PHACODYNAMICS
MODERATOR: DR CHINMAYEE
PRESENTER: DR ANJALI H
OUTLINE
• History
• Introduction
• Components- ultrasonic
-fluidic
• Power of phaco
• Needle and hand piece
• Aspiration systems
• Surge
• Venting
• Applications
History
• February 1965 CHARLES KELMANN: ultrasonic
tool to fragment the crytalline lens.
• First surgery:3hours,aphakic,rigid IOL.
• 3 developments :technological progress
:new surgical technique
:foldable IOL
Introduction
• Goal of phacoemulsication:
• To remove cataract through a small incision to
achieve rapid visual rehabilitation.
Three factors
Biometry
Surgical skills
• Application of principles of phacodynamics
Basic functions of phaco machine
• Ultrasound emulsification
• Irrigation
• Aspiration
Foot pedal functions
• Perfect functioning of this pedal is crucial to
the success of the procedure
Foot pedal positions
Phaco comprises of 2 components
• Ultrasonic energy
• Fluidic circuits
Ultrasonic power
• Piezo electric
• Magnetosrictive
MAGNETOSTRICTIVE HAND PIECE PIEZOELECTRIC HAND PIECE
Electric current induces electric energy, translates into
magnetic field oscillations
Less efficient power generation More efficient power generation
Heats up more readily Heats up slowly
Heavy Light weight
Less cost More costly
Unbreakable Fragile
Power of phaco
• Ability to destroy lens nucleus
• Depends on: 1. Amplitude
2. Frequency
3.Coupling force
Amplitude
Stroke length: penetration of the tip into nuclear
mass with each oscillation
Frequency
• Determines how much of amplitude will be
transformed productively into penetration
Coupling force
This can be achieved by:
*Pressing against the nucleus
*Aspirating
*Pressing the nuclear fragment
with the second instrument
Phaco needle tip
-Distal opening:
aspiration port
Silicon sleeve
-Irrigation fluid flows
through 2 ports located
180◦
Silicon hub
Ultrasonic hand piece
Phaco needle tip
• Titanium Tip
• Usual Frequency 40 KHz
• Usual Amplitude 3/1000 of an inch
• Piezoelectric Quartz Crystal
• Diameter (19 G-0.9mm,20G-0.6mm)
• Bevel angle (0,30,15,30,45)
Phaco needle tip design
Sleeves
•Made of silicon material which
covers the phaco tip
•It protects the cornea and iris
from transmitted heat energy by
the probe.
Mechanism of action of phaco
• Mechanical impact of tip against nucleus
• Jackhammer effect
• Acoustic waves
• Cavitation phenomena
Jack hammer effect
Acoustic shock
waves
Cavitations phenomena
Tortional ultrasound
•Produces a side-to-side motion of the
phaco tip
•Reduces the repulsion of nuclear
material from the phaco tip.
Phaco hand piece terminologies
• Phaco power: ability of hand piece needle tip
to cut/emulsify cataract.
• Directly related to 1. stroke length
2. frequency
3. efficiency of hand piece
Phaco modes
• Constant mode: sculpting the nucleus
• Pulsed mode: used in the direct chop of nucleus.
• Hyper pulse mode: allows to vary duty cycle.
-Soft cataract:low duty cycle 15-20%
-Hard cataract:phaco energy is increased with DC
25-33%.
-Large cooling time after each phaco:COLD PHACO
Various modes
Duty cycle
Pulse mode
Power can be delivered in various
modes:
• Burst mode:This mode provides a surrounding
tight seal around the nucleus.
-Individual bursts of phaco are ideal for
impaling and gripping dense nuclear material
for chopping.
• Occlusion mode: Ability to change pump
speed & power modulation pre and post
occlusion
Phaco modes..
Maximum phaco power
• Maximum obtainable ultrasonic energy when
foot pedal control is fully depressed
Actual phaco power
• Power actually delivered at a given time
proportional to foot pedal position.
Effective phaco time
• Total phaco time at 100% phaco power.
• Less EPT: Less energy delivered to the eye thus
reducing side effects
Fluidics
• Balance of fluid inflow and fluid outflow
• Irrigation system: inflow : bottle height
Outflow : sleeve-incision relationship.
Balanced AC dynamics:
irrigation=aspiration+leakage from wound
• Aspiration system:flow rate:How well
particulate matter attracted to phaco tip.
Irrigation system and bottle height
A. Bottle height
B.Fluidity of the eye
C.Evacuation pump
D. Exit fluid.
Aspiration systems
• Flow rate: quantity of fluid pulled from eye
per minute through irrigation tip.
• Vaccum : negative suction pressure created by
the pump.
Aspiration pumps
• Peristaltic pump
• Venturi pump
• Diaphragmatic pump
Peristaltic pump
Rollers
Compression of the tube
in peristaltic manner
Rotation of the pump
Milking action of the fluid
column
Venturi pump
Diaphragmatic pump
Comparison of pumps
Peristaltic Venturi
Flow based Vacuum based
Vacuum created on occlusion of Vacuum created instantly via
phaco tip pump
Flow is constant until occlusion Flow varies with vacuum level
Drains into a soft bag Drains into a rigid cassette
Rise time
• Amount of time required to attain a given
level of vacuum
• Speed with which the maximum value of
vacuum is reached, once the aspiration port is
occluded
• Rise time ∝ AFR ∝ Pump speed
Rise time v/s pump design
How does it imply??
• Rapid Rise Time :
• Less surgical time
• Machine responds fast
• Infusion should be adequate
• Surgeon needs to have quick reflexes.
• Margin of safety is less.
Surge
• Sudden cessation of occlusion
• Occlusion High vacuum Occlusion
broken Fluid gushes into Phaco tip
Exceeds inflow capacity of irrigation line
SHALLOW AC
Surge
• means collapse of A.C after occlusion breaks
HOW TO PREVENT SURGE??
•Decrease vaccum
•Decrease flow rate
•Stiff and short tubing
•Tighter wounds and raising
bottle height
•Aspiration bypass system
Aspiration bypass system
Venting
•Breaking of
vaccum
•Air venting
•Fluid venting
Venting system
• To break the vacuum
Air Fluid
high time delays for detecting low time delays detection for
vacuum change vacuum change
Responds slowly to Responds faster to
compensate vacuum surge compensate vacuum surge
Air venting increases Compliance is less in a system
compliance of the system, with fluid vents with lesser
which surge as a result
increases surge
Central safe zone
Area within the CCC margin where phaco can be done safely
csz
Peripheral unsafe zone
Applications
• Phaco-emulsification
-Sculpting / Trenching
-Segment / Quadrant removal
-Epinucleus removal
• I /A - Cortex removal
Parameter setting
• Stage of surgery
• Experience of the surgeon
• Machine characteristics
Sculpting
• Power- 60 - 70%
• AFR -16 - 20 ml/min
• Vacuum- 0 - 30 mm Hg
Segment / quadrant removal
• Power- 40 - 50%
• AFR -24 - 26 ml/min
• Vacuum -100 - 400 mm Hg
Epinucleus removal
• Power 10 - 30%
• AFR 26 - 30 ml/min
• Vacuum 200 - 400 mm Hg
Cortex removal
• Power- Zero
• AFR -24 - 26 ml/min
• Vacuum -400 mm Hg
Parameter settings
AFR VACCUM POWER BOTTLE
HEIGHT
Central 20-25/min 0-15mm Hg 60-70% 25cm
sculpting
Chopping 25-30/min 100- 50-60% 75cm
200mm Hg
Quadrant 25-30/min 100mm Hg 50% 65cm
removal
Epinucleus 30-35/min 70-100mm 10% 75cm
removal Hg
Cortex 25-30/min 400mmHg - 65cm
aspiration
Successful phaco…
• Know your machine!
• Supervised training
• Proper patient selection
References …
• MYRON & YANOFF DUKER’S
OPHTHALMOLOGY. 3rd edition
• Physical and mechanical principles of
phacoemulsification and their clinical
relevance L.Yow S Basti
Alcon Laboratories, Irvine, California, USA .IJO
• Phacoemulsification Agarwal .4th edition
• Phacodynamics-Barry S Seibel. 4th edition
