When ‘Up Time’ has elapsed, Signature proactively steps down vacuum before the occlusion breaks

Time

Fig. 5.32 Proactive vacuum adjustment using CASE

5.3.2.8 Applying Signature Technology to CMICS and BMICS

A standard 30° 20 gauge Kelman style needle supplied by AMO was used initially for both C and BMICS. Latterly the 700μm needle mentioned above has been tried, which works very well. The settings for both C and BMICS are the same but again are tip specific (Table 5.5).

As can be seen from the table, the settings available are varied and many. This table sets out only the basics for each type of ultrasound delivery Standard longitudinal and Ellips transversal. To set up the machine for these settings is relatively straight forward but initially may require some help from a company representative. These settings will work well for all grades of cataract with one exception. For soft/medium nuclei the sculpting setting is used to chop, as this is sufficient vacuum to hold the nucleus without pulling it through the phaco needle. Once the nucleus is chopped, the higher settings are used to remove the nucleus. The author calls this the “soft chop” technique. Both Standard and Ellips ultrasound will work well to get the desired occlusion in this way.

Both the Infiniti and the Signature work well for CMICS and BMICS (Figs. 5.33 and 5.34). This author is currently implanting the Acrysof IQ as his lens of choice for these small incisions using the D cartridge and the Duckworth and Kent single handed injector through a 1.8 mm incision with the Infiniti for B and CMICS, and the Signature for BMICS. CMICS with the Signature is done currently through 2.2 mm incisions due to lack of a suitable sleeve for anything smaller.

Table 5.5 Settings for the Signature for 20 gauge and 700μm tips using Standard ultrasound and Ellips for both sculpting and segment removal

Fig. 5.33 CMICS using 700μm tip and Signature

Fig. 5.34 BMICS with Signature

Take Home Pearls

ßAppropriate choice of incision size, tip size, ultrasound and fluidics settings is essential for

successful MICS with either the Infiniti or Signature phaco machines.

ßWound-assisted lens insertion with minimal enlargement with BMICS and none with

CMICS completes the procedure with both these machines.

5.3.3MICS with Different Platforms: Stellaris Vision Enhancement System

Mark Packer, I. Howard Fine,

and Richard S. Hoffman

Core Messages

ßInnovative design concepts incorporated into the Stellaris Vision Enhancement System make

it a superlative choice for MICS. These concepts include monitoring and maintenance of fluidic parameters, millisecond level surgeon control of ultrasound power and ergonomic comfort and adaptability for any surgical technique.

ßThe Stellaris Vision Enhancement System is safe and effective for BMICS and CMICS.

ßThe advantages of BMICS include enhanced surgical flexibility and control made possible

by separation of inflow and outflow.

ßThe CMICS solution enables the incision to be decreased to 1.8 mm without any change in the

current coaxial phaco technique.

5.3.3.1 Innovations in Phacoemulsification

The Stellaris Vision Enhancement System (Bausch & Lomb, San Dimas, CA) represents revolutionary progress in phacoemulsification technology (Fig. 5.36). Building on the success of the Millennium, which has offered both Venturi and peristaltic pumps with dual linear foot pedal control, the Stellaris incorporates multiple advances in design. Innovative Stellaris System technology includes the Advanced Flow Module that allows intraoperative toggling between flow and vacuum modes, and also accurately monitors and maintains targeted vacuum levels and intraoperative aspiration rate; the StableChamber Pack, containing small diameter

M. Packer ( )

Oregon Health & Science University, Drs. Fine, Hoffman and Packer, 1550 Oak Street, Eugene, OR 97401, USA

e-mail: mpacker@finemd.com