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Comparative Study
. 2014 Jul 30:14:96.
doi: 10.1186/1471-2415-14-96.

Comparison of occlusion break responses and vacuum rise times of phacoemulsification systems

Pooria Sharif-Kashani, Douglas Fanney  1 , Val Injev
Affiliations
Comparative Study

Comparison of occlusion break responses and vacuum rise times of phacoemulsification systems

Pooria Sharif-Kashani et al. BMC Ophthalmol. .

Abstract

Background: Occlusion break surge during phacoemulsification cataract surgery can lead to potential surgical complications. The purpose of this study was to quantify occlusion break surge and vacuum rise time of current phacoemulsification systems used in cataract surgery.

Methods: Occlusion break surge at vacuum pressures between 200 and 600 mmHg was assessed with the Infiniti® Vision System, the WhiteStar Signature® Phacoemulsification System, and the Centurion® Vision System using gravity-fed fluidics. Centurion Active FluidicsTM were also tested at multiple intraoperative pressure target settings. Vacuum rise time was evaluated for Infiniti, WhiteStar Signature, Centurion, and Stellaris® Vision Enhancement systems. Rise time to vacuum limits of 400 and 600 mmHg was assessed at flow rates of 30 and 60 cc/minute. Occlusion break surge was analyzed by 2-way analysis of variance.

Results: The Centurion system exhibited substantially less occlusion break surge than the other systems tested. Surge area with Centurion Active Fluidics was similar to gravity fluidics at an equivalent bottle height. At all Centurion Active Fluidics intraoperative pressure target settings tested, surge was smaller than with Infiniti and WhiteStar Signature. Infiniti had the fastest vacuum rise time and Stellaris had the slowest. No system tested reached the 600-mmHg vacuum limit.

Conclusions: In this laboratory study, Centurion had the least occlusion break surge and similar vacuum rise times compared with the other systems tested. Reducing occlusion break surge may increase safety of phacoemulsification cataract surgery.

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Figures

Figure 1
Figure 1
Occlusion break surge: gravity-based systems. The schematic depicts (A) the anterior chamber and (B) IOP. During unobstructed flow, aspiration and infusion are balanced to maintain a stable anterior chamber (A1) and IOP (B1). When the phaco tip becomes occluded with nuclear material, fluid flow is blocked (A2) and IOP increases (B2). With occlusion break, vacuum stored in aspiration tubing during occlusion (ie, no flow) can cause a sudden increase in aspiration rate (A3) and lead to a drop in IOP (B3). Infusion during unobstructed flow after occlusion break leads to recovery of the anterior chamber (A4) and IOP (B4). IOP = intraoperative pressure.
Figure 2
Figure 2
Experimental setup for (A) occlusion break surge and (B) vacuum rise time testing. Tubing was clamped at the sites indicated with arrows. PEL = patient eye level; XDCR = transducer.
Figure 3
Figure 3
Occlusion break surge responses with increasing aspiration vacuum. Gravity fluidics (bottle height, 90 cm) was used unless otherwise indicated. IOP = intraoperative pressure.
Figure 4
Figure 4
Comparison of Centurion occlusion break surge response. Gravity and Active Fluidics IOP target settings were used. IOP = intraoperative pressure.
Figure 5
Figure 5
Vacuum rise times at a vacuum limit of 400 mmHg. Testing was performed with flow rates of (A) 30 cc/minute and (B) 60 cc/minute. Gravity fluidics (bottle height, 90 cm) was used unless otherwise indicated. IOP = intraoperative pressure.
Figure 6
Figure 6
Vacuum rise times at a vacuum limit of 600 mmHg. Testing was performed with flow rates of (A) 30 cc/minute and (B) 60 cc/minute. Gravity fluidics (bottle height, 90 cm) was used unless otherwise indicated. IOP = intraoperative pressure.
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