PHACODYNAMICS

Pande Made Gustiana

Divisi Katarak dan Bedah Refraktif

Rumah Sakit Mata Bali Mandara
UNDERSTANDING PHACOEMULSIFICATION
➤ Phacoemulsification is a dynamic procedure requiring understanding of the:
➤ Machine
➤ The functions of the machine
Machine
The machine consists of the:
• Console
• Foot pedal
• Handpiece and their connections.
Console
• Consists of a computer which controls all the functions of the machine.
• The setting for the various parameters, i.e. power, vacuum and flow rate
Foot pedal
• The main part of the foot pedal controls irrigation, aspiration and
phaco power.
• Position 1 produces irrigation, whereas position 2 engages the
aspiration mode at a constant or variable rate. Position 3 adds phaco
power at a variable or fixed level.
• When fixed, the power level may be set from 0% to 100%, and the
chosen power level is delivered immediately when the foot pedal is
depressed to position 3.
Handpiece
There are two types of handpieces:
• Phaco handpiece
• Irrigation aspiration handpiece.
PHACODYNAMICS
➤ Definition
➤ The various functions of the phaco machine and their inter relationship

➤ Basic Functions of phaco machine:

➤ Ultrasonic power
➤ Irrigation and aspiration system
ULTRASONIC POWER
➤ Phaco power is generated by vibrations of quartz
crystals in the hand piece.
➤ Quartz is silicone oxide and is peizoelectic: That
means if you squeeze a quartz crystal, it generates a
tiny electric current.
➤ The opposite is also true: if you pass electricity
through quartz, it vibrates at a precise frequency.
ULTRASONIC POWER
➤ The frequency of quarz crystal vibrations is variable from
29–60 KHz in different machines.
➤ High frequency of vibrations (from more quartz crystals
or more electric power) results in better cutting but may
result in more heat generated.
ULTRASONIC POWER
• In each machine the vibrations (oscillations) are fixed
but the power is modulated by changing the stroke
length (axial or torsional).

• Power = oscillations (fixed/constant) x stroke length

Energy: power x time

Mechanism Of Emulsification

Jack Hammer effect: The

Is a combination of: rapid to and fro movement of
➤ Jack-hammer: Mechanical bombarding of the tip bombards the tissue in
front and disintegrates it
the tip (axial or torsional).
➤ Cavitation: Mainly by axial movement of
Cavitation phenomenon:
the tip. The frequency of oscillation
is 40,000/ second. The
➤ The forward movement of the tip also swift backward movement
of the tip results in a
generate an Acoustic wave of fluid: From cavitation phenomenon
causing an implosion of
the forward (little with tortional) movement surrounding tissue.

of the tip pushing fluid away which can

integrate soft lens matter.
Phaco Tip
➤
The angulation of the tips may vary from 0–60°.
➤ The higher the angulation the lesser the holding power
and the more the cutting.

➤ For divide and conquere: use 45° (trenching is

important)
➤ For stop and chop: use 30° (holding is very
important).
Power Delivery
➤ Power = oscillations (fixed) x stroke length
➤ Two modes for power delivery:
1. Surgeons mode (A.K.A linear /continuous):
the power varies from 0 - maximum Phaco power

according to the depression in the foot pedal

Extent of depression of position 3
in position.

2. In the panel mode: power is maximum in all Phaco power

of position 3.
Extent of depression of position 3
 Power Delivery
➤ Variations of the continuous mode include
pulse mode: variable intervals of on and
off at a particular phaco power (equal
on and off time).
➤ Variation of the panel mode include the
burst mode, however, now can be also made
into a linear mode: Depression on the foot
pedal in position 3 varies the time between
the intervals.
➤ Both are aimed at decreasing the absolute
phaco time (energy) as well as using the
vacuum to help with removal of the cataract.
Fluids
➤ Fluidics in phaco refers to the integrated system of irrigation and aspiration
where the A/C volume is kept stable.
➤ Phaco has a major advantage over ECCE in that it is performed in a closed system
thus avoiding damage to the cornea, iris…etc.
Irrigation
➤ Consists of a bottle, the height of which provides the gradient

for flow. The tubing from the bottle is run through a pinch valve
which is controlled by the foot pedal.

➤ The inflow of balanced salt solution into the eye is governed by

the pressure gradient at the tip of the phaco probe: that is the
pressure difference between the positive pressure created by the
bottle height (gravity) and the negative pressure created by the
aspiration port.

➤ Newer machine have an active infusion where there is a sensor at

the phaco tip. This allows active control of the IOP during the
surgery.
Aspiration
➤ To emulsify the cataract: Figure 1

1. There needs to be lavage (sucking) of the cataract to the tip of Phaco Foot Pedal Function
the phaco probe: This is governed by the flow rate.
Irrigation = 1
2. Holding power of the cataract to the phaco tip so it does not slip Aspiration = 2
away: This is governed by the vaccum created by the phaco
Ultrasound = 3
machine.

➤ Therefore there are two types of aspiration systems

(pumps):
1. Flow based system: Peristaltic
2. Vacuum based system: Venturi
Venturi
➤ Direct control of the vacuum and indirect
control of the flow rate.
➤ The amount and speed of gas through the
tubing governed by the depression in
position controls the amount of vacuum and
thus flow rate.
➤ The relationship of the vacuum created to the
flow rate is not linear (modified by the port
size and tubing).
➤ The advantage of this system is that the
vacuum is directly transmitted to the tip from
the system ensuring a better followability.
Peristaltic
➤ Direct control of the flow rate and indirect
control of the vacuum (only max can be set).
➤ Flow rate is the amount of fluid aspirated from
the A/C per unit time.
➤ The rollers compress the silicone tubing to
withdraw the fluid in the drainage bag. The
larger the depression in position 2 the faster the
movement of the rollers and thus higher flow
rate.
➤ Vacuum is only built up when the tip is occluded
and negative pressure builds inside the tubing.
Flow Rate In Peristaltic
➤ Normally between 20-36 cc/min
➤ What happend if flow rate is slow?
➤ Slow surgery and flowability to the tip is decreased
➤ What happens of flow rate is too fast?
➤ Surgery will be uncontrolled and cataract pieces may slip away as the rollers
may slip from the tubing decreasing the effectiveness.
Thank You