Can we improve the efficacy of modern cataract surgery by using different tip designs? A comparison of balanced and tapered tip in femtosecond laser-assisted cataract surgery and manual phacoemulsification.

Abstract

Different tip designs in modern cataract surgery have not been studied between the reported systems. Aim of this study is to assess the efficacy of two tip designs, Intrepid® balanced tip (BT) and Kelman tapered tip (TT), in femtosecond laser assisted cataract surgery (FLACS) and the microcoaxial torsional phacoemulsification. Prospective randomized unmasked cohort outcome study (hospital setting). Threehundert-forty-three eyes of 343 patientes underwent cataract surgery. Data of n=196 FLACS and n=147 manual phacoemulsification were analysed. Intrepid® balanced tip and Kelman tapered tip, Alcon, USA, were tested in FLACS (LenSx Alcon, USA) und manual phaco (Alcon Centurion System, USA). Four study cohorts were formed; FLACS BT (n=90, 70.2 years), FLACS TT (n=106, 68.1years), Manual BT (n=70, 71.3 years), Manual TT (n=77, 71.8 years). The nuclei were graded in Lens Opacities Classification System (LOCS) II,III and IV. Cumulative dissipated energy (CDE%s), balanced salt solution volume (BSSml), total longitudinal energy (%s) and torsional amplitude (%s). Lower CDE values were seen in FLACS compared to manual phacoemulsification (CDE %s median FLACS BT 3.28, FLACS TT 4.07, Manual BT 5.57, Manual TT 6.27). There was a significant difference between CDE FLACS BT and FLACS TT (p=0.038), and between FLACS BT and Manual TT (p=0.001). The right choice of tip designs in advanced phacoemulsification systems is a key factor in increasing efficacy in cataract surgery. The balanced tip showed a considerable energy-saving advantage in FLACS and manual phacoemulsification compared to the tapered tip.