Eyeworld Daily News

EW SHOW DAILY 56 Meeting Reporter Monday, April 16, 2018 by Rich Daly EyeWorld Contributing Writer the Centurion system (Alcon, Fort Worth, Texas) aims to avoid using more energy than necessary. Her techniques for such lenses include stop and chop, as well as divide and conquer. With the Centurion system, longitudinal phaco is excellent for grooving through the lens, Dr. Park said. "In this case, torsional phaco can actually cause vibrations in a dense lens, and therefore we need to come up with a good combination and a balance between those two modalities," Dr. Park said. She decreases the torsional if the lens is very dense and she is concerned a lot of movement will result. Even when using longitudinal phaco, Dr. Park rarely goes higher than 50%. Although sculpting a dense cataract requires more energy than continuous mode, pulse settings can minimize the energy from longitudi- nal phaco. Additionally, the use of Intelli- gent Phaco (Alcon) can clear the tip when sculpting a dense nucleus. "We know we're going to use a lot of power, we know we're really going to have to get into the meat of the lens, but we don't want to use more power than necessary," Dr. Park said. The approach also can reduce the chances for post-occlusion surge. Modifications in her technique include sculpting a deep groove and ensuring a complete crack. Her viscoelastic use in such cases follows the Arshinoff soft shell technique, which uses a dispersive to coat and protect the cornea, as well as a cohe- sive viscoelastic to create space and flatten the capsule. EW Editors' note: This event was supported by educational grants from Bausch + Lomb and Johnson & Johnson Vision. uses for the Stellaris system (Bausch + Lomb, Bridgewater, New Jersey) are driven by greater concerns of wound burn, posterior capsule rupture, and endothelial cell loss. Dr. Al-Mohtaseb's dense cataract approach includes minimizing the harm of phaco energy by keeping it farther away from the corneal endo- thelium. She performs phaco in the capsular bag as much as possible and widens her stop and chop groove commensurate with the hardness of the lens. The dense cataract Stellaris settings used by Dr. Al-Mohtaseb include a lower pulse rate. She min- imizes repulsion by using vacuum more efficiently. Dense cataracts also require a higher duty cycle with the Stellaris but no need to change the phaco tip. The dense cataract approach Lisa Park, MD, New York, uses for "In chop, you want a good grip on that nucleus using multiburst," Dr. Basti said. When removing segments in dense—but not brunescent—cata- racts, Dr. Basti uses Whitestar hyper pulse to control the direction of ultrasound energy. In brunescent lenses, he uses continuous power with 10% non-zero start. Vacuum changes in dense cat- aracts include utilizing those high enough to ensure efficient removal of the lens material. Specifically, he uses vacuum levels of 400 mm Hg in chop and segment removal modes. Also, he increases the "pump ramp" to 60% and vacuum rise time. His dense cataract surgical technique includes sculpting using a shallow central bowl approach, chopping into six segments, then removing the segments. Dense cataract setting changes Zaina Al-Mohtaseb, MD, Houston, S urgical approaches to hard cataracts should change in key ways based on the phacoemulsification system that the surgeon is using. Surendra Basti, MD, Chicago, alters his usual cataract settings on the Whitestar Signature Pro system (Johnson & Johnson Vision, Santa Ana, California) when removing dense cataracts. The changes are needed, he said, because emulsifi- cation of dense cataracts requires greater-than-usual phaco power and removal requires higher vacuum settings. "In dense cataracts, the balance of power and vacuum is critical," Dr. Basti said. In the sculpt mode, Dr. Basti uses continuous power. However, in chop mode, multiburst power is effective, especially in brunescent cataracts. System-specific approaches needed for dense cataracts Dr. Basti discusses the best settings for dense cataract removal using the Whitestar Signature Pro system.

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