Aqualase system viable for small incision cataract removal

By Ana Hildago-Simón MD, PhD

NICE - Aqualase liquefaction is a capsule- and user-friendly technology that is emerging as a viable tool for cataract extraction, according to a US ophthalmologist.
Speaking at the XX ESCRS Congress, Paul Ernest MD outlined the development of the new emulsification technology.
Fifty cataract procedures were performed using the Aqualase in the first half of the year. The system easily removed 2+ nuclear cataracts and with cataracts over a 3+, the time required increased.

The cornea was clear in the majority of cases postoperatively, he said.
He explained that the Aqualase system uses minimum fluid of pulse-heated water for the removal of the cataract material.
The water is heated to 57ºC and the rapid stream causes the emulsification of the cataract material.

The tip does not move and there is no mechanical motion. The system has a highly polished plastic tip where the pulses (one at a time, 100 pulses per second) are produced.
"An interesting fact is that despite the high temperature of the water at the tip, this does not cause an increase in the temperature of the anterior chamber because the temperature of the irrigating solution is 2ºC lower than the standard.

"Furthermore, the fluid burst does not cause significant increases in the pressure experienced by the chamber," Dr Ernest explained.
He noted that the structure of the current hand piece would be familiar to most cataract surgeons. The original tips were disposable but the new units have re-usable hand pieces. The edges are rounded so the tip is also capsule-friendly. The standard tip has a 1.1 mm flare tip with 1.32 mm outer diameter.

According to Dr Ernest, the learning curve to become confident with the new device is not difficult. One reason for this is that there is no friction at the incision point.
"This would be one of the technologies which could be used for endocapsular phaco when we want to preserve both anterior and posterior capsules.
"It might be important in the future if we want to replace the lens with an injectable IOL, for example," he remarked.

The Aqualase technology is made by Alcon Labs.