First 100 Cases: The Stellaris Platform for MICS

This article describes my impressions of the capabilities of the Stellaris Vision Enhancement System (Bausch & Lomb, Rochester, New York) (Figure 1) platform for microincision cataract surgery (MICS), based on my first 100 surgeries with this new phaco system.

The Bausch & Lomb engineers developed the Stellaris phaco machine by applying the input of cataract surgeons and operating room staff from around the world. It features a small, ergonomic footprint and is electric with no need for external air supply.

The Stellaris can be used for standard coaxial phaco, but the system has been more specifically designed for coaxial and biaxial MICS (C-MICS and B-MICS) procedures through incisions of less than 2 mm.

The instrument is user-friendly, featuring an 18-inch touch display (Figure 2) with an intuitive interface. Streaming video will soon be available, making it possible to monitor surgery via the screen.

The device is equipped with a lightweight, ergonomically designed six-crystal handpiece (Figure 3). Its low frequency operation delivers optimal cavitation and emulsification with minimal thermal loading. By increasing the stroke length (Figure 4), more efficient cutting of the nucleus is achieved, reducing the total amount of phaco energy.

The fluidics system on the Stellaris is called EQ Fluidics. EQ, which stands for equalization, refers to the need to balance in- and outflow to maintain solid chamber stability throughout the surgical procedure. Advanced software and sensors contribute to surge suppression and fluidics control.

Because of the Stellaris' modular design, the surgeon can choose between an advanced flow module or a vacuum-based pump. Having worked with the venturi pump on the Millennium microsurgical system (Bausch & Lomb) for several years, my personal preference is for the vacuum module on the Stellaris.

The wireless foot pedal of the Stellaris offers dual linear technology, with independent linear control of vacuum and phaco power. Together with the custom control software, the Stellaris provides a complete range of customizable power modulations for advanced MICS techniques.

ASPIRATION TUBING
As chamber stability is imperative for safe MICS surgery, I prefer to use the StableChamber tubing (Bausch & Lomb) for MICS cases. This system consists of an aspiration tubing line with an internal diameter of 1 mm, rather than the 1.5-mm standard tubing diameter, leading to a significantly lower aspiration flow rate. To prevent clogging of the line, the proximal portion of the tubing is equipped with a filter that captures nuclear fragments larger than 0.5 mm in diameter.

The StableChamber tubing allows me to raise the vacuum level significantly, without increasing the aspiration flow rate. In this way, anterior chamber stability is maintained even during occlusion breaks.

C-MICS
A specially designed C-MICS needle with a high-volume infusion sleeve is available on the Stellaris MICS platform, allowing coaxial MICS phaco through a 1.8-mm incision.

From my personal experience, I find evacuation efficiency in segment removal somewhat slower in C-MICS because of the small inner diameter of the needle, even when using higher vacuum levels. Still, for surgeons who do not want to abandon their coaxial technique, this needle and sleeve provide the ability to perform coaxial surgery through a 1.8-mm microincision.

B-MICS
To me, a biaxial technique is the more logical approach to cataract removal when performing MICS. With irrigation separated from aspiration, the circulation of fluid in the anterior chamber is improved, and competing currents around the phaco tip are avoided. Additionally, an irrigating chopper can be used to manipulate and mobilize tissue. With the free movement that can be achieved with the bare unsleeved phaco needle, the efficiency of the phacoemulsification procedure through small incisions can be greatly improved.

For biaxial cases, I use a 19-gauge Nagahara irrigating chopper (Storz/Bausch & Lomb) and a 15º thin-tip needle. Maximum vacuum is set at 350 mm Hg and maximum phaco power at 15%. For phaco parameters, I use 6-millisecond micropulses with 12-millisecond intervals, which is equivalent to 55 pulses per second in a 33% duty cycle.

In conclusion, my personal experience with the Stellaris system confirms that it has excellent fluidics control based on innovative mechanical and software-enabled technologies. The ultrasound power is enhanced by the new six-crystal handpiece operating with low frequency and increased stroke length.

The input of customers around the world has resulted in a more compact and user-friendly machine that is customizable to the preferences of every surgeon. The work being done on the Stellaris system demonstrates how our growing interest in MICS encourages industry to develop microincisional technology, instruments, and IOLs for the benefit of our patients.

Ann Haustermans, MD, is the head physician for the Department of Ophthalmology, AZ KLINA Hospital, Brasschaat, Belgium. Dr. Haustermans states that she has no financial interest in the products or companies mentioned. Dr. Haustermans may be reached at +32 3 2389389; annhaustermans@skynet.be.