ABSTRACT
In the late 1980’s, as phacoemulsification was increasing in popularity, the desire on the part of most phacoemulsification surgeons was for increased power availability in order to address increasingly hard cataracts. In the 1990’s this became available, as did other very important technical innovations like high vacuum tubing and cassettes, microprocessor controls integrated with central onboard computers, and downsized tips with better holding power and increased followability. In the late 80’s and early 90’s, we described two endolenticular phacoemulsification techniques, chip and flip2 and chop and flip phacoemulsification3 in which we utilized pulse mode for the removal of nuclear material. In doing so, we recognized decreased chattering and increased holding power of the nuclear material. More recently, multiple modulations in the delivery of power have become available which allow for dramatic reductions in the total amount of ultrasound energy delivered into the eye. In addition, the Allergan systems provide occlusion mode phaco allowing for different parameters of percent power, vacuum levels, and aspiration flow rate on tip occlusion compared to an unoccluded tip. The Alcon Legacy has a bimodal option allowing linear aspiration flow rate or vacuum in foot position 2. More recently we described the use of burst mode4 and bevel down chop techniques.5
