Dr.

Prathibha

 

Console, foot pedal and hand piece.with the connections The console computer based controls the functions of the machine Settings of parameters flow rate, power, vacuum are preset and represent the maximum level that will be achievable during phaco by the surgeon Multimodel panel diplay Memory button- surgeon setting saved

 

2 types- phaco and irrigation Phaco hand piece- piezoelectric crystals(2-6)

Central part and side clicks Controls the infusion, aspiration and the phaco power 2dentations 3 excursions- I/IA/IAP Tactile feedback Auditory feedback

During the irrigation the pichvalve opens and irrigation is switched on- no pressure gradient:on/off I dentation- nuclear rotation, manipulation of nuclear fragments, epinuclear plate etc..require irrigation with no aspiration IA-irrigation +aspiration IAP excursion: the phaco energy intially zero ->reachs the preset level with foot pedal at the end of full excursion The phaco energy delivery is linear in both surgeon mode(phaco1) and pulse mode(phaco 2) Panel mode or the burst mode- energy is delivered as soon as the foot pedal is into IAP(step 3)

   

Side kick functionsReflux button Vitrectomy Continuous infusion mode

The various functions of the the machine and it inter relationship with all parametersdynamics 2 main functions of machine- emulsificationprovides ultrasound energy and aspiration of the materialmet with irrigation and aspiration Irrigation aspiration- the parameter on which they depend is fluidics

Phaco needle movement creates mechanical power. Total power is a combination of the frequency of the needle movement and stroke length. Power generation Produced in the hand piece by the ultrasound vibrations of piezoelectric crystals 2-6 in number. Stroke length-Tip excursion or stroke length is defined as the distance the tip displaces in the longitudinal direction at maximum power. Stroke length varies for different machines and normally ranges from 1.5-3.75 mille-inches. Frequency- 29-60KHz; most common 40KHz Each machine frequency is fixedso power altered with stroke length 2/1000-6/1000 of inch

Jack hammer effect Cavitation

Angulation-0-60 degree 60 0 ,450 ,300 , 150 and 00 More the angulation less the holding power..more cutting power 30 and 45 deg tip preferred for divide and conquer

Surgeon mode/linear Panel mode Pulse mode Burst mode

Refers to the integrated functions performed by infusion and aspiration systems by which a stable AC is maintained Advantage closed chamber maintaining a stable AC depth prevents damage to the cornea , iris and PC

Bottle with BSSheight of this creates a gradient for flowgravity fed The tubing from the bottle leads to a pinch valve which id controlled by the foot pedal Gravity fed.2 feet= 44mmhg of pressure Increasing the bottle height increases the flow and pressure- zonular stressiris prolapse..miosis

2 functions lavage of AC and creation of hold for emulsification and crushing the fragments of nucleus Lavage or clearing of AC is flow rate governed Hold is a function of vacuum Aspiration system has a Pump of the machine flow based- peristaltic Vacuum based- venturi

The rotation of the rollers by the pump pinches the soft silicon tubing's creating a negative pressure by squeezing the fluid out of the tube. The faster the rollers rotate the higher the flow rate The flow rate and the vacuum are set independently..the vacuum builds up only after occlusion

It determines how fast the things happen in the eye- cc/min

It is generated by the machine and is a measure of the strength of the hold that the hand piece has on the nucleus- holdability Level of vacuum and port size determine the hold Holding power is inversely proportional to the port size Vacuumnucleus,cortex,chopping,aspiration,I&A

The time taken by a machine to reach the preset maximum vacuum after occlusion In peristaltic depends on the vacuum after occlusion also on flow rate In venturi- linear, fast and preset vacuum dependent not on flow rate

Area within CCC Peripheral unsafe zone Capsular fornices and angle region

Poitive presure of infusion and negative pressure of aspirationcreate pressure gradient around the tip.eddy curren..area in the eddy current zonezone of followabilty.tendency of the nuclear fragments th come into the tip Area of highest followability in front of the tipas go away from the tip no followabilty

Indian journal of ophthalmology:1997/45/issue4/page241-249 Textbook of ophthalmic surgery- Dr.Steinert CME series- volume 21