Dr. Inder Paul Singh is a private-practice ophthalmologist in Wisconsin with a passion for the latest technology. He works in several surgery centers and has experience with a variety of phacoemulsification machines. Dr. Singh noted, “Stellaris Elite is my main and preferred machine because it balances efficiency and safety. With Stellaris Elite, in any circumstance—including shallow chambers, deep chambers, and dense eyes—it allows me to be consistent with my technique and to be extremely efficient in my use of phaco energy.”1
Stop and chop technique for cataract surgery
Dr. Singh has performed thousands of cataract surgeries. Although stop and chop is his preferred technique, he is comfortable with many techniques so that he can adapt depending on how the lens reacts and the eye anatomy.
Typically, he starts by making a groove about 80% through the lens and then cracks the lens in half. Next, he moves one half of the lens towards the iris plane and chops it with a second instrument and then emulsifies it. Because of the direct vacuum and the space in the capsular bag, the second half of the lens easily moves to the tip; there is no need to chase it. At no point does he need to rotate the lens, which is particularly beneficial in patients with glaucoma* and weak zonules or shallow chambers.
“When I have a dense cataract, I only want to use Stellaris Elite because of the cutting efficiency.”- Dr. I. Paul Singh
Stellaris Elite is Dr. Singh’s preferred phacoemulsification machine for cataract surgery
Dr. Singh prefers Stellaris Elite because the vacuum-based system allows him linear control of vacuum which brings lens pieces to the phaco tip, and thus allows him to stay in the middle of the eye further away from the capsule. He also notes that Stellaris Elite has excellent chamber stability which keeps the capsule back and also helps ensure capsular integrity of an inadvertant capsular break.
As a glaucoma specialist, Dr. Singh has many patients with narrow angle, shallow chambers, small pupils, and weak zonules due to conditions like pseudoexfoliation. Stellaris Elite provides chamber stability in these fragile situations through the Adaptive Fluidics™ technology. Adaptive Fluidics™ proactively manages chamber stability for 3 times higher chamber stability than Alcon Centurion® during phaco.2,3 The surgeon is able to stay in the middle of the eye where the chamber is deepest, and the pieces come to the tip because of the vacuum and followability.
Dr. Singh recalled a recent patient with a small pupil and pseudoexfoliation. He used Stellaris Elite to remove the cataract through a 4-mm pupil using a sub 2-mm incision which kept the chamber stable and minimized the amount of fluid usage.
Stellaris Elite allows Dr. Singh to be aggressive with phacoemulsification. The machine provides efficient cutting and full control.1 Dr. Singh noted, “With Stellaris Elite, I have an extreme amount of control with every step of the surgery. Having linear control of the vacuum is important because there are times that I just want to have a small amount of vacuum to bring the piece to me without having to engage the lens.” With Stellaris Elite, occlusion is not needed to build vacuum.
The dual-linear foot pedal allows the surgeon to customize the foot pedal's settings by adding control for vacuum and ultrasound energy independently by yawing to the right or left, not just up and down. Dr. Singh notes “For example, in epinuclear mode, I can set the ultrasound to engage only when I yaw to the right and keep the vacuum control up and down. This allows me to use small bursts of phaco only when I need it yet have full control of vacuum as I go down on the foot pedal.” The dual-linear foot pedal enables the surgeon to be efficient with phaco energy and maximize control of vacuum in cases such as soft cataracts.
Dr. Singh also takes advantage of the different types of phaco energy modes Stellaris Elite offers. These include the multiburst mode, which allows him to increase phaco “on time” as he depresses the dual-linear foot pedal without increasing the amount of phaco energy. The Attune® Energy technology truncates energy wave forms, thus enabling him to use only the amount of phaco energy necessary.
MICS Needle Parameters2
30° MICS™ Straight Needle BL3318S
RIS: 1.8-2.00 mm
OD: 0.74-0.95 mm
ID: 0.5-0.79 mm
<2-mm incision is possible with Stellaris Elite
Stellaris Elite offers a microincisional cataract surgery (MICS) needle with a sleeve that fits through an incision of <2 mm. Many other machines need at least a 2.2-mm incision. By creating a small incision, <2 mm, Dr. Singh is minimizing the amount of surgically induced astigmatism and is keeping the chambers stable while using low levels of fluid. In addition, the Stellaris Elite has sensors that allow it to proactively infuse fluid depending on the amount of vacuum used to help reduce postocclusion surge.2 Dr. Singh has noticed that he is able to reduce his fluid use to only 50 cc or less with standard cataract surgery because of the small incision size, tubing, and efficiency of cutting. The reduced fluid has the potential advantage of reducing postoperative corneal edema.4
Retained lens fragments are very rare with Stellaris Elite
Dr. Singh has not experienced many retained lens fragments when using Stellaris Elite. A patient with a retained lens fragment can typically present a week after surgery with corneal edema or inflammation. These retained lens fragments can be missed during cataract surgery because they were camouflaged by the iris color or the pieces are lodged under the iris near the equator. The vacuum with Stellaris Elite allows the lens fragments to migrate from the angle and periphery to the phaco tip.
“Stellaris Elite offers a significant difference in efficiency and ability to stay in the middle of the eye. In addition, I prefer Stellaris Elite because of the excellent followability.”- Dr. I. Paul Singh
Dr. Inder 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 ophthalmology at Cook County Hospital in Chicago and his fellowship in glaucoma at Duke University.
Financial disclosure: Consultant to Bausch + Lomb