Alcon phaco instruments

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In addition, here are general guidelines for disinfecting surfaces. If there are alcohol-sensitive lasers in the room these should be powered off during disinfection. Use disposable gloves and wipe the surfaces of the device. Higher alcohol percentage can remove paint and sticker adhesive. Let the alcohol dry for 1 minute. Cover alcohol bottle after use to prevent the solution to absorb water in the air that will decrease alcohol percentage.

Discard used paper towels and gloves accordingly. Clean hands immediately after gloves are removed. Here are our recommended cleaning and disinfecting solutions for Alcon devices. I am a Patient or Consumer. What precautions should be taken before cleaning and disinfecting? Park emphasizes selecting the right pulse rate and duty cycle for the right circumstances. During sculpting, for example, energy creates a groove and, therefore, higher pulse rates tend to work better because the narrower time intervals between pulses produce a smoother delivery of ultrasound energy.

For quadrant removal, she says, a lower duty cycle tends to be a better choice most of the time because a long interval between pulses allows for the aspiration of nuclear fragments.

Burst, the third mode, also helps in special situations. The more the pedal is depressed, the shorter the off period is between each burst. In other words, the bursts of energy are delivered more rapidly as the pedal is depressed.

At the maximum point of depression, the time between bursts becomes infinitely smaller and essentially constitutes a continuous delivery of energy. The vacuum and fluidics of the phaco machine are used to aspirate the cataract fragments and give small bursts of power only when necessary, she notes. Long pulse mode is a to millisecond pulse duration. Remember Your Parameters Dr.

Auran, also the surgical curriculum director for the Columbia University ophthalmology residency program, says intelligent use of phaco parameters is essential. Increased IOP also stabilizes the chamber, especially in the presence of high aspiration and vacuum or when leaking incisions are involved.

We can minimize post-occlusion surge in these situations. Auran points out that, according to in vitro data, increasing the IOP to as high as mmHg in the Alcon Centurion system can make the machine more efficient. Auran notes that vacuum varies when the phacoemulsifier is turned on, requiring you to use vacuum for aspiration only. Quick taps of the tip will advance the tip deeper into the nuclear fragment, enabling a firmer hold.

Auran says you can ensure the best use of vacuum to hold a lens, capsule or iris against the instrument tip. Increasing vacuum can also increase phaco efficiency in some machines, to some extent. Meanwhile, a very high vacuum setting decreases efficiency, 6 but does allow for the aspiration of soft and medium pieces of the nucleus, which can be aspirated with minimal or no phaco power, notes Dr.

Meanwhile, when you increase aspiration you increase phaco efficiency, Dr. Auran points out, noting that high aspiration can help with sticky material, such as the epinucleus and cortex, and for viscoelastic removal. However, high aspiration can also be risky.

Appreciating Variable Power Dr. Auran says increasing phaco power generally increases efficiency. Higher power can increase the risk of corneal injury, wound burn, iris damage and capsular rupture. Are there any other approaches to increase efficiency? One example, Dr. Park points out, is limiting power to prevent excessive heat build-up. She also urges you to use the innovations in phaco technology that augment longitudinal phaco, when indicated.

Remember that transversal ultrasound helps emulsify the nucleus in more than one direction, increasing cutting efficiency. The main advantage of torsional phaco is increased energy efficiency, but the main disadvantage is significant tip movement. Note that transverse and torsional phaco are proprietary. Figures 4 and 5. When performing an anterior vitrectomy during cataract surgery, James D. Auran, MD, recommends removing the vitreous at 4, cuts per minute and aspirating fluid in the third pedal position.

For lens removal with the vitrector, make careful adjustments to draw the lens pieces away from vitreous without aspirating the vitreous while slowing the cut rate to to cuts per minute, he says. This opens the cutter port enough to produce sufficient aspiration and vacuum to engage the lens pieces. Meanwhile, remember that specific phaco units perform differently.

Auran adds. The Whitestar Signature Pro, when used with longitudinal power and a degree bevel straight tip, increases efficiency up to percent. Efficiency is optimal at 90 percent power in the transverse mode with a cm bottle height and vacuum at mmHg.

Auran explains how phaco modes can help keep your surgeries safe, efficient and responsive to the needs of varied patients. Unlike torsional or transverse power, longitudinal power will likely draw the nucleus toward the tip. The chop mode is for holding the lens, he continues.

Some surgeons go right to quad, drawing pieces of the lens toward the phaco tip, relying on increased aspiration and vacuum and as much phaco power as needed.

The torsional or transverse modes, less likely to repel nuclear particles, might be best. Epinuclear settings are for handling the rubbery outer layer of the nucleus, again with moderate to high vacuum and aspiration, as needed, with minimal or no phaco power and high IOP to push the capsule posteriorly, as appropriate, he notes.

To prevent this, elevate the IOP, pushing the capsule bag back and making it taut. When engaging and stripping cortex in the periphery, use moderate vacuum and high aspiration. Once cortex has been drawn into a safe area in the center at the iris level, increase aspiration and vacuum to aspirate cortex.

Polish is best used with a silicone tip, according to Dr. It involves very low settings while you keep the pressure high and capsule taut.

Very low vacuum and aspiration are indicated to gently remove cells while minimizing the risk of aspirating capsule material. Viscoelastic can be used to viscopolish the lens capsule.

Removing viscoelastic requires the same settings as for the epinucleus, including high IOP to keep the capsule away from your tip and increased vacuum and aspiration to remove the viscoelastic. Figure 6. Auran emphasizes the need to prepare for an unexpected complication. Lower the IOP to nearly zero before withdrawing the tip. Halt all irrigation.

Wiggle your sideport instrument sideways within the incision to potentiate controlled fluid egress from the sideport. Then withdraw the phaco tip quickly through the main incision, taking care not to depress the base or lift the roof of the incision while withdrawing the instrument.

For an anterior vitrectomy, Dr. Auran repeats common words of caution: Never pull on the vitreous. These settings allow you to apply minimal traction to the vitreous.

For lens removal with the vitrector, Dr. Auran recommends drawing the lens pieces away from vitreous. You may need to apply the vitrector port directly against the lens piece using irrigation only , then apply vacuum and aspiration to engage the piece, carefully pulling it into a safe zone, he says.

Lens removal requires a much slower cut rate to per minute , allowing the cutter port to open wide enough to produce sufficient aspiration and vacuum to engage the lens pieces.

For a peripheral iridotomy, Dr. Other Potential Challenges A few other potential challenges might include a chamber collapse in a normal-pressure eye, Dr. Auran says. A lot of fluid escapes through the sideport, so removing or angling your sideport instrument may help.

Matching the diameter of your sideport instrument with the sideport as well as hydrating or suturing the incisions may also help. Watch out for high phaco power, as well, he warns.

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