IOP (mmHg)
50
100
50
100
ASP Flow
Kelman MiniFlared Tip 45
INTREPID® Balanced Tip 45
20
75
30
70
25
25
115
70
115
70
30
160
120
160
125
35
200
175
210
180
40
260
225
260
235
45
310
290
320
290
50
360
345
375
360
55
420
405
430
420
60
480
460
490
485
For a given aspiration flow and phaco tip, the pre-vacuum value decreased as the IOP increases. • In absence of occlusion, the lower the pre-vacuum value, the less risky it is to get close to the iris or the capsule with the tip. In brief, Table 1 shows that phacoemulsification tips are associated with different non-occluded pre-vacuum values. Non-occluded pre-vacuum values vary according to pre-set aspiration flow rate and IOP.
Table 1. Pre-vacuum values with varying IOPs and aspiration flow (unpublished data)
Balanced Energy™ Technology 1) Improving Phaco Efficiency Using the INTREPID® Balanced Tip (D. Tognetto, Trieste, Italy)
“
T
he main disadvantage of a phaco tip with a longitudinal movement is the repulsion of lens fragments, known as chattering,” Prof. Tognetto said. Lateral movement of the tip helps prevent chattering, thus improving “followability” and “holdability”. Another problem that may occur when using a phaco tip is its obstruction by lens fragment (clogging and fogging). • Clogging disappears when using the IP (“Intelligent Phaco”) system (OZil®), which delivers short longitudinal pulse released in torsional modality. • The way to improve the efficacy of phaco-emulsification using OZil® is to associate Active Fluidics™ technology with an INTREPID® Balanced Tip able to maximize stroke and to reduce movement along the tip axis.
• The areas of high and low or minimal displacements can be revealed by stroboscopy, which allows the observation of fast moving objects by illuminating them with a flashing light lasting a fraction of a second. As a result, the object appears “frozen” or in slow motion. When applied to a phaco tip, its displacements can be measured thus showing areas of high (nodes) and low or minimal (anti-nodes) displacement. A correlation between nodes and thermal hotspots can be established. • Thermal profiles of phaco tips may vary markedly. Thermal imaging below shows hot spots (red) observed with a Kelman tip and a INTREPID® Balanced Tip. The latter exhibits no such thermal hotspots, i.e. little heat production. • In conclusion, Prof. Tognetto said that that the Active Fluidics™ technology associated with an INTREPID® Balanced Tip exhibit some distinctive features, such as improved efficiency, “followability” and “holdability”, as compared with other tips and gravity systems. A lateral stroke of 180 µm allows fast and safe removal of lens fragments in conjunction with the IP system.
Figure 2. INTREPID® Balanced Tip showing torsional movement
• The INTREPID® Balanced Tip was designed to achieve more efficient phaco-emulsification by enhancing torsional tip movement at the distal end while reducing bending movement at the incision site, as compared with Kelman tip. As a result, cutting efficiency and thermal profile are improved. This tip forms a bend angle of 16° relative to its axis. The angle of the tip bevel is 30° or 45°.6
0.9mm Mini-Flared ABS® 45˚ Kelman tip 100% Torsional amplitude
0.9mm Balanced 45˚ bevel up tip 100% Torsional amplitude
Figure 3. Maximal and minimal displacements revealed by stroboscopy: Mini-flared 45° Kelman Tip (left) and Balanced 45° bevel Tip (right)6
3
ALCON CENTURION® VISION SYSTEM COUNCIL MEETING 2014
Figure 4. Thermal profiles of a Kelman tip and a INTREPID® Balanced Tip, showing spots of high temperature (red) along the Kelman tip6