PHACODYNAMICS

Phacoemulsification for Residents

Unpad - Cicendo Eye Hospital 2020

Andrew M.H. Knoch, MD

Two Basic Elements of Phaco Dynamics
Ultrasound Power:
• emulsify the crystalline lens

Fluidics:
• remove the emulsate via the aspiration port
• counteract the potential heat buildup and repulsive action of the
phaco tip
• maintaining adequate depth and pressure in the anterior chamber
Phaco Machine

Consist of :
• Console
• Foot pedal
• Handpiece
Console
BSS Lift Rod
Control panel

Mainframe Fluid management system

(Phaco driver)

Hand piece
Foot pedal
Console.
Phaco cataract surgery requires the use of complex phaco machines

Electrical mechanical
Phaco driver energy Handpiece energy Phaco tip cataract
(Computer)
Foot Pedal
• Three major function, controlled with foot pedal :

• Irrigation
• Aspiration
• Fragmentation
Foot Pedal.
Foot pedal position 2 and 3 :

Linear / Fixed /
Surgeon Control Panel
Handpiece
Phaco tip

Irrigation
Aspiration
Phaco Handpiece
I/A Handpiece.
Main Phaco Parameter

Flow Rate

Vacuum

Power
Aspiration Flow Rate (cc/min)
• Primary force that attracts material to the phaco tip
High Flow

Low Flow

• Determines how fast material is drawn to the tip = Followability

Vacuum –Occlusion (mmHg)
Ultrasound Power = Stroke Length (%)
• Frequency (kHz) – fixed
How OFTEN

• Stroke length (%) – variable

How FAR
This length is generally 2 to 4 mils
(50 – 100um）

Stoke length
Stroke Length
• The setting phaco power is the percentage of stroke length
Such as :
The maximum stroke length = 100um
30%(phaco power) = 100um(stroke length ) X 30%
= 30um

The actual stroke length is determined by :

• phaco machine setting
• foot pedal excursion in position 3
Phaco Parameters

Aspiration Flow Rate Ultrasound Power

• cc/min •%
• Followability • Emulsifying forces
Vacuum Others
• mmHg • Bottle height
• Holding Forces • U/S Power Modulation
Bottle Height

Every 15cm (6 inches) bottle

height above the eye
=
Approximately 11mmHg
pressure is produced
intraocularly
Surge
Surge
Surge
Surge
Bottle Height and Vacuum.

Vacuum Bottle Height

150 65
200 – 250 85
250 - 300 110
U/S Power Modulation

Continous

Pulse

Burst
Continuous mode

START FINISH
FOOTSWITCH FOOTSWITCH
POSITION 3 POSITION 3

The power(stoke length) is determined by foot pedal

Pulse mode

Linear power
Pre-selected Duty Cycle (on-off time)

START FINISH
FOOTSWITCH FOOTSWITCH
POSITION 3 POSITION 3

The power is determined by foot pedal

Burst mode
Variable duration(Duty Cycle)

Fix power

START FINISH
FOOTSWITCH FOOTSWITCH
POSITION 3 POSITION 3

The duration is determined by foot pedal

Burst and Pulse

Finish FP3
Start FP3
burst

Start FP3 pulse Finish FP3

Continous, Pulse, Burst ?

Sculpting : Chopping: Quadrant

Linear, Burst mode removal:
Continuous then to have Pulse mode
mode or pulse the vacuum on
mode fixed so that it
will build
quickly
TAKE HOME MESSAGE

Understanding Phacodynamics :
• Allows surgeon to optimize machine settings
• Safely trouble shoot problems during surgery
THANK YOU
Phaco Setting
Bottle Height
• 30 cm = 1 feet = 22 mmHg
• 60 cm = 2 feet = 44 mmHg
• 90 cm = 3 feet = 66 mmHg

Flow Rate
• Peristaltic : 20 - 30 cc/min  optimum

Vacuum
• + 10 times of Flow Rate
Phaco Setting
Power for Sculpting :
• Power = (grade of nucleus x 15) + 25
• Grade 1 = 15 + 25 = 40%
• Grade 2 = 30 + 25 = 55%
• Grade 3 = 45 + 25 = 70%
• Grade 4 = 60 + 25 = 85%
• Grade 5 = 75 + 25 = 100%

Power for Quadrant Removal

• 30% less than Sculpting
 Two Types of Pump

Peristaltic Pump: Flow type – Active Control of Venturi Pump: Pressure Type – Active Control of
Flow, Passive Change of Pressure Pressure, Passive Change of Flow
Venturi vs Peristaltic
Vacuum –Rise Time
• The faster the flow rate, the shorter the vacuum rise time
• Aspiration flow rate decreased by half, the vacuum rise time is doubled