lomb. E ven seasoned ophthalmic surgeons can benefit from a review of phacoemulsi- fication basics, and that's just what Sunday morning's "Phaco Fundamentals: Phacodynam- ic Principles & Pearls for Routine, Complex, and Femto-Phaco Cases" offered. Panelists discussed some of the basic phaco concepts and ma- chine-specific pearls. An audience survey at the ses- sion found that the largest group of attendees had more than 15 years of phaco experience. "Phaco funda- mentals aren't just for residents. There are things with fundamentals that we need to constantly relearn," said program chair David F. Chang, MD, San Francisco. Deepinder Dhaliwal, MD, Pittsburgh, reviewed pump basics and the importance of inflow and vacuum. One pearl she shared is ad- justing the vacuum as necessary—for instance, increase the vacuum when nucleus pieces are flying around, but decrease it if the anterior chamber is flattening. Flow rate is adjustable only on machines with a peristaltic pump, Dr. Dhaliwal said. "This should be increased when things are moving too slowly in the eye and the nucle- ar pieces are not following one an- other to the phaco tip," she advised. "Decrease aspiration flow when you want to slow things down," such as in a complex case. Surendra Basti, MD, Chicago, focused on post-occlusion surge, which he characterized as one of the most frustrating events of cataract surgery. Factors that can lead to post-occlusion surge include problems with inflow and outflow, the latter of which can involve the gauge of the tip, vacuum, and tub- ing. Some pearls to manage this in- clude: 1) engaging the nuclear piece from the side, 2) balancing levels of vacuum and fluid flow, and 3) using machine features to help control it. In a presentation on power surge, Rosa Braga-Mele, MD, Toron- to, discussed the pros and cons of different forms of ultrasound power. Phaco basics provide review for experienced and new surgeons Watch for our weekly emails every Saturday, broadcasting recorded live cornea presentations Learn from the experts @http://VideoEd.CorneaSociety.org Copyright ©2017 Cornea Society. All rights reserved. The Cornea Society portal features cornea presentations and expert interviews from educational events throughout the year VideoEd.CorneaSociety.org Watch, Learn & Share! Available on all mobile devices, tablets, and desktops All content is archived for future reference Watch, Learn, and Share! VideoEd

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