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EVA in Combination with 1.8 mm MICS and Nano Laserphaco Surgery

Reinhard J. Lehmann, MD, Münchengladbach, Germany, shares his experience using the EVA platform in combination with anterior surgical techniques.

The EVA phaco-vitrectomy system incorporates a unique fluid control system that uses pistons and timed valves to optimize intraoperative transportation of fluids in either vacuum or flow modes. “I’ve been working with the innovative EVA system for over one year now and, in my eyes, it is one of the most fully equipped and versatile phaco-vitrectomy machines available,” said Dr. Reinhard Lehmann.

Primary features include precise flow control (with a precision of 0.1 cc), no unwanted pressure pulsation caused by peristaltic pump rollers, fast vacuum response time, and the option to switch between flow and vacuum mode during surgery, explained Dr. Lehmann. Preset configurations can be made for various surgeon-specific situations. There is also a wireless dual linear footswitch and foot pedal for an optional integrated laser.

An enlarged phaco needle range now incorporates a triple step flared phaco needle with irrigation sleeve and a triple step angled flared phaco needle with irrigation sleeve. Assessment of the irrigation and aspiration performance of eight different phaco needle/irrigation sleeve combinations showed similar results for angled flared phaco needles compared with straight phaco needles, although the irrigation flow was always higher than aspiration flow.

Dr. Lehmann recalled the recognized advantages of 1.8 mm microincision cataract surgery (MICS): less or no induced astigmatism, less change in corneal wavefront (important if you want to provide patients with customized lenses), potentially faster healing, stable anterior chamber during surgery and better visibility in narrow pupils. Surgical experience demonstrates that there is sufficient phaco power with 1.8 mm MICS to complete a hard nucleus, the procedure marked by good overall holdability, said Dr. Lehmann.

The 1.8 mm nano laserphaco technique provides physicians with a comfortable alternative cataract treatment without additional ultrasound, although it is not suitable for hard opacities above grade 4, added Dr. Lehmann.

Nano laserphaco technology is based on a pulsed q-switched Nd-Yag laser that is transferred to the probe by a quartz fiber optic and is focused on a titanium target within the probe tip. Pulsing energy leads to optical breakdown and plasma formation, which creates circular shockwaves to emulsify the substance of the cataract. Advantages are small-incision surgery, no heat at the incision site, no corneal burn, less energy distributed into the eye by indirect laser-tissue interaction and performance of the complete procedure using single-use instruments. In combination with EVA, nano laserphaco provides good aspiration, good holdability and anterior chamber stability.

Dr. Lehmann emphasized the versatility of the EVA VacuFlow VTi system, arguing that it provides surgeons with a selection of solutions suitable for all aspects of anterior segment surgery as well as combined phaco-vitrectomy procedures. ■