The document discusses advancements in phacoemulsification techniques, presented by Dr. Paresh Nichlani and moderated by Prof. K.N. Jha, aimed at improving cataract surgery outcomes. Key highlights include innovations in ultrasound energy delivery, fluidics management, and new technologies such as the Aqualase device and femtosecond laser-assisted surgery. The focus is on minimizing complications, enhancing visual acuity, and improving efficiency through better power modulation and foot pedal systems.

1. NEWER
PHACOEMULSIFICATION
TECHNIQUES
 Presenter – Dr. Paresh Nichlani
 Moderator – Prof. K N Jha
 Dr. A R Rajalakshmi

2. Evolution

3. Aims of good phaco surgery
 Low endothelial damage
 Emulsification of nucleus in less time and
using minimal power.
 No complications.
 Maintain the anterior chamber – Less
fluctuation.
 Great post operative visual acuity- Less
astigmatism.

4. Components of Phaco
 Ultrasound energy – Phaco power
 Fluidics-:
 Irrigation
 Aspiration

5. Terminologies
 Phaco Power
 Vacuum is the suction force applied
 Flow Rate is the rate of fluid flowing out of
the eye
 Rise Time is the time taken for the vacuum
to rise to the preset maximum
 Pump speed is the speed of the rotation of
the peristaltic pump.

6.  Venting means breaking of vacuum
 Compliance-Is inversely related to the
outflow resistance
 Followability means the ability of the phaco
tip to attract nuclear pieces.
 Holding ability is the ability of the tip to hold
the nuclear piece
 Surge – Sudden swallowing of AC
 Chatter - tendency of the vibrating phaco
tip to push away material.
 Duty cycle –Phaco power used per min

7. Ultrasound energy
 Power - generated by the vibrating
piezo-electric crystals
 Back and forth motion to the phaco tip
 Frequency of vibration is a fixed entity,
while the stroke length is variable.
 Absolute phaco time

8. Fluidics
 Inflow and outflow of fluid
 Inflow depends upon -:
 Bottle height
 Tubing size
 Sleeves
 Outflow depends upon -:
 Pump system
 Size of probe/tubing system
 Leaking wound

9. Peristaltic Pump – Pinch valve
system

10. Venturi Pump

11. Membrane or Diaphragmatic
Pump

12. Centrifugal Pump-
Concentric

13. Surge Protection
 Increase bottle height
 Increase lumen of irrigating tube – TUR
set
 Reducing lumen of aspiration probe
and/or tubing system.
 Material of aspiration tube system
 Venting system

14.  Cruise control – disposable flow
restrictor placed between the phaco
hand piece and the aspiration tubing. It
is having an internal diameter of 0.3mm
 ABS tips – alternate bypass system
 Vacuum Surge Suppressor
 Microprocessor

15. Foot Pedal

16.  Dual linear foot
pedals allow side
ways movement at
any stage of position
2 to allow phaco
power to start before
reaching the
maximum aspiration.

17. Phaco power modulation
 Panel mode – All or none
 Continuous mode
 Burst Mode
 Pulse mode
 Hyper pulse mode – Cold phaco

19.  Energy is delivered in extremely brief, microsecond
pulses, interrupted by rest periods

20. Phaco tip

21. Advancement in Phaco
 Pure tortional ultrasound
 Ellips ultrasound - which blends
longitudinal ultrasound with transversal
ultrasound.

22.  OZil Intelligent Phaco

23.  NeoSoniX
 Uses both ultrasound and mechanical oscillation
 Control both the amplitude of the oscillation and
the threshold of ultrasound power independently
 Minimizes risk of thermal burns
 Oscillation automatically breaks occlusion and
reposition for more efficient lens removal

25.  AquaLase Liquefaction Device
 Uses pulsed surgical solution to safely break up
and remove the natural lens material.
 generates 4-microliter pulses of surgical solution
 Pulses are warmed at 55 degrees and
propelled by a smooth, rounded-bevel
polymer reflective tip that disperses fluid for
enhanced safety and "tissue specificity.“
 Minimizes risk of thermal incision burns almost
completely.

27.  Active fluidics

28. Foot pedal
 Non-zero start
 When you push down on the foot pedal in
foot-position three, the machine can start
at whatever power you want
 Less time spent getting to the power you
want and this makes the system more
efficient
 Wireless foot pedal

29. Bimanual phaco
 PhakoNIT – Dr. Amar agarwal in 1998
 Phaco done with a needle opening via an
incision and with phaco tip
 Cold BSS 4º
 Microflow needle

30. Hand piece
 Weight – reduced from 97 grams to 46
grams
 size of phaco tip – 21g with outer
diameter of 0.8mm and inner 0.6mm

31. Femtosecond laser assisted
 Photodisruption –
 Femtosecond laser energy is
absorbed by the tissue
 Plasma of ionized molecules
rapidly expands, creating
cavitation bubbles.

32. Zepto Precision Pulse
Capsulotomy
 Device uses a gentle suction to create a
uniform capsular contact.
 Electrical nanopulses are delivered to a
nitinol ring to create the capsulotomy
with no cautery or burning of tissue.

33. To Summarise
 Cataract in today’s time is considered a refractive
surgery.
 Phaco probe -:
 Combination of longitudinal and transverse motion.
 Mechanical rotatory motion.
 AquaLase – Use of no ultrasound energy.
 Bimanual phaco
 Different phaco energy delivery modes
 Phaco tip
 Angulation
 ABS
 Size of tip
 Microflow tip

34.  Surge protection
 TUR set – tuning system
 Venting system
 ABS
 Microprocessor
 Active fluidics
 Pump System
 Concentric pump system
 Foot pedal
 Dual linear system
 Wireless foot pedal
 Femtosecond laser
 Zepto pulse capsulotomy