Spotlight ON TECHNOLOGY & TECHNIQUE

The Stellaris: A Phaco System With Customized Fluidics

By Leslie Goldberg, Associate Editor

The Stellaris Vision Enhancement System from Bausch & Lomb (Rochester, N.Y.) provides surgeons with a modular, intuitive phaco system that delivers precision, control and flexibility.

"From the beginning, one of our overriding goals was to optimize the balance of power and fluidics to create a machine that was simple to use, safe and efficient for any technique," says Terence M. Devine, M.D., chief of ophthalmology at The Guthrie Clinic in Sayre, Pa., and part of the Stellaris development team.

System Features

The EQ Fluidics Management Technology includes a choice of two different pump modules. The Advanced Flow Module can operate in either a flow or vacuum mode and switch back and forth during the same case. There is also an Advanced Vacuum Module that is all electric.

"The Stellaris' vacuum characteristics are more precise and responsive than those of traditional venturi systems and eliminate the need for compressed gas," explains Dr. Devine. Users can set the machine with vacuum limits anywhere between 0 mm Hg and 600 mm Hg.

"In terms of balanced power, the Stellaris has Custom Control Software II, which gives tremendous flexibility in power modulation including expanded pulse rates, duty cycles and a choice of square wave or waveform pulses to reduce phaco energy and improve followability," says Dr. Devine.

The Stellaris also includes a wireless Bluetooth foot pedal. "When I first used it, I questioned whether it might lose some of the responsiveness of hardwiring," says Dr. Devine. "In fact, it worked flawlessly and in my opinion, is more precise and responsive and can be programmed in a variety of different ways to suit individual surgeon preferences."

The foot pedal interfaces with the Custom Control Software II, the vacuum and flow sensors and the new computer algorithms to ensure precise control of fluidics and optimum chamber stability.

The new handpiece is smaller, lighter and more ergonomic. The infusion is 50% larger to improve fluidics and chamber stability. The Stellaris has six crystals, which deliver up to 25% increased stroke for improved mechanical cutting and operates at 28.5 KHz to optimize cavitation to emulsify the lens particles. "It has a unique locking infusion line that eliminates the risk of accidentally disconnecting and creating chamber collapse," says Dr. Devine.

Coaxial, Biaxial and Microaxial Incisions

The Stellaris supports standard small-incision coaxial phaco, as well as microincision surgery using coaxial or bimanual modes. "My particular interest is in coaxial procedures and B&L offers two choices of needles," says Dr. Devine. He began working with B&L on the 1.8 mm coaxial needle and sleeve.

"Our goals for this technologywere to minimize any learning curve and to be compatible with any surgical technique. Whether you performed chop, divide-and-conquer or phaco flip, you should not have to change your technique to fit the technology. Technology should work for you," says Dr. Devine.

B&L also wanted surgeons to be able to use their preferred fluidic settings, maintain optimum chamber stability at any vacuum level and have efficient case times.

"I don't want to give the impression that the Stellaris was developed only for micro-incision surgery, but any technology that is safer for the challenging fluidics of sub–2-mm incisions will certainly be safer for standard phaco techniques," says Dr. Devine.

"I prefer to use the Dual Linear foot pedal control with a linear range between 50 mm Hg and 300 mm Hg for my standard 2.8-mm and 1.8-mm microcoaxial cases," says Dr. Devine. "This means that when the needle tip is open, the foot pedal is controlling the vacuum in the cassette. But inside the eye I am controlling the flow rate. There is a very precise linear relationship between cassette vacuum and intraocular flow rate. So, even though this is a vacuum-based system, we have precise linear control of flow and followability."

In addition to these features, the system is designed to be fully adaptable for future upgrades. OM

For more information on the Stellaris system, visit the Web site at www.bauschsurgical.com/cataract/default.aspx.