Dr. I. Paul Singh is a private-practice ophthalmologist in Wisconsin with a passion for new technology. When he moved into private practice, one of the centers in which he operated purchased a Stellaris Elite®. He recalls that “Not just me, but other surgeons as well felt that the Stellaris Elite® combined both exceptional chamber stability and cutting efficiency like we had never experienced before. That became our preferred machine.”
The preference for Stellaris Elite® is based on a multitude of factors. First, with a vacuum-based system, occlusion is not needed to build vacuum during cataract surgery. When the pedal is depressed, the amount of vacuum increases linearly, and the pieces of cataract move to the needle tip. The surgeon does not need to chase pieces of the nucleus. Followability allows the surgeon to keep the needle in the middle, staying away from the capsular bag, thus reducing the risk of inadvertent iris touch and posterior capsule rupture, and maintaining exceptional chamber stability.
Another benefit of Stellaris Elite® is the Adaptive Fluidics™ System whereby the infusion adapts to the vacuum command.2,3 The machine proactively increases the amount of fluid infusion as vacuum needs increase, to keep the chamber stable, instead of being reactionary.2 By prophylactically keeping the infusion pressure above a certain desired level, the chamber is protected from a post-oclusion surge.2
Stellaris Elite® offers some unique mechanical elements that contribute to cutting efficiency. Data has shown that there is a strong correlation between four specific factors and efficient tissue removal.4 These factors are stroke length, vacuum (suction), tip acceleration, and opening area. Stellaris Elite® incorporates a 28.5 kHz cutting oscillation and a 142-micron stroke length with longitudinal cutting action for highly efficient cataract emulsification.
This unique design balances mechanical cutting with acoustic cavitation to focus energy at the needle tip. “The oscillation and stroke length are important as it creates mechanical disruption and cavitation. The balance of stroke length and speed allows optimized cutting,” according to Dr. Singh. Additionally, the machine balances energy with efficiency; the cutting efficiency reduces the amount of energy needed thus minimizing heat and minimizing postop corneal edema. The reduction in postoperative corneal edema is in part due to a reduction in the amount of fluid put into the eye during a cataract removal surgery.5 All of these factors allow him to get through extremely dense cataracts, in a controlled fashion and without the lens moving within the eye. Stellaris Elite® is also effective in softer, less complex cataracts.
There are several other features of Stellaris Elite® that Dr. Singh enjoys. One is the wireless, dual linear foot pedal. This allows him to control the position and move up or down and yaw laterally using the foot pedal. The dual linear foot pedal also allows for independent control of irrigation, vacuum, and ultrasound power (phaco energy) based upon the motion of the pedal. Depending on the technique and stage of surgery, the foot pedal can be customized for the surgeon’s preferences. Another feature Dr. Singh appreciates is the multiburst mode setting, which allows him to increase the phaco “on time” as he depresses the foot pedal, but not increasing the amount of phaco energy. This allows him to use phaco energy only “when he needs it.” Attune® energy technology, with a built in 6-crystal hand piece, truncates the energy wave forms so that only the necessary energy is utilized, thus increasing efficiency by allowing exceptional cutting rates at low power settings.
The microincisional cutting needle (MICS) that can be used with Stellaris Elite® allows for efficient cutting and can be inserted through an incision of less than 2 mm. The small incision is another element that helps to maintain chamber stability and can be a benefit in cases with a risk of chamber collapse, narrow angle eyes, short eyes, and floppy iris syndrome. Of note, the MICS needle and Stellaris Elite® are appropriate for all cataract surgeries, not just in specific scenarios.
Stellaris Elite® allows Dr. Singh to “create the most optimized, consistent, and predictable operating environment.” This reduces his stress during procedures.
“Stellaris Elite delivers cutting efficiency and a controlled environment based on Adaptive FluidicsTM and thus stabilizes the chamber. The vacuum nature allows pieces to come to the tip and stay there, while maintaining a stable chamber.” – Dr. I. Paul Singh
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. I. Paul Singh, a Wisconsin native, is in private practice and the President of The Eye Centers of Racine & Kenosha, Ltd. Dr. Singh completed his residency in opthalmology at Cook County Hospital in Chicago and his fellowship in glaucoma at Duke University.
Financial disclosure: consultant to Bausch + Lomb