Every surgeon strives to maximize cutting efficiency during a cataract removal procedure. They are confident in the belief that less time in the eye can mean fewer complications and lower risk. So, the question becomes one of how to maximize efficiency rather than why.
Timothy Page, MD, is a nationally recognized ophthalmologist specializing in complex and refractive cataract surgery who is in private practice with Michigan-based Oakland Ophthalmic Surgery, P.C. He explained what most surgeons strive for regarding cutting efficiency. “We certainly want to minimize the amount of phaco energy we’re putting into the eye—because the less energy used, the less likely you are to have swelling in the cornea. And we also want to avoid breaking the zonules. In complex cases where those zonules are weak or broken, you want to be able to cut through that dense cataract like a hot knife through butter to minimize the stress on the zonules.”
To maximize his own cutting efficiency, Dr. Page uses Bausch + Lomb’s Stellaris Elite®, which is a vacuum-based system. “I was trained on a flow-based system— as were most of my peers,” he said. “But, about 10 years into my practice, I tried the Stellaris Elite®. From the very first case, I loved it.” He described the Stellaris Elite® as being smoother than what he had experienced with flow-based systems and he appreciates how it allows him to increase his cutting efficiency during both routine and complex surgeries.
In a study comparing the tissue removal efficiency of vacuum-based pump systems with flow-based pump systems, vacuum-based systems demonstrated significant improvement in efficiency at moderate levels of vacuum compared with a peristaltic pump. Additionally, there was significantly less chatter occurrences at moderate levels of vacuum.1
The Stellaris Elite provides surgeons an advantage in key areas regarding cutting efficiency. Data demonstrate that there’s a strong correlation between four factors and efficient tissue removal. These factors are stroke length, suction (vacuum), acceleration of the tip, and the opening area. Of those four factors of tissue fragmentation, the Stellaris Elite® demonstrates a strong advantage in stroke length and opening area.2
“Everyone knows that a longer stroke is more efficient,” said Dr. Page. “With the Stellaris Elite®, we can set the needle—which oscillates at the low speed of 28.5 kHz—at the longest stroke length of any other technology available.” The stroke length and longitudinal cutting action of the Stellaris Elite® result in highly effective emulsification.4 With its Attune® Energy capabilities, the Stellaris Elite® delivers exceptional cutting rates even at low power settings. This translates to highly efficient cutting using only the energy required for a specific case.3
Another reason Dr. Page cites the Stellaris Elite® as playing a critical role in improving cutting efficiency is the system’s responsiveness. “When you put your foot on the vacuum pedal to evacuate material, the vacuum is there immediately, on demand, no occlusion needed,” he explained. “With a peristaltic system, you’re required to get some occlusion before the vacuum kicks in. You have to put the needle on the cataract, push on the pedal, and then a small amount of fluid has to go through the system in order to build up vacuum. You get there—but the vacuum-based system gets there faster.”
Another efficiency-saving feature of the Stellaris Elite® is the Micro Incision Cataract Surgery (MICS) needle tip. With a narrower inner shaft than the balanced tip of the Centurion system’s needle , post occlusion surge is minimized. “Post-oc- clusion surge occurs when a piece of cataract gets stuck at the end of the needle,” explained Dr. Page. “This is a problem for surgeons because as soon as that clears, there’s a sudden surge of fluid and material that rushes up to the needle and then you can break the posterior capsule. This is one of the most feared complications during cataract surgery. But, because the Stellaris Elite® needle tapers down to 500 microns, it acts as a flow restrictor. This helps reduce that surge of flow and helps maintain a great chamber stability.”
The Stellaris Elite® also provides surgeons the ability to manage both vacuum and phaco energy independently. “With the dual linear foot pedal of the Stellaris Elite®, you have pitch and yaw linear functions,” explained Dr. Page. “So, for instance, when I’m engaging a piece of nucleus and I need to bring it out, I can use the yaw linear function to add an additional 100 mm Hg of vacuum. Now, I have this super holding power that allows me to just go in and pick up the piece and then I can drop back into pitch to use low vacuum and prevent surge.” The integrated movements of the pedal allow a surgeon to simultaneously control irrigation, ultrasound and aspiration, while also customizing their vacuum response.
From its longer stroke length, to its needle design, to the direct control of phaco and vacuum energy, the Stellaris Elite® is designed to improve surgeons’ cutting efficiency—as well as their confidence. “As a surgeon, confidence is everything,” said Dr. Page. “I have supreme confidence when I use the Stellaris Elite.”
To learn more about the Stellaris Elite System, please go to www.bauschsurgical.com. Connect with a representative today, if you would like to hear more about how to demo the system in your OR.
Dr. Timothy P. Page is a board certified ophthalmologist in Birmingham, Michigan. He received his medical degree from Wayne State University School of Medicine and has been in practice for more than 20 years.