Bimanual Microincision Cataract Surgery with Stellaris Advanced Flow Module

Mark Packer, MD, FACS Clinical Associate Professor Oregon Health & Science University

Financial Interest: Consultant-Advanced Medical Optics, Inc.; Advanced Vision Science, Inc.; Bausch & Lomb, Inc.; Carl Zeiss Meditec, Inc.; Carl Zeiss Surgical GmbH; Celgene Corporation; Gerson Lehman Group, Inc.; Ista Pharmaceuticals, Inc.;iTherapeutix, Inc.; Johnson & Johnson Vision Care, Inc.; Leerink Swann & Company; Sirion Therapeutics, Inc.; Transcend Medical, Inc.; Visiogen, Inc.; VisionCare, Inc.; WaveTec Vision Systems. Travel & Honoraria: Endo Optiks, Inc 1

Purpose
To

assess facility of use, safety and efficacy of the Stellaris Vision Enhancement System for bimanual microincision cataract surgery

Method
30

unselected eyes of 26 patients presented for cataract surgery Pre-existing pathology other than cataract

Pseudoexfoliation glaucoma Strabismus/amblyopia Epiretinal membrane Pigment dispersion syndrome

1 2 2 1 4
3

Previous

ocular surgery

S/P LASIK

Patient Profile
13

women, 13 men age nucleus 64.2 8.3 years 1.4 + NS

Mean Mean

Technique
Bimanual

microincision cataract surgery

Temporal clear corneal incisions, 1.4 mm

Trapezoidal diamond blade

20 g irrigating chopper, 30 straight phaco tip LRIs performed prior to IOL insertion
90% depth, 10 mm OZ, Nichamin nomogram

IOL implanted via 3rd incision, 2.2 2.8 mm

Machine Parameters

Phaco Chop

Phaco Flip
20 Linear Fixed burst Duration: 10 msec Interval: 30 msec 25

IA Cortex IA

IA Viscoelasti c Removal BI/COAX Hi speed

Cut rate: 1500 cpm (yaw to turn cutter on/off)

Vit Regular (pneum)

Cut rate: 600 cpm

Power %

20 Linear (waveform not enabled)

Mode

30 pps

Duty cycle % Vac (yaw for max) Flow Vacuum response Bottle ht In programs

30

125-325

250-325 30 fixed 2

500 linear NA

500 fixed 30

150 linear 30 fixed

150 linear 25 fixed

NA

140

140 Fixed flow Linear vac

140

140/80 Linear flow Fixed vac

75

50

Linear vac ACF

Linear vac

IOL Selection & Astigmatism

40%

Presbyopia correcting IOLs

45% ReZoom 36% crystalens 18% ReStor

53%

Cornea customized aspheric IOLs

56%Tecnis 25% IQ 19% AO

30%

Limbal relaxing incisions

8

Intra-Op Outcomes
Mean

surgery time start to end = 19.7 5.5 min effective phaco time = 0.77 1.58 sec

Mean

Average

phaco power = 2.04 2.25 %

9

Post-Op Outcomes
20/30

mean uncorrected acuity 2 24 hours post-op

Excluding eyes with pre-existing pathology and prior surgery 75% 20/40 or better 63% 20/30 or better 53% 20/25 or better 32% 20/20 or better

No

complications
10

Summary
30

consecutive eyes operated with the Stellaris,10/4/07 to 2/14/08. Mean age 64 years. Average nucleus 1.4+ NS. 40% had presbyopia correcting IOLs (45% ReZoom, 36% crystalens, 18% ReStor) 30% had LRIs 53% has corneal-customized aspheric IOLs (56%Tecnis, 25% IQ, 19% AO)
11

Conclusion

Stellaris

with advanced flow module is efficient, safe and effective for bimanual microincision cataract surgery

12