Phaco Tip 127:
AC Air Bubbles

The usual cause of this annoying phenomenon during phaco is as follows:

Just prior to insertion, the handpiece is usually moved toward the eye with the tip facing downward and the footpedal in position 0 (no infusion). Fluid therefore passively drains from the infusion sleeve and is replaced with environmental air. The air moves upward into the hub of the silicone sleeve, and remains there as infusion is activated and the tip is inserted. Soon thereafter, usually during application of ultrasound and/or during a fluid surge, the air "breaks loose" from its contact with the sleeve and a shower of bubbles rapidly enters the eye.

This can be prevented by taking the following steps before and during tip insertion.

1. Hold the handpiece in the vertical position (tip up) with the fluid-filled test chamber in place.
   
   
2. Briefly place the footpedal in position 3 while tapping the handpiece 2-3 times, then return it to position 0.
   
   
3. Remove the test chamber, and while keeping the tip pointed upwards, move the tip close to the eye.
   
   
4. Place the footpedal in position 1 (infusion), then aim the tip downward toward the eye and insert it through the phaco incision.

Doing this should prevent air from entering the infusion sleeve prior to tip insertion, and should prevent the problem of intracameral air during phaco.

* Phaco Tip TM of Richard J. Mackool, M.D.

The parameters (instrument settings) and incision size presented here have been established by the surgeon and do not reflect recommendations by Alcon.