Phaco with novel system yields excellent cutting efficiency, chamber stability

Take-home message: A new phacoemulsification system offers surgical functionality, features, and technology in a compact form factor.

By Nancy Groves; Reviewed by Daniel H. Chang, MD

Bakersfield, CA-A novel phacoemulsification system (Compact Intuitiv, Abbott Medical Optics [AMO]) offers state-of-the-art fluidics and phacoemulsification technology and could fill a niche as an upgrade for users who prefer the value of a mid-level system to the expense of a high-end system.

“[The manufacturer] has taken a multi-pronged approach to cataract surgery, allowing surgeons to decide what system suits their surgical and operational needs instead of just having one cataract system for everyone,” said Daniel H. Chang, MD, Empire Eye and Laser Center, Bakersfield, CA, who has experience with the new device.

The small (about the size of a briefcase) and lightweight system is reminiscent of a previous-generation phacoemulsification system (Sovereign Compact, AMO), but it incorporates much of the phacoemulsification and fluidics technology of the company’s flagship line (Whitestar Signature, AMO), Dr. Chang explained.

Fluidics, technology

The new system has the peristaltic fluidics of the Signature system as well its energy modulation feature (Ellips FX handpiece, AMO). The tip of the handpiece moves both longitudinally and transversally, so the combined movements produce an elliptical pattern. The elliptical pattern improves cutting efficiency since the entire circumference of the tip is in motion-not just the off-axis portion, as in torsional phacoemulsification. This can help to ease nuclear removal and to reduce phacoemulsification time.

The tip cuts smoothly on both hard and soft lenses and also minimizes heat from strain forces because the stress on the phacoemulsification needle during ultrasound generation is concentrated at the hub rather than distributed along the entire shaft, as in torsional ultrasound.

“Since the hub never touches the wound, you gain thermal protection at the incision,” Dr. Chang said. “This couples well with the energy modulation abilities of the Whitestar technology.”

As important as the Ellips FX technology is the chamber stability provided by the Compact Intuitiv, Dr. Chang said.

“Compared with a number of other systems, the Intuitiv has much less surge because of various implementations in the fluidics,” he explained.

These features include physical modifications like smaller-bore tubing as well as software-based technology (Occlusion Mode and Chamber Stabilization Environment [CASE]).

These proprietary computer algorithms help to maintain IOP by proactively adjusting vacuum settings in the milliseconds after sensing an occlusion. The fluidics system gives the surgeon intraoperative intraocular control and the ability to adjust vacuum, flow rate, and rise time in order to maximize chamber stability.

User-friendly accessories

Accessories include an advanced linear foot pedal, a wireless remote control, a high-speed vitreous cutter, and an auto-loading tube pack and one-step prime/tune for easy operating room setup.

The device currently is sold with a disposable tubing system but is expected to have a reusable tubing option by the end of the year, Dr. Chang said. This would be a useful option for the value-minded segment of surgery centers that are interested in minimizing their per-case cost, he added.

In summary, the system “brings much of the technology from modern high-end phacoemulsification systems into a simple, easy-to-use, and compact form factor,” Dr. Chang said. “Alongside the Whitestar Signature, with its dual-pump Fusion Fluidics, the Compact Intuitiv provides surgery centers with a choice for a system that best suits their surgeons’ needs.”

Daniel H. Chang, MD

E: dchang@empireeyeandlaser.com

Dr. Chang is a consultant for Abbott Medical Optics.