EyeWorld India December 2019 Issue

2 | ROLE OF FLUID DYNAMICS IN CATARCT SURGERY ΖQWUDRSHUDWLYH ȵXLG G\QDPLFV LQȵXHQFH WKH LQWUDRFXODU SUHVVXUH Ζ23 ȵXFWXDWLRQV DQG WKHUHIRUH WKH SRVWRSHUDWLYH RXWFRPHV LQ FDWDUDFW VXUJHU\ $ SURORQJHG LQFUHDVH LQ Ζ23 LV DVVRFLDWHG ZLWK DQWHULRU VHJPHQW LQȵDPPDWLRQ DQG Ζ23 ȵXFWXDWLRQV GXULQJ FDWDUDFW VXUJHU\ LQFUHDVH WKH ULVN RI SRVWHULRU FDSVXODU UHQW D SRWHQWLDOO\ VLJKW WKUHDWHQLQJ intraoperative complication. Constant measurement and maintenance of IOP during cataract surgery is therefore FUXFLDO 5HFHQW LPSURYHPHQWV LQ WKH VFLHQFH DQG WHFKQRORJ\ RI ȵXLG G\QDPLFV KDYH RSHQHG QHZ DYHQXHV IRU FDWDUDFW VXUJHRQV DOORZLQJ WKHP WR FXVWRPL]H ȵXLGLFV VHWWLQJV ZLWK ZLGHU UDQJH RI WDUJHW Ζ23V ZKLOH PDLQWDLQLQJ FKDPEHU stability. Active Sentry ® Handpiece Technology and Intrepid ® Hybrid Tip David Lubeck 3RVWHULRU FDSVXODU UXSWXUH 3&5 LV DVVRFLDWHG ZLWK SK\VLFDO HFRQRPLF and emotional consequences such as prolonged surgery, increased LQȵDPPDWLRQ QHHG IRU DGGLWLRQDO VXUJHU\ DQG GHFUHDVHG YLVXDO RXWFRPHV 3&5 FDQ RFFXU GXULQJ SKDFRHPXOVLȴFDWLRQ LUULJDWLRQ and aspiration, posterior capsule polishing, most commonly due to LQDGYHUWHQW FRQWDFW EHWZHHQ SKDFR WLS DQG FDSVXOH H[SODLQHG 'U 'DYLG /XEHFN DQ RSKWKDOPLF H[SHUW IURP $UERU (\H&DUH 86$ Active Sentry ® LV WKH ȴUVW DQG RQO\ KDQG SLHFH ZLWK D EXLOW LQ LQWUD RFXODU SUHVVXUH VHQVRU WKDW GLUHFWO\ PHDVXUHV LQWUDRSHUDWLYH Ζ23 LQ UHDO WLPH DQG FRPPXQLFDWHV ZLWK HQKDQFHG $FWLYH )OXLGLFV WR DFWXDWH immediate adjustments to maintain anterior chamber stability. 11 The ΖQWUHSLG ® hybrid balance tip is a polymer over-moulded titanium tip with no sharp metal edges, which reduces the likelihood of capsular WHDU 2QH ODE VWXG\ VKRZHG WKDW SKDFR SRZHU ZDV UHTXLUHG WR UXSWXUH D FDSVXOH ZLWK D K\EULG WLS FRPSDUHG WR RQO\ ZLWK D metal tip. 12 The combined Hybrid tip and Active Sentry™ technology provides 7KH FRPELQHG ΖQWUHSLG +\EULG WLS DQG $FWLYH 6HQWU\Ƞ WHFKQRORJ\ SURYLGHV VLJQLȴFDQW DGYDQWDJHV GXULQJ FDWDUDFW VXUJHU\ 7DEOH H[SODLQHG 'U /XEHFN Ȋ$ WHFKQRORJ\ WKDW XVHV D VDIHU SKDFR WLS DQG SURYLGHV VXSHULRU FKDPEHU VWDELOLW\ ZLWK OHVV VXUJHV ZLOO EH KLJKO\ EHQHȴFLDO LQ UHGXFLQJ WKH ULVN RI 3&5 7KDWȇV ZKHUH WKH $FWLYH 6HQWU\ ® KDQGSLHFH WHFKQRORJ\ DQG ΖQWUHSLG ® +\EULG 7LS FRPHV LQ WR SOD\ ȋ 'U 'DYLG /XEHFN Table 1: Advantages of Combined Hybrid tip and Active Sentry ® technology 1. $OORZV SKDFRHPXOVLȴFDWLRQ FORVHU WR WKH FDSVXOH 2. $OORZV KLJKHU DVSLUDWLRQ ȵRZ UDWH DQG YDFXXP 3. )DFLOLWDWHV VXUJHU\ DW SK\VLRORJLF Ζ23 4. 6LPSOLȴHV VXUJHU\ LQ KLJK ULVN DQG XQVWDEOH H\HV P\RSLD SDUV SODQD YLWUHFWRP\ RU WUDEHFXOHFWRP\ WUDXPDWLF FDWDUDFW 5. 'HFUHDVHV OLNHOLKRRG RI GDPDJH WR LULV LQ LQWUDRSHUDWLYH ȵRSS\ LULV V\QGURPH Ζ)Ζ6 DQG VPDOO SXSLO H\HV 7KH ΖQWUHSLG ® +\EULG WLS DQG $FWLYH 6HQWU\ ® WHFKQRORJ\ DOORZV WKH VXUJHRQ WR KDYH UHDO WLPH FRQWURO LQ WKH KDQGSLHFH WR IDFLOLWDWH VXUJHU\ DW SUHIHUUHG RU SK\VLRORJLF Ζ23 PDLQWDLQ FKDPEHU VWDELOLW\ DQG UHGXFH WKH ULVN RI FDSVXODU WHDUV WKXV LPSURYLQJ SDWLHQW VDIHW\ DQG VDWLVIDFWLRQ GXULQJ FDWDUDFW VXUJHU\ Active Sentry ® and dynamic real-time IOP measurements in rabbit eyes Abhay Vasavada * Kruskal Wallis Test used 'U $EKD\ 9DVDYDGD DQ H\H H[SHUW IURP WKH 5DJKXGHHS (\H +RVSLWDO LQ ΖQGLD SUHVHQWHG WKH DQHFGRWDO UHVXOWV RI KLV VWXG\ XVLQJ G\QDPLF UHDO WLPH Ζ23 PHDVXUHPHQWV LQ UDEELW H\HV FRPSDULQJ SKDFRHPXOVLȴFDWLRQ ZLWK WZR W\SHV RI ȵXLGLF V\VWHPV WKH $FWLYH ȵXLGLFVȠ ZKLFK R΍HUV Ζ23 FRQWURO WKURXJK SUHVVXUH VHQVRUV LQ irrigation and aspiration line; versus Active Sentry ® Handpiece, ZKLFK IHDWXUHV D EXLOW LQ SUHVVXUH VHQVRU WKDW UHDFWV LQ UHDO WLPH ΖW communicates with the hardware and software to compensate for FKDQJHV LQ WKH DQWHULRU FKDPEHU UHPDUNHG 'U 9DVDYDGD 7KH VWXG\ DLPHG WR UHFRUG UHDO WLPH G\QDPLF Ζ23 GXULQJ QXFOHXV UHPRYDO XVLQJ WZR W\SHV RI DFWLYH ȵXLGLF V\VWHPV DQG DOVR FRPSDUH WKH WLPH WDNHQ WR UHFRYHU WR EDVHOLQH Ζ23 IROORZLQJ RFFOXVLRQ EUHDN VXUJH LQ ERWK V\VWHPV 6WDQGDUG VXUJLFDO WHFKQLTXH ZLWK VWDQGDUGL]HG Ζ23 DQG YDFXXP VHWWLQJ ZDV XVHG LQ ERWK JURXSV :KLOH $FWLYH ȵXLGLFVȠ ZDV DVVRFLDWHG ZLWK ODUJHU Ζ23 ȵXFWXDWLRQV ZLWK ZLGHU VORSH WR UHFRYHU\ IURP GURS RI Ζ23 $FWLYH 6HQWU\ ® was associated with VPDOOHU Ζ23 ȵXFWXDWLRQV ZLWK QDUURZHU VORSH WR UHFRYHU\ IURP GURS RI Ζ23 7KH Ζ23 GXULQJ IUDJPHQW UHPRYDO DQG UDWH RI GURS RI Ζ23 following occlusion break response was lower in the Active Sentry ® JURXS )LJXUH 7KH UDWH RI UHFRYHU\ RI Ζ23 IROORZLQJ RFFOXVLRQ EUHDN response was also faster with Active Sentry ® . Group Mean (+ SD) IOP (mmHg) % Reduction from Maximum IOP (Mean) *URXS Ζ Ȃ &HQWXULRQ 9LVLRQ 6\VWHP 53.6 + 7.2 35 *URXS ΖΖ Ȃ $FWLYH 6HQWU\ ® ZLWK &HQWXULRQ 9LVLRQ 6\VWHP 51.7 + 6.6 31 3 9DOXH 0.05 0.03 * Kruskal Wallis Test used Figure 3: Lower IOP and lower rate of drop of IOP following occlusion break response with Active Sentry ® $FWLYH 6HQWU\ ® SURYLGHV WKH VXUJHRQ ZLWK FRQWURO DW ȴQJHUWLSV WR ORZHU DEVROXWH Ζ23 DQG IDFLOLWDWH EHWWHU PLWLJDWLRQ RI RFFOXVLRQ EUHDN VXUJH GXULQJ FDWDUDFW VXUJHU\ Ȋ$ WHFKQRORJ\ WKDW DOORZV WKH VXUJHRQ WR SUHVHW ORZHU Ζ23V DQG PLWLJDWH LQWUDRSHUDWLYH Ζ23 ȵXFWXDWLRQV LV DGYDQWDJHRXV GXULQJ FDWDUDFW VXUJHU\ 'U $EKD\ 9DVDYDGD