Lens removal with phaco system suited for refractive lens exchange

Key Points

Atlanta-An ultrasound alternative phacoemulsification system (Sonic Wave, STAAR Surgical) offers an economical, safe, and effective modality for lens removal in patients undergoing refractive lens exchange, according to Trevor Woodhams, MD.

Dr. Woodhams is an ophthalmologist in Atlanta, with a private practice limited to refractive surgery, including keratorefractive procedures and refractive lens exchange. He became interested in the ultrasound alternative system, he said, when he began to research other options to the phaco system he was using, trying to identify technology that would help maintain costs.

"Our goal was to find other equipment that would do the job with the same level of quality as the major phacoemulsification machines, but at a lower cost per case. Our analyses showed the [ultrasound alternative system] was the best choice because it provided excellent outcomes in removing the type of lenses typically present in patients undergoing lens removal as a refractive surgery procedure, but was far more cost-effective than its competitors," said Dr. Woodhams, former clinical associate professor of ophthalmology, Emory University, Atlanta.

Dr. Woodhams said he is able to use the sonic energy mode of the system exclusively in up to 80% of his cases. In the remaining eyes, where there is more sclerosis, he uses the traditional ultrasound phaco mode.

Phaco technique

Dr. Woodhams' technique involves an initial stage during which he sculpts and divides the nucleus using very low flow and energy settings, generally 60% power, 60 mm Hg vacuum, and a flow rate of 28 ml/sec. Then, to remove the lens material, the vacuum is increased to 400 mm Hg and the flow rate raised to 40 ml/sec. The ultrasound mode is used only as necessary.

"With this approach, I can evacuate the nucleus and epinucleus using a one-handed technique in about 95% of eyes, and often even without needing to use the irrigation-aspiration tip for cortical removal. Avoiding a second-hand technique, minimizing intraocular manipulation, and using the gentle sonic setting greatly minimizes intraocular trauma to enable the excellent visual outcomes on the first day after surgery that are so important in the refractive surgery patient population," Dr. Woodhams said.

Dr. Woodhams operates out of a single room and typically will schedule 10 cases for a half-day session. He said he uses the same tubing for all the cases, along with about one-half bottle of balanced salt solution per case.

"Excluding the IOL, my cost per case using the [ultrasound alternative system] is less than half of what it would be using this or another system with disposables," he said.