Fluidics of Phacoemulsification Systems

Han, Young Keun

doi:10.1007/978-4-431-54538-5_10

Cited by 6 publications

(6 citation statements)

References 18 publications

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“…Anterior chamber stability is essential during cataract surgery, and near-constant anterior chamber volume needs to be maintained throughout the procedure for the best safety and patient comfort. 6 This study assessed transient changes in anterior chamber volume after occlusion break using a mechanical spring eye model that mimicked compliance of the anterior chamber of a human eye. The results demonstrated that surge volume depended on which phacoemulsification system was used and the specific surgical settings.…”

Section: Discussionmentioning

confidence: 99%

“…Occlusion break can cause an abrupt clearance of materials from the phacoemulsification tip and a subsequent rapid flow of fluid from the anterior chamber of the eye. 4,6 The fluid surge from the eye can lead to a number of complications, including anterior chamber collapse, posterior capsule rupture, and vitreous loss. 1,7 In addition, eyes with a history of capsule rupture and vitreous loss are at increased risk for endophthalmitis and cystoid macular edema.…”

mentioning

confidence: 99%

“…Compliance is the volume change associated with a corresponding pressure change (Δvolume/Δpressure). 6 The relationship between pressure and volume in human eyes is nonlinear as eyes become more rigid at higher IOPs. 14 Recently, a mechanical spring eye model that mimics the compliance of the human eye was developed (Figure 1).…”

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confidence: 99%

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Experimental study of occlusion break surge volume in 3 different phacoemulsification systems

Miller¹,

Dyk²,

Yalamanchili³

2021

J Cataract Refract Surg

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Experimental study of occlusion break surge volume in 3 different phacoemulsification systems

Miller¹,

Dyk²,

Yalamanchili³

2021

J Cataract Refract Surg

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“…1 One primary factor in maintaining a safe and stable anterior chamber is controlling intraocular pressure (IOP) to stay within or near the physiologic range. 2 However, large fluctuations in IOP can occur during cataract surgery.…”

Section: J Cataract Refract Surg 2016; 42:157-162 Q 2016 Ascrs and Escrsmentioning

confidence: 99%

Experimental anterior chamber maintenance in active versus passive phacoemulsification fluidics systems

Nicoli

Dimalanta

Miller

2016

Journal of Cataract and Refractive Surgery

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DESIGN: Experimental study.METHODS: An acrylic test chamber was used to model the anterior chamber of the eye. Two passive (gravity-based) systems were tested using bottle heights yielding infusion pressures of 41, 75, and 109 cm of water under zero-flow conditions. One actively controlled system was tested using equivalent target IOPs of 30, 55, and 80 mm Hg. Test chamber IOPs were measured at aspiration flow rates of 15, 30, 45, and 60 cc/min. RESULTS:The measured flow rates were similar between fluidics systems across the range of intended aspiration flow rates. All systems achieved the desired target IOPs under zero-flow conditions. After activation of aspiration flow, however, measured IOPs decreased from target IOPs for the 2 passive systems. Each 15 cc/min increase in the aspiration flow rate produced a pressure drop of 14.0 to 16.2 mm Hg or 9.3 to 14.2 mm Hg, depending on the system. Measured IOPs in the actively controlled system closely matched the targeted IOPs across all tested aspiration flow rates, deviating from targets by no more than 4.3 mm Hg.CONCLUSIONS: All phacoemulsification aspiration infusion fluidics systems achieved target IOPs under zero-flow conditions. Only the actively controlled system maintained target IOPs across a range of aspiration flow rates. These experimental findings suggest that anterior chamber stability might be better in the clinical setting using an actively controlled system. Financial Disclosure: Dr. Dimalanta is an employee of Alcon Research, Ltd. Dr. Miller is an investigator and speaker for and a consultant to Alcon Laboratories, Inc. Dr. Nicoli has no financial or proprietary interest in any material or method mentioned. J Cataract Refract Surg 2016; 42:157-162 Q 2016 ASCRS and ESCRSAnterior chamber maintenance is one of the keys to successful outcomes in phacoemulsification cataract surgery.1 One primary factor in maintaining a safe and stable anterior chamber is controlling intraocular pressure (IOP) to stay within or near the physiologic range.2 However, large fluctuations in IOP can occur during cataract surgery.3 An IOP that is too high can cause ocular discomfort, decreased ocular perfusion, accelerated glaucomatous optic nerve damage, and postoperative corneal edema. 4,5 An IOP that is too low or that fluctuates widely can lead to instability or collapse of the anterior chamber, ocular discomfort, and trauma to anterior segment structures such as the cornea, iris, and lens capsule. In passive or gravity-based phacoemulsification aspiration devices, pressure and flow are inversely related; increased flow results in decreased pressure and vice versa, in particular when the source pressure is held constant.7 During phacoemulsification, inflow supplied by the irrigation line equals outflow under steady-state conditions. Total outflow is the sum of flow through the aspiration line and leakage through the incisions.8 If incision leakage is zero, the infusion flow rate equals the aspiration flow rate. Because

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“…6 An occlusion break can cause an abrupt aspiration of lens materials from the phacoemulsification tip and a subsequent rapid inflow of fluid from the anterior chamber. 7 The fluid surge can cause several complications, such as anterior chamber collapse, posterior capsule rupture, and vitreous loss. 8 9 The fluid surge is prevented with the Active Sentry system of the Centurion Vision System (Alcon Laboratories, Inc.) with the venting mechanism.…”

Section: Introductionmentioning

confidence: 99%

The comparison of handpiece anti-surge system and main body in cataract surgery

Kim,

Kim

et al. 2023

Preprint

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Background/aims: To compare the efficacy of the Centrion handpiece anti-surge system (Active Sentry) and main body according to the grade of nucleosclerosis. Methods: 600 eyes of 415 patients who underwent cataract surgery was retrospectively enrolled. Intraoperative parameters included phacoemulsification time (seconds), cumulative dissipated energy (CDE), and balanced salt solution (BSS) use (ml). Clinical measurements were made preoperatively and at one day, one month, two, and three months postoperatively, including the best corrected visual acuity (BCVA), and the corneal endothelial cell (CEC) count in the handpiece group (N=300) and main body group (N=300). Within the anti-surge group, the number of anti-surge system activated was collected. Results: Anti-surge (times), phacoemulsification time, CDE, and BSS use significantly increased with increasing nucleosclerosis grades and in zonule weakness, poor mydriasis, and pseudoexfoliation syndrome in handpiece group, respectively (p < 0.05). Phacoemulsification time, CDE, and BSS use of handpiece group were significantly lower than those of main body group (p < 0.05). Phacoemulsification time, CDE, and CEC loss of handpiece group were significantly lower than those of main body group in nucleosclerosis grade 5 and 6 (p < 0.05). BSS uses of handpiece group were significantly lower than those of main body group in all nucleosclerosis grade (p < 0.05). Conclusion: Because of the fast-reacting anti-surge, Intraoperative parameters were saved in handpiece anti-surge system rather than in main body. Therefore, the anti-surge system in the Centrion handpiece helps the surgeon perform safer cataract surgery in higher nucleosclerosis grade, zonule weakness, poor mydriasis, and pseudoexfoliation syndrome.

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Fluidics of Phacoemulsification Systems

Cited by 6 publications

References 18 publications

Experimental study of occlusion break surge volume in 3 different phacoemulsification systems

Experimental study of occlusion break surge volume in 3 different phacoemulsification systems

Experimental anterior chamber maintenance in active versus passive phacoemulsification fluidics systems

The comparison of handpiece anti-surge system and main body in cataract surgery

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