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Instrumentation

By Dr Lewis Levitz
Monday, October 29th, 2012

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Alcon Centurion Versus Alcon Infiniti Phacoemulsification machines

In 2014 I started using the Alcon Centurion phacoemulsification machine instead of the Alcon Infiniti machine. The change was smooth but there were a few small adjustments that had to be made.

The main adjustments to be made were as follows:

A.  Differences in the Foot pedal.

Foot pedal of the Infinity Phacoemulsification machine (pic 1)

pic--1-Infinity-footpedal

Advantages

  • There is a clip that allows one to adjust the size of the pedal for both large and small feet.
  • It has side “cushions” which hug the sides of the foot pedal. This allows for a very rapid sidewise swipe. This is intuitive and affords great safety as one can immediately generate a reflux in the suction tube. The movement is mainly of the heel swivelling and is comfortable as it does not involve the leg or knee moving.
  • The movement is therefore  one of a “flick” pivoted on the ankle.
  • The foot pedal is light and can be moved easily.

 
Disadvantages

  • The Infiniti has a foot pedal which is attached to the machine with an electric cable. This cable sometimes gets in the way of the foot pedal if it is being moved around the floor.
  • The foot pedal is on a plate which is held up with a spring. The spring and mount can get wet and it takes a little time to dry all the components.

 

 

Foot pedal of the Centurion Phacoemulsification machine (pic 2)

pic-2-Centurion-Footpedal

Advantages

  • The foot pedal is wireless.
  • There are no moving parts and any size foot can operate it.
  • It is easy to clean.

 
Disadvantages

  • It is heavy to move once placed on the floor.
  • The sideways movements are very different. Instead of a quick flick of the ankle to initiate the reflux you have to swing the entire distal lower foot to the side.
  • The sideways movement seems to involve the knee as well, and sometimes I feel that I am doing perineal strengthening exercises when I use the lateral and medial controls on the pedal.
  • The foot pedal has a slope which can collect water while operating.

If I had the choice, I would have kept the Infinity foot pedal and put up with a chord attaching to the new Centurion.

B. Bimanual cortical aspiration

pic-3-Irrigation-Aspiration-handpieces-compared

Ultraflow Bimanual I/A, versus Alcon 0.3mm Polymer I/A, versus Medicel Bi-Manual hand pieces.  (Pic 3)
For three years I have used the disposable Ultraflow bimanual aspirator and infusion cannulas.The instrument pass nicely through a 1.2 mm paracentesis.I have been very happy with them but in late 2014 there seemed to be a continuous disruption in supply. I was then offered the choice of the new Alcon 0.3 Polymer I/A bimanual set and the Medicel 21G Bimanual set.

My thoughts are as follows:

Alcon/ Grieshaber Ultraflow Bimanual I/A disposable set. 170.71/2 (pic 4)

pic-4-Alcon-Grieshaber-UltraFlow

Advantages

  • The handpieces sits nicely in my hands and has little bumps on the handle that gives good tactile control.
  • The irrigation port is large enough to stabilise the anterior chamber.
  • The aspiration port is large enough to remove adherent cortex quickly and safely.
  • Outer diameter of 0.8mm which fits snuggly through a 1.2 mm incision.
  • The aspirator tip can be textured or polished.

 
Disadvantages

  • Supply seems erratic.

 

 

Alcon 0.3 Polymer I/A Bimanual set, part of the Intrepid micro-coaxial system (pic 5)

pic-5-Alcon-0.3mm-Polymer-IA

Advantages

  • Corrugated handle that does not slip.
  • Soft tip on the aspirator.
  • Polycarbinate tip for capsular polishing.
  • 23 G with an outer diameter of 0.6 mm so it can fit through a smaller 1mm incision.
  • The handpiece is longer than that of the Alcon 0.3mm Polymer I/A or the Medicel Bi-Manual handpiece and feels more like a pencil in the hand.

 
Disadvantages

  • The infusion has a sharp point. I think this dangerous.
  • The aspiration has a much smaller diameter 0.3mm that the Ultraflow 0.5mm, I was used to. This slows down the aspiration of cortex and may lead to retained viscoelastic in the anterior chamber.
  • For the life of me I cannot understand why a cataract surgeon would want a bimanual system that has a safe polymer tip on one instrument and a sharp point on the other.

 

 

Medicel Bi-Manual set – MCEL-SBS110A (pic 6)

pic-6-Medicel-bi-manual-set

Advantages

  • Fits nicely through a 1.2mm incision.
  • Good anterior chamber control.
  • Good purchase of cortex with a good size port.
  • Slight roughening of the distal end of the instrument.
  • Allows rapid removal of cortex through the aspiration port.

 
Disadvantages

  • The handpiece does not have the “ridges” of the 0.3mm polymer I/A or the “bumps” of the Ultraflow bimanual handpiece. I am always concerned that if there is torque in the tubing while aspirating, then a smooth handle could contribute to the aspirator suddenly turning to relieve the tension in the tubing.

My feeling is that the Ultraflow is the safest and most efficient of these products, followed closely by the Medicel bi-manual set.

 

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Comments

  1. L Levitz says:
    November 8, 2014 at 7:52 pm

    There is a bimanual set labelled SBS105 also made by Medicel. It is almost identical to the one reviewed above being the Medicel SBS110A.
    Although the two bimanual sets look identical, with the same colour hand-pieces and identical packaging there is a difference that may catch the unwary. The SBS105 model has a very blunt irrigation port that does not fit through the 1.2mm paracentesis. One then finds oneself trying to force this blunt tip through an incision that is simply to small. The best is then to slightly open the incision with a blade to allow the irrigation port into the eye. This decreases the risk of stripping descements membrane or traumatising the wound. The next step would be to inform the theatre staff that the SBS110A should be ordered and not the SBS 105.

    Reply
    • Susannah says:
      December 28, 2016 at 4:34 pm

      . So how does integrity differ from chYarcter?aou said that a person of integrity would have high character. I’ve always defined the words as being essentially the same — is there a difference?

      Reply

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