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Infiniti and OZil™ Torsional Technology
Evolution to the Present
Con N. MoshegovFRANZCO FRACS
Sydney
Alcon Legacy
Alcon InfinitiAlcon Infiniti
Fluid Management SystemFluid Management System
Maximising AC maintenance and holdability of the Infiniti
FMS has two major components
1. Dual Sensing Technology1. Dual Sensing Technology
Irrigation pressure sensorIrrigation pressure sensor
Vacuum pressure sensorVacuum pressure sensor
Improved anterior chamber stabilityImproved anterior chamber stabilityExcellent holding abilityExcellent holding ability
2. Rigid Fluid Paths2. Rigid Fluid Paths
Mechanism of Occlusion BreakMechanism of Occlusion Break
Unobstructed flow
Full occlusion
Occlusion break
AquaLaseTM Technology
• Fluid pulses propelled in front of tip Fluid pulses propelled in front of tip to delaminateto delaminatetissue tissue 4 microlitres 4 microlitres ~60º C~60º CUp to 50 ppsUp to 50 pps
• No mechanical touching of tissue as No mechanical touching of tissue as in phacoin phaco
• No mechanical motion of the tip as No mechanical motion of the tip as in phacoin phaco
AquaLaseTM: indications
Perfect for clear lens extraction
Extremely good for soft cataracts:– cortical– posterior subcapsular– posterior polar– nuclear sclerotic up to 2+ (0 to 4+)
But: not good for harder nuclei
Different instruments and techniques for various nuclei
Even with Traditional Phaco SettingsEven with Traditional Phaco Settings
Depending on density of cataracts the following are modified for each situation:
• Power• Vacuum• Aspiration flow rate• Pulse and burst settings• Bottle height
Traditional Phaco SettingsTraditional Phaco Settings
The parameters are also modified depending on technique:• Divide and conquer• Pre chop• Stop and chop• Chop
Some surgeons use different settings depending on whether they’re up to 1st, 2nd or 4th quadrant
OZil™
Torsional PhacoemulsificationTorsional Phacoemulsification
Exclusive energy modality on the Exclusive energy modality on the
INFINITI™ Vision SystemINFINITI™ Vision System
OZil
For me:
One set of parameters for all densities of cataracts
Like an automatic gear box after driving a manual
Sculpt Screen – Torsional Only
100% amplitude linear for most densities
Quadrant Removal Screen: very dense nuclei
10% ultrasound power and 100% amplitude for dense lensesProbably only an occasional situation
Fixed ratio of 20 ms ultrasound then 80 ms torsional
to 10% to 100%
Torsional Ultrasound
Shearing effect
More efficient than the jackhammer effect
No repulsion since the tip is not moving toward the lens
StraightStraight
KelmanKelman
Useful only with Kelman (bent) tips
Kelman bent tip
Cutting movement at the tip is a side to side action
Small rotational displacement at wound but bigger rotational displacement at tip
Amplifies the distal tip movement
Incision
NeoSoniX™
LEGACY® 375/40
OZil™ Torsional
INFINITI™ U/S
Handpieces
Torsional PhacoemulsificationTorsional Phacoemulsification
Oscillatory motion works at a frequency lessOscillatory motion works at a frequency less
than traditional ultrasound.than traditional ultrasound.
– Longitudinal phacoLongitudinal phaco 40,000Hz40,000Hz
– Torsional phacoTorsional phaco 32,000Hz32,000Hz
– NeoSoniX NeoSoniX 100 Hz100 Hz
Longitudinal Slow Motion
Torsional Slow Motion
100% Torsional amplitude vs. 100% ultrasound power7.5 seconds with sealed incision and no irrigation or aspiration flow
OZil Studies
20% Less irrigation solution used– Less turbulence → Less egress of OVD?
OZil Personal Observations
• Transition to Kelman bent tip not as difficult as one would imagine
• Actually easier to operate on deep set eyes with it• Mechanical advantage in cracking (rotation of fingers)• Facilitates posterior extension of groove• Can angle shaft up a little if concerned (ie hold handpiece
more parallel to ground)• Can have bevel pointing to the side (laterally and medially)
OZil Personal Observations
• The feel of an OZil handpiece is no different to present Infiniti handpiece
• OZil is actually very quiet compared to US• No problem if soft (or even clear) lens• No effort involved in transition to torsional
• Ask your rep to substitute an OZil handpiece for your existing one, set machine to 100% continuous torsional and just proceed as normal
Taking OZil a step further:Microincisional Phaco
Small incision clear corneal surgery is desirable because:
Causes less induced astigmatismPossibly reduces risk of endophthalmitisQuicker stabilisation of final refraction Potentially better AC maintenance
Prospective evaluation of early visual and refractive effects with small clear corneal incision for cataract surgery.
Lyle WA, Jin GJC. J Cataract Refract Surg 1996; 22: 1456-60
Surgically induced astigmatismSurgically induced astigmatism
Microincisional PhacoMicroincisional Phaco
Two methods of microincision cataract surgery available:
Bimanual
Coaxial
Co-axial Microincisional Phaco
OZil™ Torsional Technology is possible through a 2.2mm incision using ‘Ultra Sleeve’
Any single piece AcrySof IOL can now be implanted through an unenlarged 2.2mm incision
Minor alterations to usual technique required– CCC– IOL implantation
Intrepid FMS
• Includes New Products designed specifically for the micro-coaxial procedure
• Less compliant narrow wall aspiration tubing
Available in Q1 2008
Occlusion Recovery ComparisonOcclusion Recovery Comparison
Recovery Time
mm
Hg
Occlusion Break SurgeOcclusion Break Surge
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
20.0
200 250 300 350 400 450 500 550 600
ASPIRATION VACUUM (mmHg)
Note: All testing conducted as primed with 0.9mm MicroTip and sleeve.Data on file
S
UR
GE
AR
EA
(m
mH
g*s
ec
)
Existing FMS Intrepid FMS
MONARCH® D Cartridge
Lockout Feature
30% smaller nozzle size than Monarch® C cartridge
D C
~ 33% reduction vs. ‘C’ nozzle tip
BA
D
C
Monarch III ‘D’ Cartridge & H4 (blue) Injector
Monarch II ‘C’ Cartridge & H3 (green) Injector
Very similar to the Very similar to the MonarchMonarch®® II (Green) Injector II (Green) Injector
Blue color for ease of identificationBlue color for ease of identification
Same ergonomic feelSame ergonomic feel
Same threads and lens advance rateSame threads and lens advance rate
Smaller plunger tip to accommodate the smaller Smaller plunger tip to accommodate the smaller MonarchMonarch®® D cartridge D cartridge
MONARCH® III Injector
I’ll bet…OZil™ Torsional Technology will prove to be a most popular method of phacoemulsification
Better efficiency and improved followability
Safer thermal profile
Utilized across all lens densities
Requires no change in technique
Goes well with microincisional surgery
Bimanual MICS will fall in popularity
So where does this leave AquaLase?
AquaLase – Future DevelopmentsAquaLase – Future Developments
Can’t compete with Ozil incision widths but…Can’t compete with Ozil incision widths but…– Micro Incision Tip coming: compatible with 2.2 mm Micro Incision Tip coming: compatible with 2.2 mm
incisionsincisions
May have specific applications May have specific applications – for cortex and LEC removalfor cortex and LEC removal
Looking ForwardLooking Forward
4+3+
2+1+
CortexCapsule cleaning
LEC Removal
OZilMicroCoaxial
AquaLaseMicroCoaxial
No financial interest in any of the products No financial interest in any of the products mentionedmentioned
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