Purchasing surgical equipment is a large expenditure for any practice. For ophthalmologists who work on both the anterior and posterior segments of the eye, having one system that allows them to perform procedures in both areas may make the most sense. One such system that has these capabilities is the Stellaris Vision Enhancement System from Bausch + Lomb.
What It Is
According to Dr. Victor H. Gonzalez, managing partner at the Valley Retina Institute in McAllen, Texas, the Stellaris Vision Enhancement System is a complete system for managing intraocular surgical procedures in the eye. "It is one of the few instruments that is able to give you that combined capability of both anterior segment — cataracts and everything associated upfront — to the vitreoretinal aspect," he said.
The Stellaris is a phacoemulsification platform that can be customized to offer excellent control through various fluidic and ultrasound options depending on the surgeon's needs. And the Stellaris PC takes the established Stellaris platform and adds to it the ability for phaco, vitrectomy and combined procedures.
Dr. Deepinder K. Dhaliwal, director of both Cornea and External Disease Service and Refractive Surgery Service at the University of Pittsburgh, and a professor in the Department of Ophthalmology, said the ability to customize the Stellaris system is crucial when you have multiple surgeons — and in this case, residents — using the same machine. “You can acquire either just the anterior segment platform with phaco or add the vitrectomy modules as well for vitreoretinal surgeons,” she explains. “It’s nice to have the flexibility of designing the machine to suit your needs.”
For Cataract Surgery
Dhaliwal mainly uses the Stellaris system for cataract surgery. One of the things she likes best about the Stellaris is that it is vacuum-based system because it allows her to build vacuum without occlusion. “I don’t have to bury my phaco tip into the nuclear piece in order for me to build vacuum and emulsify it," she explained. “I can be very close to it, build vacuum, pull it in and go ahead and take care of removing the nucleus. I think this is really important and enables you to be more efficient and, in my opinion, it’s actually safer.”
For surgeons who are used to working with a peristaltic system, Dhaliwal said the transition to a vacuum-based system is not difficult. “Once surgeons start to use it, it’s like this really impressive, sophisticated race car — you can go slowly or you can ramp up as you get more used to the parameters,” she said. “It’s so customizable and it’s very responsive.”
Dr. Deepinder Dhaliwal discusses different phaco settings and Venturi fluidics on the Stellaris platform with resident Siwei Zhou.
Another benefit of the Stellaris system Dhaliwal pointed out is its dual linear foot control. For example, during a phaco procedure the surgeon can yaw and get a burst of vacuum. Or during an epinucleus removal, the foot pedal is set for vacuum and yawing engages a bit of phaco to clear the instrument tip as needed. “It gives you a lot of control,” Dhaliwal added.
And with the Stellaris' phacoemulsification handpiece, Dhaliwal said its six piezoelectric crystals allows it to provide more efficient cutting while using less energy, making it appropriate for removing both soft and very dense cataracts. Using less power results in less endothelial cell loss and a reduced risk of wound burn.
“The phaco handpiece is designed to work at a lower ultrasound frequency than other systems,” she explained. “This provides a significant reduction in frictionally induced heating at the wound site, and provides more effective emulsification of the lens.”
For Retinal Surgery
For vitreoretinal procedures, Gonzalez uses the Stellaris PC system in his practice. From right out of the box, Gonzalez was impressed with how easy it was to set up the system. “With some systems, you practically need a PhD just to learn how to set up,” he explained. “Now you take your skilled nurses and you use them for what they need to be doing, and that’s taking care of your patients, not taking care of the machine.”
Like Dhaliwal, Gonzalez likes the dual linear technology of the included wireless foot pedal, which is completely programmable to allow for phacoemulsification or vacuum depending on how the surgeon's foot is moved. Additionally, the surgeon can yaw from side to side to yield varying cutting and vacuuming rates. “So I can control my cutting and suction for the exact specifications for the maneuver I’m trying to accomplish during my retina surgery,” he explained.
When it comes to the Stellaris PC's accessories, Gonzalez praised its illumination system including the different colored filters that he said can be used to help identify things such as tissue edges when the surgeon is trying to grasp membranes from the surface of the retina. “Under certain settings, the diffusion of the light inside the eye can cause a lot of glare and interrupt our ability to see appropriately to finish the surgery,” Gonzalez explained. “Engaging the appropriate filter there can also help us reduce that glare, increasing our contrast and our ability to see inside the eye.”
Gonzalez also said the Stellaris PC's Entry Site Alignment (ESA) valved cannula system helps him achieve a 99 percent sutureless wound rate for his patients. “These valved systems come with exceptional yield to allow us to insert them with precision, and allows us to build a sutureless wound,” he added.
And having all of these different options, said Gonzalez, gives him the flexibility he needs to meet his patients’ unique needs. “Just like one shoe doesn’t fit all, when it comes to equipment you need to be able to adjust your equipment to meet your needs, and your equipment should also be able to adjust to the needs of the patient’s pathology,” he added. “That’s what this system is very good at doing.”
One System For Both
While most of what Gonzalez and Dhaliwal have already talked about can be construed as both practice benefits, Gonzalez also added having one system for both cataract and retinal surgeries can help a practice provide the highest quality service to its patients at the most cost-effective level. Not only is it only one capital expenditure, but there's only one yearly service contract and Gonzalez purchases procedural packs from only one company. “You can see how the benefit just snowballs. We’ve been able to benefit from this instrument not only in our surgical outcomes, but also in the profitability of our surgical centers,” he added.
And ultimately all of these benefits, Dhaliwal said, allows her to meet the expectations of her patients who want to see well post-op day one. “Whether or not a patient has to pay out-of-pocket for vision enhancement, their expectations are much higher," she said. "They want to see well right away because their friends told them that vision recovery is rapid.”
Click here for more information on the Stellaris Vision Enhancement System from Bausch + Lomb.