New phaco system, new era of cataract surgery

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James A. Davison, MD, describes the features and performance of a new phacoemulsification system (Centurion Vision System, Alcon Laboratories).

Dr. Davison

By Cheryl Guttman Krader; Reviewed by James A. Davison, MD, FACS

Marshalltown, IA-A new phacoemulsification platform (Centurion Vision System, Alcon Laboratories) is propelling cataract surgery into an entirely new era, according to James A. Davison, MD, FACS.

“Surgeons who presume that the [new phaco platform] is a minor makeover should think again and would do well to take a close look at this . . . new system,” said Dr. Davison, who specializes in cataract and refractive surgery at the Wolfe Eye Clinic, Marshalltown and West Des Moines, IA.

“The [new system] is an exponential advance compared [with] any of the machines that have been available up until this time,” he said. “I expect that, just as I did, surgeons who try it will very quickly appreciate the revolutionary differences.”

Enhanced performance

Dr. Davison had the opportunity to use the new phaco system in premarket testing and believes that it stands out for making cataract surgery easier and safer, particularly when operating on hard cataracts and in other challenging situations.

“Every step is easier when operating on a hard cataract with this new system, and so those cases really seem to be no different than those with average nuclei,” Dr. Davison said.

Among the innovations found in the new phaco system is proprietary new fluidics technology (Active Fluidics Technology). This automated system allows surgeons to set and maintain a target IOP during the procedure for enhanced anterior chamber stability.

“With the new fluidics system, surgeons no longer have to develop customized settings or make any adjustments in bottle height when operating on eyes with dense nuclei, at risk for IFIS, or with small pupils,” Dr. Davison said. “Now, they can program the unit with a single set of parameters to use in all cases and be assured of tight fluidics control.

“For instance, if an incision is leaking more than it should, laser controlled sensors will read the lower pressure at the eye and increase flow so that the target IOP can be maintained,” he said. “The efficiency of live feedback in Active Fluidics makes high vacuum and flow parameters unnecessary, resulting in a quieter experience for the surgeon and greater comfort for the patient.”

The new phaco system also features Balanced Energy Technology that enhances phacoemulsification efficiency through use of OZil Intelligent Phaco and the new Intrepid Balanced Tip. The new Balanced Tip, which is available in both 30° and 45° aperture configurations, can be used for all cataracts. However, it particularly shines in cases with hard nuclei where, thanks to the unique tip motion, the lens material appears to essentially dissolve.

“With the combination of the motion of the Balanced Tip and the new fluidics, we don’t need to move the tip around within the eye re-acquiring nuclear fragments,” Dr. Davison said. “The nuclear material flows to the tip and stays on it so that it virtually disappears as it is emulsified at the shearing plane.

“The performance of the new tip in hard cataracts was so phenomenal that during the trial period with the new platform, we actually moved cases with hard cataracts on a few occasions while waiting for the new tips to be supplied,” he said.

His own preference is to use the 45° version of the Balanced Tip as he finds that configuration makes cutting a little easier for his preferred divide and conquer–thin bowl technique, Dr. Davison noted.

He suggested that surgeons who are “choppers” may favor the 30° tip.

Design and integration

In addition to its enhanced performance, the new phaco system has a new highly ergonomic and aesthetic design, and features an elegant battery-powered wireless foot pedal. The operating room staff enjoy using it because it rolls and sets up easily, and is easy to program using the intuitive touchscreen display, Dr. Davison said.

The new phacoemulsification system was also developed to be seamlessly integrated with other Alcon surgical technologies, including the Verion System for registration of pre- and intraoperative images, the LenSx Laser, and the LuxOR Surgical Microscopes with Q-VUE 3-D assistant. Dr. Davison noted his center is just beginning to take advantage of that capability, but he believes it will be a valuable asset.

“Any innovation in measurement, automation, and inter-machine communication that limits the possibility for error from human interaction is a good thing for improving outcomes,” Dr. Davison said.

James A. Davison, MD, FACS

E: jdavison@wolfeclinic.com

Dr. Davison is a consultant to Alcon Laboratories, but has no financial interest in any of the devices mentioned. Ophthalmologists attending the annual meeting of the American Academy of Ophthalmology in New Orleans in November will be able to see live surgery sessions with the new phacoemulsification system.

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