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Alcon innovations
Alcon innovations
Alcon innovations
Alcon innovations
Alcon innovations
Alcon innovations
Alcon innovations
Alcon innovations
Alcon innovations
Alcon innovations
Alcon innovations
Alcon innovations
Alcon innovations
Alcon innovations
Alcon innovations
Alcon innovations
Alcon innovations
Alcon innovations
Alcon innovations
Alcon innovations
Alcon innovations
Alcon innovations
Alcon innovations
Alcon innovations
Alcon innovations
Alcon innovations
Alcon innovations
Alcon innovations
Alcon innovations
Alcon innovations
Alcon innovations
Alcon innovations
Alcon innovations
Alcon innovations
Alcon innovations
Alcon innovations
Alcon innovations
Alcon innovations
Alcon innovations
Alcon innovations
Alcon innovations
Alcon innovations
Alcon innovations
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Alcon innovations

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Perfect Vision's Dr Con Moshegov presentation on: Alcon innovations

Perfect Vision's Dr Con Moshegov presentation on: Alcon innovations

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  • 10a
  • 8b
  • Thank you for the introduction. Well it is certainly my pleasure to be here today and to share with you what I believe is important for the beginning phaco surgeon to know.
  • 10a
  • 13a
  • Thank you for the introduction. Well it is certainly my pleasure to be here today and to share with you what I believe is important for the beginning phaco surgeon to know.
  • Thank you for the introduction. Well it is certainly my pleasure to be here today and to share with you what I believe is important for the beginning phaco surgeon to know.
  • Occlusion recovery is quicker with Intrepid FMS further reducing surge amplitude post occlusion break.
  • Occlusion break surge area is much less with Intrepid FMS over existing FMS. Surge area at 400 mmHg is less than half of surge area with existing FMS.
  • 10a
  • Transcript

    • 1. Infiniti and OZil™ Torsional Technology Evolution to the Present Con N. Moshegov FRANZCO FRACS Sydney
    • 2. Alcon Legacy
    • 3. Alcon Infiniti
    • 4. Fluid Management System
      • Maximising AC maintenance and holdability of the Infiniti
      • FMS has two major components
    • 5. 1. Dual Sensing Technology Irrigation pressure sensor Vacuum pressure sensor
      • Improved anterior chamber stability
        • Excellent holding ability
    • 6. 2. Rigid Fluid Paths
    • 7. Mechanism of Occlusion Break Unobstructed flow Full occlusion Occlusion break
    • 8. AquaLase TM Technology
      • Fluid pulses propelled in front of tip to delaminate
      • tissue
      • 4 microlitres
      • ~60º C
      • Up to 50 pps
      • No mechanical touching of tissue as in phaco
      • No mechanical motion of the tip as in phaco
    • 9. AquaLase TM : indications
      • Perfect for clear lens extraction
      • Extremely good for soft cataracts:
        • cortical
        • posterior subcapsular
        • posterior polar
        • nuclear sclerotic up to 2+ (0 to 4+)
      • But: not good for harder nuclei
      • Different instruments and techniques for various nuclei
    • 10. Even with Traditional Phaco Settings
      • Depending on density of cataracts the following are modified for each situation:
      • Power
      • Vacuum
      • Aspiration flow rate
      • Pulse and burst settings
      • Bottle height
    • 11. Traditional Phaco Settings
      • The parameters are also modified depending on technique:
        • Divide and conquer
        • Pre chop
        • Stop and chop
        • Chop
      • Some surgeons use different settings depending on whether they’re up to 1 st , 2 nd or 4 th quadrant
    • 12. OZil™
    • 13. Torsional Phacoemulsification
      • Exclusive energy modality on the
      • INFINITI™ Vision System
    • 14. OZil
      • For me:
      • One set of parameters for all densities of cataracts
      • Like an automatic gear box after driving a manual
    • 15. Sculpt Screen – Torsional Only
        • 100% amplitude linear for most densities
    • 16.  
    • 17. Quadrant Removal Screen: very dense nuclei
        • 10 % ultrasound power and 100% amplitude for dense lenses
          • Probably only an occasional situation
          • Fixed ratio of 20 ms ultrasound then 80 ms torsional
      to 10% to 100%
    • 18. Torsional Ultrasound
      • Shearing effect
      • More efficient than the jackhammer effect
      • No repulsion since the tip is not moving toward the lens
    • 19. Straight Kelman Useful only with Kelman (bent) tips
    • 20. Kelman bent tip
      • Cutting movement at the tip is a side to side action
      • Small rotational displacement at wound but bigger rotational displacement at tip
      • Amplifies the distal tip movement
      Incision
    • 21. Handpieces NeoSoniX™ LEGACY® 375/40 OZil™ Torsional INFINITI™ U/S
    • 22. Torsional Phacoemulsification
      • Oscillatory motion works at a frequency less
      • than traditional ultrasound.
        • Longitudinal phaco 40,000Hz
        • Torsional phaco 32,000Hz
        • NeoSoniX 100 Hz
    • 23. Longitudinal Slow Motion
    • 24. Torsional Slow Motion
    • 25. 100% Torsional amplitude vs. 100% ultrasound power 7.5 seconds with sealed incision and no irrigation or aspiration flow
    • 26. OZil Studies
      • 20% Less irrigation solution used
        • Less turbulence -> Less egress of OVD?
    • 27. OZil Personal Observations
      • Transition to Kelman bent tip not as difficult as one would imagine
      • Actually easier to operate on deep set eyes with it
      • Mechanical advantage in cracking (rotation of fingers)
      • Facilitates posterior extension of groove
      • Can angle shaft up a little if concerned (ie hold handpiece more parallel to ground)
      • Can have bevel pointing to the side (laterally and medially)
    • 28. OZil Personal Observations
      • The feel of an OZil handpiece is no different to present Infiniti handpiece
      • OZil is actually very quiet compared to US
      • No problem if soft (or even clear) lens
      • No effort involved in transition to torsional
      • Ask your rep to substitute an OZil handpiece for your existing one, set machine to 100% continuous torsional and just proceed as normal
    • 29. Taking OZil a step further: Microincisional Phaco
      • Small incision clear corneal surgery is desirable because:
      • Causes less induced astigmatism
      • Possibly reduces risk of endophthalmitis
      • Quicker stabilisation of final refraction
      • Potentially better AC maintenance
      • Prospective evaluation of early visual and refractive effects with small clear corneal incision for cataract surgery.
      • Lyle WA, Jin GJC.
      • J Cataract Refract Surg 1996; 22: 1456-60
    • 30. Surgically induced astigmatism
    • 31. Microincisional Phaco
      • Two methods of microincision cataract surgery available:
      • Bimanual
      • Coaxial
    • 32. Co-axial Microincisional Phaco
      • OZil™ Torsional Technology is possible through a 2.2mm incision using ‘Ultra Sleeve’
      • Any single piece AcrySof IOL can now be implanted through an unenlarged 2.2mm incision
      • Minor alterations to usual technique required
        • CCC
        • IOL implantation
    • 33. Intrepid FMS
      • Includes New Products designed specifically for the micro-coaxial procedure
      • Less compliant narrow wall aspiration tubing
      • Available in Q1 2008
    • 34. Occlusion Recovery Comparison Recovery Time mmHg
    • 35. Occlusion Break Surge
    • 36. MONARCH ® D Cartridge 30% smaller nozzle size than Monarch ® C cartridge Lockout Feature D C
    • 37. ~ 33% reduction vs. ‘C’ nozzle tip B A D C Monarch III ‘D’ Cartridge & H4 (blue) Injector Monarch II ‘C’ Cartridge & H3 (green) Injector
    • 38. MONARCH ® III Injector
      • Very similar to the Monarch ® II (Green) Injector
          • Blue color for ease of identification
          • Same ergonomic feel
          • Same threads and lens advance rate
          • Smaller plunger tip to accommodate the smaller Monarch ® D cartridge
    • 39. I’ll bet…
      • OZil™ Torsional Technology will prove to be a most popular method of phacoemulsification
          • Better efficiency and improved followability
          • Safer thermal profile
          • Utilized across all lens densities
          • Requires no change in technique
          • Goes well with microincisional surgery
      • Bimanual MICS will fall in popularity
    • 40.
      • So where does this leave AquaLase?
    • 41. AquaLase – Future Developments
      • Can’t compete with Ozil incision widths but…
        • Micro Incision Tip coming: compatible with 2.2 mm incisions
      • May have specific applications
        • for cortex and LEC removal
    • 42. Looking Forward 4+ 3+ 2+ 1+ Cortex Capsule cleaning LEC Removal OZil MicroCoaxial AquaLase MicroCoaxial
    • 43.
      • No financial interest in any of the products mentioned

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