Eyeworld Supplements

by Lawrence Woodard, MD Centurion Vision System provides improved anterior chamber stability Please refer to pages 7 and 8 for important product information about the Alcon products described in this supplement. EW San Diego 2015 6 T he Centurion Vision System (Alcon, Fort Worth, Texas) is a significant improvement over my previous Infiniti Vision System (Alcon) in a number of ways. The most glaring difference is the improved anterior chamber stability with the Centurion System. This is a result of Active Fluidics technolo- gy, a different approach to fluidics management. The Centurion System uses dynamic compression plates that actively compress and relax the BSS (Alcon) bag inside the machine to better control the delivery of fluid into the eye. This allows for much better control of the volume of fluid and pressure in the anterior chamber compared to traditional gravity based fluidics systems. As there is much less anterior chamber vola- tility, the posterior capsule move- ment appears to be greatly reduced during the case. Therefore, safety is improved, and there is less chance of posterior capsule rupture. Due to this improved chamber stabili- ty, I have been able to increase my vacuum levels during the case, so I am able to vacuum more of the lens and use less ultrasound energy. This allows me to lower my CDE ratio, which relates to better outcomes and less corneal edema postoperatively. That has been a welcome surprise. Additionally, the design of the balanced phaco tip has allowed me to use less phaco energy, which also helps to improve outcomes. This computer-designed, double-bend tip creates more excursion at the distal end of the tip while providing less movement of the proximal end of the tip near the incision. The result is that the surgeon can more effi- ciently emulsify a nuclear fragment with a lower torsional amplitude due to the increased displacement of the tip. Using this technology, I am able to further lower my ultrasound usage during the case. Additionally, in patients who have very dense nuclei, the bal- anced phaco tip allows me to be more efficient at removing the dense nucleus than with the Kelman angled tip that I previously used or a straight tip. These dense cataract cases are the ones that are high risk for thermal damage at the incision and endothelial damage due to much higher ultrasound usage. The balanced tip lessens the chance that both of these events occur, which improves recovery time and clinical outcomes. When performing femtosecond laser cases, the fact that the laser has already fragmented the nucleus allows me to maximize the features of the Centurion System to facilitate even more efficient lens fragment removal than traditional cataract surgery cases. Using higher vacu- um levels in combination with the balanced tip when removing a laser fragmented cataract, my CDE energy ratios are even lower because I am able to aspirate more of the nucleus once it has been softened with the femtosecond laser. I am perform- ing more procedures with either no ultrasound or very minimal ultrasound compared to traditional cataract cases. The Centurion System is bene- ficial with an ever-growing number of complex cases. In my experience, the iris tends to move less and the chamber appears to remain stable. The Centurion System helps me per- form safe, controlled procedures. Another example of a complex case is a mature cataract causing phacomorphic glaucoma. Typically, patients with mature cataracts also have a very narrow anterior cham- ber angle. I recently had a patient with phacomorphic glaucoma who had a dense nucleus with a very shallow anterior chamber. I was able to do that case efficiently, and I used a lot less ultrasound energy than I would have used with a different machine. That's magnified when you are doing a case with a very shallow anterior chamber because you are operating much closer to the cornea than you normally would, so minimizing ultrasound energy and fluid usage are even more important in those cases. I have a glaucoma specialist in my practice, so I've had many of these cases, and the Centurion System allows me to perform the procedure in a safe and effective manner. These types of patients potentially benefit the most from the system. In conclusion, I feel the Centurion System represents a significant advancement in phacoemulsification technology because the various features, most notably Active Fluidics technology, allow more efficient lens removal in traditional, complex, and femtosec- ond laser cases. Dr. Woodard is in private practice in Atlanta. He can be contacted at lwoodard@ omnieyeatlanta.com. " I feel the Centurion System represents a significant advancement in phacoemulsification technology because the various features allow more efficient lens removal in traditional, complex, and femtosecond laser cases " Lawrence Woodard, MD Active Fluidics: target IOP

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