The increased power and modifications to energy dispersion in the Whitestar Signature Ellips FX 2.0 phacoemulsification system (Abbott Medical Optics, Santa Ana, California, USA) have earned it the moniker 'game changer' with many ophthalmologists. After using it for over a year, I, too, am a witness to the technological improvements.

Features of the system

One of the most important features of the Ellips FX is seen in the modifications to the energy dispersion. Previous systems could identify occlusions and make the necessary adjustments to vacuuming power to avoid post occlusion surge and maintain a safe and stable chamber. However, the efficiency of the needle prevents full occlusions and surges, allowing me to change the way I use fluidics.

Additionally, the frequency of the needle movement is from 26 Kh to 38 Kh and the stoke path is up to 3 fold. The elliptical movement is both side-to-side as well as forward and back all in a blended motion. This simultaneous blend of longitudinal and transverse motion provides a precise cutting efficiency in terms of ability to disassemble the nucleus whether you are chopping horizontally or vertically.

The resulting occlusions with the FX are properly labelled micro occlusions. As a result of the movement of the needle there is sufficient influx of new fluid during the emulsification process that there is minimal vacuum build and there is no surge. Because there is no surge, I have been able to fully use this technology so that I use peristaltic for the nuclear extraction and then switch to venturi for epinulceus and cortex. I find that ability to alternate between vacuum modalities one of the great advantages of the system.

The smooth and efficient cutting delivered by the phaco system has allowed me to take the Fusion pump, which was normally being used to apply CASE fluidics to a step down vacuum, and adopt it to other phases of the surgery. It is no longer necessary to adjust the fluidics based on occlusion or non-occlusion. This results in efficient followability with the individual nuclear segments. The nuclear segments almost seem like box cars in that the segments easily and continually follow each other to the tip of the phaco needle. Even though the nuclear segments are not attached, they follow each other in a constant movement to the tip with minimal movement of the Phaco needle. I prefer to use a 20-gauge curved tip with the ultra thin sleeve, which require a 2.2–2.4 mm incision and has the advantage of rock solid chamber stability while maintaining small incision technology.

Once disassembly of the lens nuclear material is complete, I switch to venturi to remove the epinuclear shell, once again taking advantage of the efficiency of energy delivery. I continue with the venturi fluidics setting for cortical removal. This gives me the advantage of achieving vacuum without occlusion, whereas peristaltic fluidics requires occlusion to generate vacuum. As a result of the physics of the venturi system, one is able to use very refined amounts of low vacuum and gently remove the cortical material adherent to the capsule, even in patients with pseudoexfoliation or other causes of zonular/capsular instability. This prevents further damage to the supporting elements key to long-term lens stability post implantation. The ability to use venturi with the cortical removal provides the surgeon with precision and power with its high settings and maximum vacuum.