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Digital Supplement | Sponsored by Alcon

Fluidics Control in the Palm of Your Hand

With a built-in pressure sensor, the Active Sentry Handpiece can boost safety and efficiency while solving persistent challenges.

In the last decade, technologies have raised the safety and predictability of phacoemulsification to new heights. Alcon Laboratories equipped the CENTURION Vision System (Alcon) with ACTIVE FLUIDICS technology (Alcon) to overcome the problems associated with variable infusion and aspiration rates that affect intraocular pressure (IOP). This technology was the first to replace traditional gravity-based phaco fluidics with a system that compresses a bag of balanced salt solution to overcome infusion line resistance as aspiration flow from the eye varies. Surgeons can expect ACTIVE FLUIDICS technology to sense and respond to any changes in IOP very quickly and effectively, making the anterior chamber more stable.

Now, ACTIVE FLUIDICS technology has been made even more responsive with the addition of the ACTIVE SENTRY Handpiece (Alcon), which contains an integrated pressure sensor. Previously, pressure alterations at the tip of the phaco probe traveled to a sensor near the cassette at the speed of sound. Now, the ACTIVE SENTRY Handpiece measures IOP very near the tip, eliminating that millisecond delay in adjusting the fluidics. A redesigned valve is more responsive as well, and ACTIVE SENTRY software for the CENTURION platform helps ensure the process is seamless.

In helping to develop the ACTIVE SENTRY Handpiece, I was excited that locating the sensor in the handpiece would also eliminate the persistent problem of setting the patient eye level (PEL). To calibrate the fluidics accurately in any system, the PEL must be set, but many surgeons do not do it, so their IOP readings are inaccurate. The handpiece knows exactly where the eye is, so the PEL is always perfectly calibrated.

These technologies boost speed and efficiency. When used together, ACTIVE FLUIDICS technology and the ACTIVE SENTRY Handpiece reduce surge by as much as 50%. The amount of additional surge protection depends on the target IOP and the vacuum limit at occlusion break.1 Maintaining a stable chamber at a lower IOP makes the experience more comfortable for the patient. As a result, surgeons can be much more aggressive, safely setting high vacuum limits and spending less time in the eye. What’s more, the polymer INTREPID Hybrid Tip (Alcon) can help reduce the risk of trauma such as capsular tears, making surgery both safer and more efficient as surgeons proceed with greater confidence.

Just as the advent of phacoemulsification made cataract surgery less traumatic, major advances in fluidics have continued to make procedures safer and more efficient. ACTIVE FLUIDICS technology broke new ground in this area, now enhanced by the ACTIVE SENTRY Handpiece. As the four surgeons featured in this supplement will describe, these technologies are having a significant effect on the safety, predictability, and outcomes of cataract procedures.

1. Thorne A, Dyk DW, Fanney D, et al. Phacoemulsifier occlusion break surge volume reduction. J Cataract Refract Surg. 2018;44(12):1491-1496.

Kevin M. Miller, MD
  • Kolokotrones Chair in Ophthalmology, Chief of the Cataract and Refractive Surgery Division, Director of the Anterior Segment Diagnostic Laboratory
  • UCLA Stein and Doheny Eye Institutes, Los Angeles
  • miller@jsei.ucla.edu
  • Financial Disclosures: Consultant (Alcon)