New microincision surgery system earns high marks

Key Points

San Diego-A new microincision cataract surgery system ([MICS]; Stellaris Vision Enhancement System, Bausch & Lomb), has earned high marks for its performance during all phases of phacoemulsification procedures in a field observation study.

During the field observation study, Drs. Davis and Devine subjectively assessed the system's performance during procedures and rated it as acceptable or not acceptable, not applicable, yes or no, and used a scale of 1 to 5, wherein 1 indicated excellent and 5 indicated very poor, Dr. Davis explained. She is a partner, Minnesota Eye Consultants, and adjunct clinical assistant professor, University of Minnesota, Minneapolis.

"The system availability without interruption throughout the entire procedure was rated acceptable," Dr. Davis said. "The absolute phaco time was most often 0 seconds and less than 3 seconds for 3 to 4+ cataracts. There were no adverse events associated with the use of the system."

She said that her current standard vacuum-based microcoaxial technique on the new MICS is a supracapsular approach with chopping. The technique consists of prolapsing one pole of the nucleus into the anterior chamber above the capsulorhexis to reduce zonular stress. The tilted pole is supported with a second instrument. Lens manipulation and emulsification are done in the iris plane, which reduces risk of capsular tear and helps with visualization if the pupil constricts.

The linear power ranges from 0% to 4%, and the linear vacuum ranges from 200 to 600 mm Hg. Advanced fluidics keep the anterior chamber stable.

Features

The feature of the system that probably is most advantageous for surgeons is the next-generation fluidics management system (EQ Fluidics), which aims to provide equal or balanced control of flow and aspiration, Dr. Davis said. Options include flow with vacuum characteristics and vacuum with proprietary outflow tubing (StableChamber).

The fluidics system includes a six-crystal, 2.8-kHz ultrasound handpiece designed to be ergonomic; power modulation software (CustomControl II); wireless dual linear technology; a touch screen display designed to be intuitive; streaming video inlay; and a modular design platform. The all-electric drive aims to make the system more convenient in terms of space, cost, and ease of handling without affecting overall vacuum responsiveness. The increase from four to six crystals is an effort to enable the handpiece to be narrower, more compact, and better balanced for increased comfort.

"The kilohertz rate is the same as that of the [predecessor] system. The main difference is the stroke length that translates into better cutting efficiency. Tests are currently under way," Dr. Davis said.

"All competitive handpieces are at higher rates-40 kHz," she added, mentioning that one in particular (OZil, Alcon Laboratories) alternates between 40 kHz for the jackhammer and 32 kHz for the torsional part.

"Mark Shafer, PhD, has published extensively on the merits of optimized action under 30 kHz and is currently performing tests with the [new] handpiece," Dr. Davis said.

The flow module has a single-use, pre-connected cartridge and a single-use, pre-connected 300-ml cassette. The module enables precise detection of fluid levels.