Phaco Fundamentals Part 1: Choosing Steps of Surgery
ฝัง
- เผยแพร่เมื่อ 23 มี.ค. 2019
- Every Wednesday, we are going to start a new module to teach Phaco Fundamentals of machine parameters, including fluidics and ultrasonic power delivery. Understanding how to set up the phaco machine and tailor it to your surgical technique is critical to the success of cataract surgery. The topics will get progressively more detailed and complicated, but we will start with just the basics.
All phaco platforms share the same basic structure and concepts. The phaco machine aims to balance fluidics within the eye, while delivering ultrasonic energy and vacuum in order to emulsify and aspirate the cataract through a small incision.
Cataract surgery can be divided into multiple steps, each of which benefits from optimized fluidic settings. Let's review the typical progression of steps:
Pre-Phaco is a setting used to aspirate some of the anterior cortex within the confines of the capsulorhexis in order to provide better access to the nucleus. Low flow, low vacuum, and low phaco power are used.
Sculpt is the setting used to create a groove or trench, using low flow, low vacuum and moderate phaco power, for techniques such as Divide-and-Conquer or Stop-and-Chop
Chop settings have much higher vacuum to provide holding power on the nucleus so that the phaco chop technique can be used. Quadrant removal settings are similar but may have higher flow rates to bring the nuclear pieces to the phaco tip.
Epinucleus settings are all about creating appropriate flow in the eye, which, along with moderate vacuum, can be used to aspirate the epi-nuclear shell
Cortex setting is for use with the irrigation / aspiration probe where we want high vacuum and moderate flow to grab and remove lens cortical material
Polish setting has low vacuum and low flow to help gently polish the capsular bag and in particular the posterior capsule with lower risk of iatrogenic damage
Viscoleastic setting is to flush out and aspirate the viscoelastic from the eye at the end of the surgery so it has a high flow rate in addition to a high vacuum level
Note that all surgeons will not use all of these settings. For example. in my typical routine cataract, I use just three settings:
Chop setting to break up and remove the lens nucleus
Cortex setting to aspirate the lens cortical material
Viscoelastic setting to flush out and remove any residual viscoelastic
Finally there are also settings which can be saved for unusual cases such as:
coagulation which is a cautery mode to help with hemostasis
anterior vitrectomy which is not used unless we have vitreous prolapse and capsular bag compromise
Very much needed, thank you sir.
Excellent lesson for phaco lovers
Waiting for them, special parts, thanks a lot our Coach
full series of 10 parts here:
cataractcoach.com/category/phaco-fundamentals/
That’s a very good idea thank you coach
I cant wait for the next video. Thank you sir.
Videos will be posted to CataractCoach.com every Wednesday starting in April 2019.
Thanks so much. :) very helpful video
Thanks nice .. Thanks Dr Uday
Thanks sir
Can you make the same video with infinity ozil? Thank you
Waiting part 2! 🤓🤓
full series here: (10 parts total)
cataractcoach.com/category/phaco-fundamentals/
thank you very much, this is an amazing tourtial, As a scrub nurse, Today I started working in the Eye surgery room and I need to learn more about this machine, how to set it up and make it ready for the surgeon. thank you.
thank you. you will find the full series here:
cataractcoach.com/category/phaco-fundamentals/
Hi Dr. Devgan, what is the size of the phaco probe you are using for these settings? 2.2 or 2.75? Thank you!
great question since the tip size affects the fluidic parameters. these are for 2.75mm wide incisions which are what we use when teaching residents.
DR Devgan, Can you spend time covering the topic of how to match the Phaco tip width/diameter with the correct Phaco irrigating sleeve and how to match all that
with the appropriate Phaco incision width ( keratome width) for the Centurion? Thanks.
yes, it is coming. Remember that these videos are part of CataractCoach.com which will have much more of the teaching. You should go there and every Wednesday starting this week we will have new material about phaco fluidics and power.
Thanks. I’ll watch em all. Just thought I’d put in a request to cover that specific topic at some point. P.s. I’m in alameda, former partner of David Bui. !!
Also, don’t mean to be a nudge but if I go to CataractCoach.com and search the list of videos I can’t find one called “Phaco fundamentals part 1 choosing steps of surgery.” But maybe that’s the way it supposed to be. I saw in another comment you seemed to say none of them will be posted there until April. So maybe that’s the answer.
One other question: will your videos as viewed on CataractCcoach be different or more extensive than the version posted here at TH-cam?
But suggesting the viewing of them at Cataract Coach is really smart because there’s such a enormous amount of incredible material available on your site. Major bravos to you for all you do!!!!
Thank you. Yes the video will be posted this week, Wednesday April 3
Centurion?
Sir such high Iop setting.
40 to 50 is usually good.
Please post a video of your surgeries for evaluation. Thank you.
Is it important to respect Position eye level also if we are operating with Active mode or only in gravity mode?
both -- for gravity mode the distance between the bottle height and the eye level is what is important. If you raise the patient's eye level by 20 cm (tall surgeon, for example) then you should raise the bottle height by 20 cm.
@@UdayDevgan thank you. For gravity mode that is pretty clear to understand since it works thanks to Stevino low. But for Active mode I thought it was different since the pressure is not managed directly by the force of gravity but from the centurion system itself. Am I wrong?
@@eliasdelogu2756 some machines have sensors which detect the IOP and then can raise and lower the infusion pressure actively and on the fly. However they also take data such as PEL (patient eye level on the Centurion) into account for these adjustments.
Is there a video about pedal movements and tricks while making phaco chop manuever ?
Which phaco machine r u using?
this video shows the Alcon Centurion. We also have multiple other machines including AMO/J&J and Bausch & Lomb.
Centurion is the most efficient phaco machine.
Кому заплатить, что бы перевели озвучили на казахском или русском языке