Seven patients were lost in follow up and another six excluded due to either followup less than six months n1 or inability implant an intraocular lens iol because of insufficient capsular support following posterior capsule rupture n5. The infusion fluid flows between the tip and the sleeve cooling the former. May 18, 2014 maximum phaco power maximum obtainable ultrasonic energy when foot pedal control is fully depressed actual phaco power power actually delivered at a given time proportional to foot pedal position. A surgeon might use phaco 1 for sculpting, phaco 2 for cracking and phaco 3 for quadrant removal, mr. This study intended to use cde as an objective guide to evaluate the efficiency of phacoemulsification. Mar 21, 2011 a surgeon might use phaco 1 for sculpting, phaco 2 for cracking and phaco 3 for quadrant removal, mr. On further depressing the foot pedal, aspiration is initiated and vacuum is transmitted to the phaco tip. Additionally, phaco time can be reduced by delivering shorter pulses or bursts of phaco power instead of continuous ultrasound power or by decreasing the duty cycle the ratio of. Phacoemulsification versus small incision cataract surgery in. Comparison of cde data in phacoemulsification between an. Common terminology fluidics is a science or technology dealing with a control of a flow of fluid or air through a system. The venturi pump allows me to keep my phaco needle near the center of the eye and use the fluidics to draw the fragments to the tip without having to fish for fragments.
Basic concept techniques of phaco prechop asico llc. Approaching 4 million surgeries a year, cataract surgery is the most common operation performed in the united states. The system also allows 24 different users to save their mode settings. This product must be cleaned and sterilized prior to each use. As the us time is very short, the incision can be selfsealed quite. Pass clamped line off to nonsterile assistant or method 2. Chang, md to maximize the benefits from the latest in phacoemulsification technology, it is important to understand how to adjust and customize phaco parameters.
Understanding the phaco machine is vital to a successful surgery. Phaco turns 50 t he heart and soul of ophthalmology is cataract surgery. The phaco machine will automatically calculate the apt by multiplying the us ave by the ept, so that the surgeon can compare the total ultrasonic energy delivered in different cases. Optimizing machine settings for routine, complex, and. Stroke length is the forward and backward movement of the needle along the longitudinal axis. Multifocal iol have special near, intermediate and long vision apodized surface to focus near, intermediate and distance visual.
Phacoemulsification with intraocular lens iol implantation. This technique was called bimanual microincision phacoemulsi. There was little difference in uncorrected visual acuity at six weeks. Tips with 60, 45, 30, 15 and 0 angulation are available. Aspirated fluids are replaced with irrigation of balanced salt solution to maintain the anterior chamber. Get manual of phaco technique text atlas pdf file for free from our online library. Narayana health city campus bommasandra, hosur road. When compared between microcoaxial and bimanual phaco groups, ultrasound time 57 24 second versus 85 40 second, p files. Despite some limitations in the free edition of this app, including a maximum file size of 2. I have experimented with thick, thin, square, singlebeveled, doublebeveled, and flared ones and even some that looked like a chisel. Some grooves are centered and deep enough and some go into epinucleus, displaces nucleus in most grooves, attempts to split nucleus with instruments too shallow in groove, able to crack portion of nucleus, eye often moving. In order for a phaco stroke to cut through the nucleus, the lens must be immobilized. Like a vise holding a piece of wood, it is the zonules and capsule that grip and fixate the nucleus as the groove is cut by the phaco tip.
Manual small incision cataract surgery sics has emerged as an alternative to phacoemulsification in settings with high surgical volume or regions with limited access, over the last decade. Fiftysix patients of immature senile cataract with hard nucleus grade 3. Using intelligent phaco for controlled energy delivery s ince the advent of ozil torsional phacoemulsification on the infiniti vision system alcon laboratories, inc. Surgeons often question what phaco settings to use when making the transition from cracking to chopping. Phacoemulsification typically begins by inserting the phaco tip into the main wound under irrigation foot position 1. The pea is an extremely complex piece of equipment, yet its operation is relatively simple. Phacoemulsification versus small incision cataract surgery. Bimanual microincisional cataract surgery technique and. However, safety and efficacy of sics in uveitis has not. Consult en554 or aami st461993 standards for routine control of sterilization by moist heat. Phacoemulsification phacoemulsification was invented and developed by dr. Basic functionality is available without a fee, while an adfree experience can be had with inapp purchases.
Storz phaco manual on pdf database products for storzbausch lomb phaco systems. The acoustic energy produced along the ultrasonic handpiece is then transmitted onto the phaco tip. Phacoemulsification is a modern cataract surgery in which the eye s internal lens is emulsified with an ultrasonic handpiece and aspirated from the eye. I prefer largebore phaco needles for dense cataracts, because they allow for more efficient phaco aspiration of the nuclear material. During surgery, phaco time, phaco power, irrigation volume, and grade of nuclear firmness were recorded. Nov 28, 2014 phaco tip the phaco tip is made of titanium and is hollow with the distal opening functioning as the aspiration port. Its balanced energy technology enhances phaco efficiency through the ozil key features include a bluetooth footpedal, 18inch user interface, and video inlay pulsed, or highpulsed phaco, bimanual or coaxial phaco, burst mode. The following information is based upon the phaco emulsifier aspirator pea by alcon laboratories. Phaco machines have an internal reference point that assumes the location of the patients eye. Within this book the determinants of phacoemulsification machine fluidics are examined and analysed. Read online now manual of phaco technique text atlas ebook pdf at our library.
It is also one of the most effective, safe, and lifechanging procedures in all of medicine. The phaco time can be decreased by applying the ultrasonic power only when cataract pieces are at the phaco tip and vacuum alone is insufficient to aspirate the piece. Symmetric bimanual phacofragmentation is a new preslice technique in which the nucleus. Note that the sleeve can be easily cut by the phaco tip, so always inspect the sleeve for defects prior to entering the eye. When the incision size is reduced, the sleeve of the phaco tip must be removed.
The following information is based upon the phacoemulsifier aspirator pea by alcon laboratories. Occurs, though rarely, during phacoemulsification surgery. Experience the power and grace of the whitestar signaturetm. Normal frequency of various phaco machines ranges from 20,000 to 80,000 2080 khz hertz. Phacoemulsification fluidics and phacodynamics this lecture was presented by dr. Optimizing machine settings is an important factor in successful cataract surgery, but it is often overlooked or underemphasized in phaco education, dr. Raheja says the signature system senses that an occlusion at the tip has occurred and automatically implements changes. Make a complete occlusion of the phaco tip to the nucleus so that all the us energy can be used effectively to emulsify the nucleus phaco of prechopped nucleus. Basic principles of phacoemulsification and fluid dynamics. This oftenupdated app combines a large number of pdf files from your android device, as well as many other useful features. To help avoid surge, the system uses an antisurge system built into the software that controls the ramp up and ramp down of the peristaltic pump. Phaco prechop takayuki akahoshi, md principle and history of prechop phaco prechop is a technique of mechanical nucleofracture performed under viscoelastic material prior to phacoemulsification. Phaco 1223 1221 1114 1252 0299 0525 6 3 0451 0450 9 14 19 0530 capsulorhexis roundcurvedsharp phaco choppermushroom manipulator fine notched forceps, short hoskins kratzbarraquer speculum iris scissors, straight, rounded halfbody incise drape universal eye shield cellulose eye spear phaco slit knife, 2.
Other exclusion criteria were intraoperative events like manual. With phaco chop, however, it is the phaco tip that braces the nucleus against the force of the chopper. Phaco procedures are catching up to manual cataract procedures in india, as seen in surgical centers such as the aravind eye hospitals, which have 50 phaco machines, including four cuttingedge. Less energy delivered to the eye thus reducing side effects 38. Turn off irrigation and close red clamp on handpiece suction line. International council of ophthalmologys ophthalmology. Reduces phaco time and increases efficiency during surgery references 1. If a patients best corrected visual acuity does not meet government agencies and industries minimum standards of visual function for tasks for driving, flying, or operating complex equipment. Further depression of the foot pedal activates the ultrasound oscillation of the phaco tip, generating the force required to emulsify the nucleus. Meanwhile, the visual results obtained in both surgeries were similar. There are two openings on the sleeve for the exit of this fluid, which should be kept perpendicular to the tip bevel. If you are using a machine that is a few years old, you owe it to yourself to test drive the newer models. Phaco procedures are catching up to manual cataract procedures in india, as seen in surgical centers such as the aravind eye hospitals, which have 50.
Fishkind, md, facs phaco tips, we are always looking for a better one. Prime handpiece suction line with bss from phaco irrigation line until no air remains in suction line. His objective was to perform the ecce through a small incision. Selection of appropriate phaco settings imperative for success.
The 20 ascrs clinical survey confirmed strong educational interest in this topic for a majority of cataract surgeons, regardless of their experience. Rearrange individual pages or entire files in the desired order. Thanks charlie, for phacoemulsification and so much more. Phaco handpiece the phaco handpiece contains the piezoelectric crystal, which is in contact with the tip. Maximum phaco power maximum obtainable ultrasonic energy when foot pedal control is fully depressed actual phaco power power actually delivered at a given time proportional to foot pedal position.
Using intelligent phaco for controlled energy delivery. At that time, bimanual microincision cataract surgery did not gain surgeons interest since there was no available foldable intraocular lenses to be implanted through less than 2. Aug 17, 2018 the most common indication for cataract surgery via phacoemulsification with intraocular lens implantation is the patients desire to improve vision. Nucleofracture manual prior to phacoemulsification. Phacoemulsification department of ophthalmology academic. Effective phaco time total phaco time at 100% phaco power. In a bimanual procedure, the instruments can easily be switched, making access to all parts of the anterior chamber more reachable. No glasses after cateract surgery at our clinic we implant multifocal iol during cataract surgery to make you free of glasses. Click add files and select the files you want to include in your pdf.
Click, drag, and drop to reorder files or press delete to remove any content you dont want. You can merge pdfs or a mix of pdf documents and other files. Modern extracapsular cataract extraction surgery involves removal of the lens fibers, which form the nucleus and cortex of the cataract, leaving the posterior epithelial capsule to hold the new artificial intraocular lens iol and keep the vitreous humor away from the anterior chamber. Phaco fellowship narayana nethralaya chairman and md. Extracapsular techniques of cataract extraction surgery. Itvides capabilities for phacoemulsification, irrigationaspiration, bipolar coagulation, and vitrectomy pro operations. Without using any ultrasound or femtosecond laser energy, the nucleus is manually divided into fragments. Phacoemulsification is a technique which employs the ultrasound energy and fluid dynamics to facilitate the removal of nucleus and cortex of the lens in the cataract surgery. How to combine pdf files into one document lifewire. The open hospitalbased ambulatory surgical center has more surgeons individual private practice on staff, and each surgeon has a different volume of cataract surgeries.
Phaco tips phaco tips you can use the following products with the whitestar signature system, the sovereign and the sovereign compact system. Modern phaco technolosmallincision bimanual phaco chop specialized instruments help to perform the chopping. Within this book the determinants of phaco emulsification machine fluidics are examined and analysed. Comparison of cde data in phacoemulsification between an open. Like the simplicity of a pointandshoot camera, using the same phaco machine settings throughout every case might at first seem appealing. The movement of the foot pedal is of paramount importance and you should practice the positions of the foot pedal i. Aptabsolute phaco time total amount of phaco energy used apt ept x avg eptelapsed phaco time avgavarage phaco power it makes sense that if you deliver 15 seconds of energy at 100% power, it is about the same as 30 seconds at 50% power, or 60 seconds at 25% power. This analysis is based on basic mathematical and physical science and is also supported by experimental investigations to verify that the physical models are accurate. Delivering 15 seconds of 100% power is the same energy as delivering 30 seconds of 50% power, or 60 seconds of 25% power. The primary difference between the two technologies is that.
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