Newphacotip

Cataract Update
New phaco tip design allows straight tip surgeons to perform torsional ultrasound
Stefanie Petrou Binder MD A NEW bevelled ultrasound tip provides the sculpting ability of the Kelman tip during phacoemulsification, without the extreme angulation, according to Robert Osher MD, professor of Robert Osher ophthalmology University of Cincinnati College of Medicine, Medical Director Emeritus Cincinnati Eye Institute. Torsional ultrasound is a significant improvement in phacoemulsification, yet it requires a curve to the ultrasound tip. Nevertheless, 70 per cent of the worlds surgeons prefer the straight tip, and the Kelman tip with the opening opposite the curve is awkward for some of us, said Dr Osher at the XXV Congress of the ESCRS. Dr Oshers new design has a gentle curve with a bevelled down opening, opposite the typical Kelman tip. By placing the bevel down within the lens, the tip can create a divot for fluid exchange beneath the OVD. Then the surgeon turns the bevel up for sculpting. Manoeuvring the tip is easy, since it is much less curved compared to the 22 bend of the Kelman tip. One simply turns the bevel to either side when he wants to embed it into the hemispheres, then chopping them into quadrants, he explained. He described a study in which 100 consecutive eyes underwent routine cataract surgery performed by microcoaxial phacoemulsification with mixed torsional ultrasound.The new tip was used for phaco through a 2.2mm incision using mixed torsional ultrasound and Healon 5 (AMO) as the OVD of choice. The intraoperative parameters included chamber stability, nucleus chatter, incision competency, reliability of implanting a full size single-piece IOL through an unenlarged incision, and complications encountered. Postoperative factors included uncorrected vision on the first postoperative day, corneal clarity, intraocular pressure, incisional appearance, and complications. Within the two years of clinical testing, the tip performed very well. For 70 per cent of the worlds surgeons, Dr Osher envisions this tip being much easier to use than the more extreme curve of the Kelman tip, he said. When evaluated for its efficacy with torsional ultrasound, it was far more efficient than the straight tip and just as efficient as the Kelman tip. It also gave the same thermal protection in the incision, and had a lack of chatter and repulsion, which was really not a function of the tip but more a function of the torsional ultrasound, Dr Osher noted. The chamber remained very stable during phaco with this new tip. Additionally, surgeons enjoyed the ease and benefits of straight tip torsional ultrasound, with very efficient cutting and a lack of repulsion.The tip also allowed for excellent control, he said. There are many reasons to aspire to using torsional ultrasound.This new modality breaks down lenticular matter through oscillating side to side movements of the phaco tip, uses less phaco energy than standard longitudinal ultrasound, effective for cataracts of all densities. It reduces turbulence, decreases ultrasound time, increases efficiency and offers a thermo protective benefit. Oscillation of the tip provides a greater travel distance at the tip than it does with a straight shaft. The side-to-side movement of torsional phaco shears the lens material and provides decreased repulsion, while improving thermal safety, compared to traditional ultrasound.The surgical benefits of decreased repulsion are increased followability, reduced potential for turbulence, lower parameters, and increased cutting efficiency.Traditional ultrasound causes repulsion through its jackhammer effect, he noted. As with the Kelman tip, the side-to-side movements of this new tip deliver increased cutting efficiency by emulsifying lens material with both directions of movement. Standard phaco only breaks down the lens in one direction.The longitudinal back-and-forth movements are therefore only effective in one direction, while generating thermal energy in both directions, with less efficacy. Because there is no forward motion of the bevelled tip, there is less chattering, as you find with traditional straight-tipped phaco. Dr Oshers tip was released in April at the ASCRS meeting.There are a number of surgeons in the US who already prefer to use this tip, he noted. Interestingly, a Japanese colleague,Takayuki Akahoshi, MD, designed a tip with the same characteristics at about the same time as Dr Osher, unbeknownst to him, suggesting the need for a comfortable alternative to the Kelman tip for surgeons wishing to experience the advantages of torsional ultrasound. The combination of new technologies offers the phaco surgeon a safe and reliable method of performing cataract surgery through an unenlarged 2.2mm incision through which a full-size, single-piece IOL can be safely implanted, he reported. Dr Osher was hopeful that for 70 per cent of the worlds surgeons, who would like to use torsional ultrasound, this would allow them to continue using their same technique and enjoy the benefits of this new technology.
[email protected]
EuroTimes,Vol 13, Issue 5, May 2008 Not for reprinting
Courtesy of Robert Osher MD

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Cataract Update

EuroTimes,Vol 13, Issue 5, May 2008 Not for reprinting

Courtesy of Robert Osher MD

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