Making phaco platform transition increases surgical safety, efficiency

Reviewed by Jonathan Solomon, MD

When his surgery center was in the market for a new phacoemulsification platform, medical director Jonathan Solomon, MD, decided to switch from a unit equipped with a flow-based peristaltic pump to technology that features a vacuum-based Venturi system (Stellaris PC, Bausch + Lomb).

Although he was trained on and had always used phacoemulsification machines with a peristaltic pump, Dr. Solomon said he was interested in changing in order to gain increased efficiency. 

His experience shows that his goal has been met. Cases are now being completed faster with less ultrasound energy, and patients are benefiting postoperatively with quieter eyes and rapid visual recovery.

“There is some apprehension among cataract surgeons about using a Venturi system,” said Dr. Solomon, medical director, Dimensions Surgery Center, Bowie, MD, and surgical/refractive director of Solomon Eye Physicians and Surgeons, which has offices in Maryland and Virginia.

The fact that things move faster in the eye generates concern about safety, and the different dynamics may be especially intimidating for more novice surgeons, he noted.

“My message to my colleagues is do not be reluctant to make the transition,” he said. “Rather, relax and be confident while you embrace the enhanced settings that become available and the advanced power you can expect to engage when you use a Venturi system.”

Why make the switch?

Dr. Solomon said he found himself intrigued by the performance of the Venturi-based system that he witnessed while watching other surgeons performing bimanual microincision cataract surgery.

“They were able to maintain a stable anterior chamber with adequate infusion and appropriate fluidics,” Dr. Solomon said. “That to me was an obvious indication of the efficiency of the system.”

Dr. Solomon likens the switch from operating with a peristaltic system to a Venturi platform to moving from driving a practical family sedan to a German-engineered sports car.

“There is a huge difference in responsiveness,” he said. “With the Venturi pump, things evolve much more efficiently in the eye and that creates a sense of confidence for me as a surgeon.”

Seeing the differences

Seeing the differences

The differences are noticeable during both nuclear disassembly and cortical cleanup. Whether he is performing femtosecond laser-assisted or conventional cataract surgery, Dr. Solomon said the Venturi system offers the advantage of being able to have a very rapid rise in vacuum that allows for reduced use of energy.

“With this system, the vacuum is doing all of the work for removing the nuclear pieces by enhancing the ability to acquire and hold the pieces,” he said. “As a result, fragment removal becomes much more efficient in terms of using less ultrasound energy.”

Using the silicone irrigation/aspiration sleeve that is available for the Stellaris platform with the Venturi pump also makes complete cortex removal safer and easier. 

“The combination of a high-vacuum setting with the very small port silicone I/A sleeve advances cortical removal to a new level,” Dr. Solomon said.

He also finds it advantageous that thanks to the dual-function linear footpedal found on the Stellaris/Stellaris PC, he can easily adjust the level of ultrasound energy as needed for different grade cataracts in addition to having instantaneous control over vacuum.

User tips

Because things are happening faster with the Venturi system, surgeons do need to be mindful about the location of their instruments. That said, however, because the Venturi system favors followability, surgeons can keep the phaco tip steady in the middle of the eye.

“Nuclear material gently gravitates to the tip because of the dynamic rise in vacuum, and so there is very little need for moving the instrument around inside the eye,” Dr. Solomon explained. “Consequently, I can also easily switch between hands for holding the phaco handpiece and I can also use the instrument in my fellow hand to gently encourage fragments toward the phaco tip in a knife and fork-like maneuver that adds to the increased efficiency.”

The reduced movement inside the eye combined with the incredible anterior chamber stability afforded by the Venturi-based system and reduced ultrasound energy use explain the clear corneas and very quiet appearance of the eyes postoperatively, he noted.

Nevertheless, Dr. Solomon said it is important to use a dispersive viscoelastic to coat and protect the corneal endothelium.

The benefits of the Venturi pump system also provide the capacity for dual functionality to perform both cataract and vitreoretinal procedures, he noted.

Dr. Solomon said that type of versatility was another feature that attracted him to the system.

Jonathan Solomon, MD

E: jdsolomon@hotmail.com

Dr. Solomon is a consultant to Abbott, Alcon Laboratories, and Bausch + Lomb