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    Introduction Phacoemulsification

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    The document provides an introduction to phacoemulsification. It discusses several key aspects of phacoemulsification including: 1) How phacoemulsification machines work using piezoelectric crystals to create ultrasound power that vibrates the phaco tip at high frequencies. 2) The settings that control ultrasound power including frequency, stroke length, and amplitude which determines the distance and energy of phaco tip movement. 3) The importance of fluidics in maintaining chamber stability and providing adequate irrigation and aspiration flow rates dependent on bottle heights and vacuum levels. 4) Recommends mastering the "Stop and Chop" phacoemulsification technique by learning to sculpt and chop the

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    Introduction Phacoemulsification

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    6 views34 pages
    The document provides an introduction to phacoemulsification. It discusses several key aspects of phacoemulsification including: 1) How phacoemulsification machines work using piezoelectric crystals to create ultrasound power that vibrates the phaco tip at high frequencies. 2) The settings that control ultrasound power including frequency, stroke length, and amplitude which determines the distance and energy of phaco tip movement. 3) The importance of fluidics in maintaining chamber stability and providing adequate irrigation and aspiration flow rates dependent on bottle heights and vacuum levels. 4) Recommends mastering the "Stop and Chop" phacoemulsification technique by learning to sculpt and chop the

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    The document provides an introduction to phacoemulsification. It discusses several key aspects of phacoemulsification including: 1) How phacoemulsification machines work using piezoelectric crystals to create ultrasound power that vibrates the phaco tip at high frequencies. 2) The settings that control ultrasound power including frequency, stroke length, and amplitude which determines the distance and energy of phaco tip movement. 3) The importance of fluidics in maintaining chamber stability and providing adequate irrigation and aspiration flow rates dependent on bottle heights and vacuum levels. 4) Recommends mastering the "Stop and Chop" phacoemulsification technique by learning to sculpt and chop the

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    6 views34 pages

    Introduction Phacoemulsification

    Uploaded by

    nizhahye
    The document provides an introduction to phacoemulsification. It discusses several key aspects of phacoemulsification including: 1) How phacoemulsification machines work using piezoelectric crystals to create ultrasound power that vibrates the phaco tip at high frequencies. 2) The settings that control ultrasound power including frequency, stroke length, and amplitude which determines the distance and energy of phaco tip movement. 3) The importance of fluidics in maintaining chamber stability and providing adequate irrigation and aspiration flow rates dependent on bottle heights and vacuum levels. 4) Recommends mastering the "Stop and Chop" phacoemulsification technique by learning to sculpt and chop the

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    IKPAMI 2017| Februari,15, 2017

    Introduction to
    Phacoemulsification
    Joseph Mallord William Turner (1775 – 1851)
    Joseph Mallord William Turner (1775 – 1851)
    Claude Monet 1840 – 1926

    After a cataract operation he was shocked by the blueness of his world


    • Waterfall or flowing down
    Introduction

    • Mastering phacoemulsification
    (1) Know how phaco works
    (2) Understand the pump system
    (3) Fluidics

    Phacodynamics

    We will understand settings for


    phacomachines to handle different
    types of cataract
    Aspiration port
    Stroke length Handpiece
    Irrigation port
    Sleeve
    Horn

    • Phaco tip
    (needle)
    • Horn
    Piezzoelectric crystals
    • Probe (handle)
    (inside)
    U/S Power

    • Frequency
    –The speed of needle movement
    27 – 60 KHz

    • Stroke length
    –Distance of needle movement
    Max 2 – 4 mils
    U/S Power

    • Duration
    – Frequency of U/S  tip vibration
    –Factory default, ex: 40 KHz

    • Amplitude
    –Stroke length
    – Surgeon controlled, ex :
    • U/S power 100%  4 mils
    • U/S power 10%  0.4 mils
    Amplitude & Stroke length

    Stroke
    length 4
    Amplitude
    100%
    mils

    FREQ
    Frequency 40 KHz :
    Needles moves 40,000 cycles/second

    Stroke
    Amplitude
    20%
    length
    0.8 mils
    Stroke length
    Alcon AMO B&L
    Displayed
    Legacy Sovereign Millenium
    10 % 0.36 0.91 1.0

    30 % 1.10 1.57 2.02

    50 % 1.78 2.18 2.70

    70 % 2.49 2.61 3.40

    100 % 3.33 3.41 4.24

    Mackool RJ, Sirota MA. J Cat Refract Surg 2005; 31: 812
    U/S Power

    Pushes
    nucleus away

    Longer stroke length  greater energy


    Efficient power

     Impale :
    – use short pulse (burst) of U/S power
    Heat

     Mechanical (vibration tip) / friction


    –Tip can travel at over 80km/h
     Micro cavitations

    100 % U/S power in 5 sec w/ occluded tip

    Raise the temp 730 C


    Collagen shrinkage at 520 C (corneal burns)
    WhiteStar TM

    Continuous power

    Traditional pulse ultrasound

    WhiteStar technology
    During OFF period

    • Tip cools
    • Holding power is enhanced
    • Repulsive energy is reduced (lens
    chatter) enhancing followability
    • Prevent thermal damage

    Phaco wound burn


    Fluidics

    The understanding of
    how forces move fluids
    –Flow (irrigation)
    –Flow rate (aspiration rate)
    –Vacuum (aspiration level)
    –Bottle heights
    Flow

     Movement of fluid (cc/min)


    –Irrigation flow rate
    –Aspiration flow rate

     Flow
    –Passive
    –Depends on bottle high
    Bottle height

     Irrigation bottle
    –Irrigation  gravitational
    –Bottle above the eye
     15 cm = 10 mmHg
     45 cm = 30 mmHg
    –Increase bottle height, when:
     Increasing
    flow rate
     Wound leak
    Chamber stability

     Irrigation = Aspiration + Leakage


    Flow rate

     Followability
    –The ability to bring material to
    the phaco tip
    Vacuum

     Condition when pressure is decreased


    below atmospheric pressure

    Vaccum = Holding power


    Vacuum

    Occlusion

    Vacuum build
    Efficient phacoemulsification

    Jack hammer effect + cavitation energy + fluidics

    30 degree tip,
    bevel down

    Wasted cavitation
    Zero degree tip energy
    Make notes
    So many techniques..

    Quick Chop Divide &


    Conquer
    Choo choo Chop
    Carousel Technique
    Step down technique Stop & Chop
    Sculpt and Bowl
    Flip and chip Nagahara
    .... Hit and run Chop
    Which one is good for you?

    Learn ONLY one technique until 100 cases

    STOP & CHOP


    (Paul Koch, 1994)
    W H Y ?
    Stop and Chop

    We learn
    `
    how to sculpt & to chop..
    It is the basic of all techniques
    Develop others after mastering one technique
    Sculpting remove the most hard nucleus

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