move forward. If the bag contacts the tip of the phaco probe as the sur-
geon is delivering ultrasound energy and aspirating, the capsule can rup-
ture. Capsular rupture increases the risk for intraocular infection,
swelling of the retinal tissue and retinal detachment.
• Stellaris Elite. Bausch & Lomb's new phaco platform works to
precisely balance aspiration with infusion with something called adap-
tive fluidics. The technology continuously tracks vacuum flow rate
second to second and then automatically adjusts infusion pressure. As
with the Alcon Centurion, there is no longer a gravity system with a
BSS bag on the pole. The Stellaris infuses fluid through a pump sys-
tem.
According to proprietary B & L studies, the technology doesn't elim-
inate surges in pressure, but it works significantly better for this than
any competing product. And watching the machine in action, it's easy
to believe. After breaking up the lens, Dr. Schultz, who consults with
B & L, says he can turn the vacuum all the way up to 600 mm Hg and
simply hold the probe in the middle of the chamber. Fragments come
to the tip with stunning speed. They occlude the tip and then break
free, and the iris barely twitches.
"You can use high-vacuum settings from the start without worrying
about damaging the posterior capsule," says Dr. Schultz.
He says he needs to use only about half as much phaco energy as he
normally would. The system does cortical cleanup so well that Dr.
Schultz has been able to switch from a bimanual two-incision technique
to a coaxial one-incision technique. As with previous B & L phaco
machines, the new unit doubles as a posterior segment machine (it
emulsifies vitreous rather than using a guillotine). The Stellaris Elite is
so easy that this reporter, who had never touched a phaco probe before,
successfully removed a cataract and cortex from a porcine eye in a wet
lab at the American Academy of Ophthalmology.
9 6 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J A n U A R Y 2 0 1 8
