Torsional Phacoemulsification Research Articles

Evaluation of Endothelial Cell Density after Torsional Phaco-Emulsification in Patients with Pseudo-Exfoliation

Background The corneal endothelium is a single layer of hexagonal cells that do not have the ability to regenerate. The normal density of corneal endothelial cells in adults is approximately 2500 cells/mm² and it is reduced by about 0.6% a year. The endothelium performs an essential function of maintaining the hydration of the cornea. When the endothelial cells density is reduced to approximately 800cells/mm², it may lead to corneal decompensation causing corneal edema and loss of corneal transparency which disrupts vision. Aim of the Work The aim of this study is to compare pre-operative corneal thickness between normal subjects and subjects with pseudo-exfoliation and to determine the effects of phaco-emulsification surgery on corneal endothelial cell density in cataract patients with pseudo-exfoliation syndrome. Patients and Methods The type of study was case controlled study, at department of Ophthalmology at Ain Shams University hospitals. This study included 66 patients divided to two equal groups (33 each): study group: 33 patients with pseudo-exfoliation, control group: 33 patients with senile cataract without pseudo-exfoliation. Results We found that ECD loss was 11.42% in the study group and 8.11% in the Control group 4 weeks after surgery. Phaco time and used BSS values were significantly higher in patients with PXS but had no significant influence on endothelial cell loss. They also suggested that the corneal endothelium in PXS be vulnerable to cataract surgery. Conclusion Torsional mode phacoemulsification and IOL implantation provided a safe and favorable surgical outcome in patients with/without PXS. Torsional phacoemulsification led to significantly higher ECD loss in the PXS than that in the control group during the whole follow up period.

Comparative study between torsional phacoemulsification and longitudinal phacoemulsification in their effect on corneal endothelium using specular microscopy.

Comparative study between torsional phacoemulsification and longitudinal phacoemulsification in their effect on corneal endothelium using specular microscopy.

Evaluation of clear corneal incision morphology and corneal changes after coaxial torsional phacoemulsification in soft to hard nuclear cataracts

Evaluation of clear corneal incision morphology and corneal changes after coaxial torsional phacoemulsification in soft to hard nuclear cataracts

Comparisons of the energy efficiency and intraocular safety of two torsional phacoemulsification tips

BackgroundDuring cataract phacoemulsification surgery, an Intrepid® balanced (IB) tip can achieve a larger amplitude, which may lead to higher energy efficiency than a Kelman (K) tip when paired with a torsional phaco platform. In this retrospective cohort study, we compared their energy efficiency and damage to the cornea under a new energy setting.MethodsThe medical records of 104 eyes of 79 patients were reviewed, with 47 eyes belonging to the IB group and 57 eyes belonging to the K group. All surgeries were performed on an Alcon Centurion® platform with gravity infiltration. Surgical parameters, visual outcome, central corneal thickness (CCT) changes, and endothelial cell density (ECD) loss rate were recorded and calculated.ResultsNo significant differences in postoperative best corrected visual acuity (BCVA), intraocular pressure (IOP), total ultrasound time, estimated fluid aspirated, CCT changes, or ECD loss rate were observed between the two groups. We divided the included eyes into soft nucleus and hard nucleus subgroups and found lower cumulative dissipated energy (CDE, 8.15 ± 8.02 vs 14.82 ± 14.16, P = 0.023), cumulative torsional energy (CTE, 8.06 ± 7.87 vs 14.13 ± 13.02, P = 0.027), and cumulative longitudinal energy (CLE, 0.09 ± 0.17 vs 0.69 ± 1.37, P = 0.017) in the IB group than in the K group, implying less energy used and higher energy efficiency of the IB tip.ConclusionLower CLE in the IB group indicates fewer phaco tip obstructions and a significantly higher capability to conquer hard nuclei with IB tips with statistical significance. With an ultra-perfusion cannula, the balanced tip does not cause more corneal damage.

Efficacy of Balanced Torsional Phacoemulsification Tip for Cataract Surgery.

Purpose:To compare the efficacy of the Intrepid® Balanced torsional phacoemulsification tip to that of the 30° Ozil® and 45° Kelman® tips using Centurion Vision System.Methods:This study included 150 eyes that underwent torsional phacoemulsification surgery using 30° Ozil® tip (Group 1, 48 eyes), Intrepid® Balanced tip (Group 2, 52 eyes), or 45° Kelman® tip (Group 3, 50 eyes). Ultrasound time (UST), cumulative dissipated energy (CDE), average phaco power, average torsional amplitude, balanced salt solution volume, aspiration and operation time, and preoperative, postoperative corrected distance visual acuity, central corneal thickness were recorded.Results:The mean UST, CDE, average phaco power, average torsional amplitude were 49.9 ± 15.7 s, 10.8 ± 4.5%-s, 23.9 ± 4.6%, and 51.4 ± 5.7% in the Ozil® group and 47.5 ± 10.6 s, 5.3 ± 2.2%-s, 12.5 ± 5.3%, and 28.9 ± 7.2% in the Intrepid® Balanced group, and 48.1 ± 12.7 s, 6.9 ± 3.3%-s, 18.9 ± 5.9%, and 39.2 ± 7.9% in the Kelman® group, respectively. The CDE, average phaco power, and average torsional amplitude of the Intrepid® Balanced group were significantly lower than other groups (P < 0.05). There was no statistically significant difference between the three groups in terms of UST and operation time (P > 0.05).Conclusion:Intrepid® Balanced tip, by means of its distinctive “double bent” design and balanced energy distribution, offers more effective phacoemulsification compared to conventional 30° Ozil® and 45° Kelman® tips.

Transvers ve Torsiyonel Fakoemülsifikasyon ile Biaksiyel Mikroinsizyon Katarakt Cerrahisinde Saydam Korneal Kesi Değişikliklerinin Karşılaştırılması: Kohort Çalışması

Objective: To compare the effects of transverse versus torsional phacoemulsification by using the biaxial microincision cataract surgery technique on corneal structures and clear corneal incision (CCI) morphology. Material and Methods: We evaluated comparative case series of patients with moderate density nuclear cataracts who underwent biaxial microincision transverse or torsional phacoemulsification. Seventy patients have included in the study and they were divided into 2 groups: transverse and torsional. The main outcome measures included, corrected distance visual acuity, central corneal thickness, central corneal endothelial cell density, endothelial cell loss (ECL), and changes in the CCI morphology. Results: Each group comprised 35 (35 eyes) patients. Epithelial misalignment on the CCI morphology was highly significantly meaningful with the transverse group on the postoperative first day (p<0.001). Descemet membrane detachment on the first day postoperatively was high in both groups, especially in the transverse group, but the difference was not statistically significant (p=0.073). In the postoperative 3rd month, the mean ECL was 23.6% in the transverse group, and 19.0% in the torsional group, and there was no statistically significant difference between groups (p=0.187). Conclusion: In biaxial microincision cataract surgery, the corneal damage caused by transverse phacoemulsification seems to be higher compared to the torsional mode.

Comparative study of conventional versus torsional phacoemulsification in management of hard nucleus

Background Phacoemulsification acoenergy and shortening the phacotime can decrease this risk. Aim The aim of this work is to compare the safety and the efficiency of phacoemulsification using conventional and torsional ultrasound modalities for hard nucleus cataracts. Settings and design This was a prospective randomized interventional study. Patients and methods A total of 30 eyes of 29 patients having hard nuclear cataract (grades IV and V) were divided into two groups. Group A included 15 eyes whose cataract was operated on by conventional phacoemulsification using the Infiniti machine. Group B included 15 eyes whose cataract was operated on by torsional phacoemulsification using the OZil technology of the Infiniti machine. Intraoperative ultrasound time and cumulative dissipated energy were recorded. Postoperative central corneal thickness (CCT) was measured at days 1, 7, and 30, and specular microscopy was done at 1 month. Statistical analysis The collected data were coded, tabulated, and statistically analyzed. Results The mean ultrasound time and cumulative dissipated energy and the amount of irrigating fluid were significantly higher in group A. There was a highly significant decrease in endothelial cell count (ECC) in both groups. ECC was significantly lower in the conventional group than in the torsional group at 1 month postoperatively. CCT in both groups was significantly increased at day 1 and then decreased at 1 week and 1 month but was still significantly higher than the preoperative level. CCT became higher in the conventional group than in the torsional group at all follow-up times, but this was significant only at day 1 and week 1 and not significant at 1 month. Conclusion Both ultrasound modalities can be used in hard nucleus phacoemulsification. However, the torsional ultrasound proved to be safer. The choice between these technologies is of particular importance when operating eyes with low ECC.

Erratum: Comparative study of conventional versus torsional phacoemulsification in management of hard nucleus

Erratum: Comparative study of conventional versus torsional phacoemulsification in management of hard nucleus

Improved Femtosecond Laser-Assisted Phacoemulsification of Hard Nucleus Cataract

Purpose: The development and clinical study of improved femtosecond laser-assisted phacoemulsification (PE) technology of hard nucleus cataract.Patients and methods. Improved femtosecond laser-assisted PE of hard nucleus cataract performed in 83 patients (93 eyes) (1st group), known femtosecond laser-assisted PE technique performed in 72 patients (78 eyes) (2nd group), torsional PE performed in 81 patients (89 eyes) (3rd group). The degree of intraoperative myosis, effective ultrasound time, corneal endothelial cell loss were evaluated in all groups.Results. Femtosecond laser-assisted PE is an effective technique for hard nucleus cataract removal, which can significantly reduce the energy ultrasonic load on the eye tissue. The proposed method for the instillation of prostaglandin synthesis inhibitors and the observance of the minimum possible interval between the first and second stages of the operation can prevent significant intraoperative narrowing of the pupil. A significant narrowing of the pupil by more than 2 mm after the femtolaser stage was noted in 7 (7.5 %) cases in the 1st group of patients, in 15 (16.9 %) cases in the 2nd group, in 5 (6.4 %) cases in the 3rd group. The results of the study has shown a significant decrease in the effective ultrasound time for a femtosecond laser-assisted PE compared with a torsional PE. The effective ultrasound time was in the 1st group (improved technology of femtosecond laser-assisted PE) — 3.81 ± 0.75, in the 2nd group (known technology of the femtosecond laser-assisted PE) — 5.23 ± 1.07 s (p &lt; 0.05), in the 3rd group (OZil technology) — 8.67 ± 1.83 s (p &lt; 0.05). The decrease in the effective ultrasound time has become a determining factor in reducing the loss of corneal endothelial cells in both femtosecond laser-assisted PE technologies compared to torsional PE. The average loss of corneal endothelial cells 3 months after surgery was 8.7 ± 1.8 % in the 1st group, 10.3 ± 2.1% in the 2nd group, 13.5 ± 2.7 % (p &lt; 0.05) in the 3rd group of patients.Conclusion. The proposed improved technology contributes to the solution of some problems that characterize femtosecond laser-assisted PE, and also helps to reduce the effective ultrasound time and the loss of corneal endothelial cells.

Efficacy of Burst Mode Torsional Phacoemulsification in Age-Related Cataract

Introduction: Torsional ultrasound energy and burst mode interrupted energy delivery system are recent advancementsin the technique of phacoemulsification surgery. It has been reported that both these advancementshelpto reduce corneal wound burn and thermal induced endothelial cell loss and thereby helps to achieve excellent early postoperative visual outcome&#x0D; Objectives: To evaluate the efficacy of burst mode torsional phacoemulsification surgery in age-related cataract.&#x0D; Materials and Methods: Prospective observational study of 120 cases that underwent phacoemulsificationcataract surgery in which torsional energy was used in burst mode. Phacoemulsification was performed by “vertical –chop” technique. Intraoperatively corneal wound burn, Descemet’s membrane detachment, posterior capsule ruptureetc.were evaluated. Postoperatively corneal oedema, best corrected visual acuity, cystoid macular oedema were evaluated. Postoperatively eyes were examined at day 1, 1 week, 6 weeks and 3 months.&#x0D; Results: Mean age of the patients was 57.28± 8.20 years. Most of the patients 81(67.5%) had nuclear sclerosis grade-II cataract.Intraoperatively, moderate wound burn occurred in 02(1.6%) eyes, localized Descemet’s membrane detachmentin 03(2.5%) eyes and posterior capsule rupture occurred in 03(2.5%) cases. Postoperatively, moderate and severe corneal edema was found in 06(5.0%) and 04(3.3%) eyes respectively at day 1. At the end of 3 months follow-up, 114(95%) eyes maintained a best corrected visual acuity of ≥ 6/18, of which 109(90.8%) eyes achieved ≥ 6/9.&#x0D; Conclusion: Burst mode torsional phacoemulsfication is a very effective and advanced technique of cataract surgery. Intraoperative complications are very less and visual outcome is excellent.&#x0D; Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 94-97

Surgical Outcomes of Intravitreal Torsional Phacoemulsification for Dropped Lens Fragments during Cataract Surgery

ëª©ì  ë°±ë‚´ìž¥ìˆ˜ìˆ ì¤‘ ìœ ë¦¬ì²´ 내로 떨어진 ìˆ˜ì •ì²´ 조각에 대해 ë¯¸ì„¸ì ˆê°œ ìœ ë¦¬ì²´ì ˆì œìˆ ê³¼ 같이 시행한 ìœ ë¦¬ì²´ 내 íšŒì„ ì§„ë™ë°©ì‹ ìˆ˜ì •ì²´ìœ í™”ìˆ ì˜ 치료 결과에 대해 ì•Œì•„ë³´ê³ ìž 하였다.대상과 방법 2014ë „ 1월부터 2017ë „ 12월까지 시행한 ë°±ë‚´ìž¥ìˆ˜ìˆ ì¤‘ ìœ ë¦¬ì²´ 내로 떨어진 ìˆ˜ì •ì²´ 조각에 대해 ë¯¸ì„¸ì ˆê°œ ìœ ë¦¬ì²´ì ˆì œìˆ ê³¼ ìœ ë¦¬ì²´ 내 íšŒì„ ì§„ë™ë°©ì‹ ìˆ˜ì •ì²´ìœ í™”ìˆ ì„ 시행한 후 6개월 이상 경과 관찰이 가능하였던 환자 22ëª 22안을 대상으로 í›„í–¥ì ìœ¼ë¡œ 연구하였다. ìˆ˜ìˆ ì „í›„ì˜ ìµœëŒ€êµì •ì‹œë ¥ê³¼ ìˆ˜ìˆ í›„ 망막박리, 망막 째짐, ë‚­í¬í™©ë°˜ë¶€ì¢ , ê³µë§‰ì ˆê°œ 부위의 화상 등과 같은 합병증에 대해 조사하였다. ê²°ê³¼ 남자 17ëª , 여자 5ëª ì´ì—ˆê³ , í‰ê· ì—°ë ¹ì€ 71.3 ± 8.2세였다. ë°±ë‚´ìž¥ìˆ˜ìˆ í›„ ìœ ë¦¬ì²´ì ˆì œìˆ ê¹Œì§€ëŠ” í‰ê· 0.4 ± 0.8일이었으며, 모두 3일 이내에 시행되었다. í‰ê· ìµœëŒ€êµì •ì‹œë ¥(logMAR)은 ìˆ˜ìˆ ì „ 1.37 ± 0.79에서 ìˆ˜ìˆ í›„ 0.21 ± 0.15로 ìœ ì˜í•˜ê²Œ í˜¸ì „ì´ 되었다(p<0.001). ìˆ˜ìˆ ì¤‘ ê³µë§‰ì ˆê°œ 부위의 화상이나 ìˆ˜ìˆ ì¤‘ 망막의 손상은 관찰이 되지 않았다. ìˆ˜ìˆ í›„ ë‚­í¬í™©ë°˜ë¶€ì¢ 2예가 발생하였으나 ë³´ì „ì  치료로 모두 í˜¸ì „ë˜ì—ˆìœ¼ë©° 망막박리가 발생한 경우는 없었다. ê²°ë¡ ìœ ë¦¬ì²´ 내로 떨어진 ìˆ˜ì •ì²´ 조각에 대한 ë¯¸ì„¸ì ˆê°œ ìœ ë¦¬ì²´ì ˆì œìˆ ê³¼ ìœ ë¦¬ì²´ 내의 íšŒì„ ì§„ë™ë°©ì‹ ì´ˆìŒíŒŒìœ í™”ê¸°ë¥¼ 이용한 ìˆ˜ìˆ ë°©ë²•ì€ ìˆ˜ì •ì²´ìœ í™”ê¸°ì˜ 첨단부에 의한 특별한 합병증 없이 ì‹œë ¥íšŒë³µì„ ê¸°ëŒ€í• ìˆ˜ 있는 ì•ˆì „í•˜ê³ íš¨ê³¼ì ì¸ ìˆ˜ìˆ ë°©ë²•ìœ¼ë¡œ 생각된다. Keywords: Cataract, Phacoemulsification, Vitrectomy

Energy load and state of corneal endothelium in hybrid (femtosecond laser-assisted) and torsional phacoemulsification

To compare the intraoperative energy load and postoperative state of corneal endothelium in hybrid (femtosecond laser-assisted) and torsional phacoemulsification. The study analyzed surgical outcomes of 603 patients (714 eyes) divided into 3 groups: 225 patients (267 eyes) underwent modified femtosecond laser-assisted phacoemulsification (1st group), 237 patients (278 eyes) underwent standard femtosecond laser-assisted phacoemulsification (2nd group), and 141 patients (169 eyes) who underwent torsional phacoemulsification (3rd group). The follow-up period lasted up to 2 years. In patients with grade II lens density (here and further - L. Buratto classification is used), effective ultrasound time was 0.56±0.11 s in the 1st group, 0.83±0.17 s in the 2nd group, and 2.78 ± 0.51 s in the 3rd group (p(1-2)<0.05; p(1-3)<0.05; p(2-3)<0.05). In patients with grade III lens density effective ultrasound time was 2.04±0.37 s in the 1st group, 2.97±0.53 s in the 2nd group, and 4.59±0.91 s in the 3rd group (p(1-2)<0.05; p(1-3)<0.05; p(2-3)<0.05). In patients with grade IV lens density, effective ultrasound time was 3.95±0.81 s in the 1st group, 5.11±1.03 s in the 2nd group, and 8.37±1.73 s in the 3rd group (p(1-2)<0.05; p(1-3)<0.05; p(2-3)<0.05). In patients with grade II lens density, loss of endothelial cells was 3.3±1.1% in the 1st group, 3.7±1.2% in the 2nd group, and 4.3±1.2% in the 3rd group (p(1-2)>0.05; p(1- 3)<0.05; p(2-3)<0.05). In patients with grade III lens density, loss of endothelial cells was 5.1±1.4% in the 1st group, 5.7±1.5% in the 2nd group, 7.2±1.7% in the 3rd group (p(1-2)>0.05; p(1-3)<0.05; p(2-3)<0.05). In patients with grade IV lens density, loss of endothelial cells was 8.9±2.1% in the 1st group, 10.1±2.3% in the 2nd group, and 13.3±2.5% in the 3rd group (p(1-2)>0.05; p(1-3)<0.05; p(2- -3)<0.05). Both techniques of femtosecond laser-assisted phacoemulsification significantly reduce the effective ultrasound time (p<0.05) and the degree of corneal endothelial cells loss (p<0.05) compared with torsional phacoemulsification.

Linear versus Torsional Phacoemulsification: A Comparative Study

Linear versus Torsional Phacoemulsification: A Comparative Study

Active-fluidics-based torsional phacoemulsification in diabetic eyes: A prospective interventional study.

Purpose:To compare the outcomes of active-fluidics based torsional phacoemulsification in diabetics and nondiabetics using a balanced tip.Methods:Two hundred and forty-eight patients undergoing senile cataract surgery using torsional phacoemulsification on an active-fluidics-based platform from December 2016 to August 2017 were included in this prospective, nonrandomized, interventional cohort study; of the 248 patients, 54 were controlled diabetics and 194 were nondiabetics. Intraoperative parameters such as cumulative dissipated energy (CDE), total ultrasound time, torsion usage time, torsion amplitude, aspiration time, and fluid usage were documented and compared. Endothelial cell loss (ECL) and central corneal thickness (CCT) were evaluated at 1 month postoperatively.Results:Diabetics and nondiabetics did not differ in CDE, total ultrasound time, torsion amplitude, aspiration time, fluid usage, endothelial cell count, and CCT. ECL on Day 1 (10.2 ± 8.0%) and Day 30 (11.05 ± 8.3%) were significantly higher in diabetics (P = 0.025 and P = 0.045, respectively). There was an increase in CCT on Day 1 (P = 0.018), which settled by Day 30. Grade 4 cataracts in diabetics had significantly higher CCT at Day 1 (P = 0.032) and Day 30 (P = 0.007). In the diabetic subgroup, Grades 3 and 4 cataracts required lower CDE (P < 0.001) and Grade 4 cataracts showed higher ECL than others till 1 month of follow-up (P < 0.05).Conclusion:Intraoperative and postoperative parameters after torsional phacoemulsification are comparable in diabetics and nondiabetics. Endothelial changes and pachymetry may be related to the grade of cataract in diabetics.

Corneal Endothelial and Central Corneal Thickness Changes after non Complicated Uneventful Phacoemulsification

Aim of the work: this study aimed to evaluate the central corneal thickness and the corneal endothelium by specular microscopy in torsional phacoemulsification versus longitudinal phacoemulsification. Methods: in our study we did a comparative analysis of the changes in endothelial cells of the cornea (Central cell density and cell loss) and central corneal thickness after cataract extraction surgeries by torsional phacoemulsification versus longitudinal phacoemulsification. In our study thirty eyes of thirty patients were chosen from Ophthalmology clinic at Bab Al-Shaariah University Hospital for uneventful phacoemulsification surgeries (15 eyes of 15 patiens for torsional phaco and 15 eyes of 15 patients for longitudinal phaco). The types and densities of cataract were determined as cortical, posterior supcapsular (PSC), nuclear I, nuclear II and nuclear III. Divide and Conquer technique was used for phacoemulsification using (Infiniti, Ozil technology, Alcon) phaco machine. A noncontact specular microscope Topcon SP-1P (Topcon Corporation, Japan) was used to evaluate the central endothelial cell density (CD) and central corneal thickness (CCT). Results: The mean U/S time was lower in the torsional group than in the longitudinal group (p 0.05) and higher average corneal endothelial cell losses at 2 weeks postoperative (p > 0.05). Conclusions: our study suggested a better efficiency by the torsional mode rather than the longitudinal mode.

A randomized controlled trial comparing femtosecond laser–assisted cataract surgery versus conventional phacoemulsification surgery

To compare the clinical results of conventional phacoemulsification surgery (CPS) with femtosecond laser-assisted cataract surgery. Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom. Single-center prospective randomized interventional case-controlled trial. Patients undergoing cataract surgery were randomized to receive either CPS or femtosecond laser-assisted cataract surgery. The surgery was performed with a femtosecond laser (Lensx), and all operations were performed with a gravity-fluidics torsional phacoemulsification machine (Infiniti). The visual acuity, refraction, central corneal thickness (CCT), central foveal thickness (CFT), endothelial cell loss, and rates of intraoperative and postoperative events were recorded. Quality of life outcomes were measured with the EuroQOL 5 dimensions questionnaire (EQ-5D) and patient-reported quality of vision was assessed witha cataract surgery patient-reported outcome measures questionnaire (Cat-PROM5). The study comprised 400 eyes of 400 patients who had CPS (n=200) or femtosecond laser-assisted cataract surgery (n=200). Seven patients (3.5%) in the femtosecond laser-assisted group were not able to complete the treatment and received CPS. The mean uncorrected distance visual acuity (logarithm of the minimum angle of resolution [logMAR]) 0.15±0.21 (SD) and 0.15±0.19 logMAR after CPS and femtosecond laser-assisted surgery, respectively (P=1.0); the pinhole-corrected visual acuity was 0.04±0.12 and 0.04±0.12, respectively (P=1.0); the increase in CCT was 13±19μm and 15±25μm, respectively (P=.5); and the endothelial cell loss was 9.7±13.7 % and 10.2%±13.7, respectively (P=.76). The manifest refraction spherical equivalent error was -0.14±0.60 diopters (D) after CPS and -0.12±0.60 D after femtosecond laser-assisted surgery (P=.74); the mean change in CFT was 9±35μm and 6±35μm, respectively (P=.55); and the rate of posterior capsule rupture was 3% and 0%, respectively (P=.03). This study confirms the nonsignificant differences between 2 treatment modalities, notwithstanding a significant reduction in posterior capsule ruptures in the femtosecond laser-assisted surgery group.

Determining optimal ultrasound percent on time with long-pulse torsional phacoemulsification

ObjectiveTo evaluate the optimum percent on time for the most efficient lens fragment removal using long-pulse torsional ultrasound (US). DesignIn vitro laboratory study. MethodsPorcine lens nuclei were incubated in formalin for 2 hours and then cut into 2 mm cubes. Phacoemulsification was performed using the Centurion® Vision System and Infiniti OZil handpiece with the balanced tip. Vacuum was set at 500 mm Hg, aspiration rate at 50 mL/min, and intraocular pressure (IOP) at 50 mm Hg. Pulse rate was 26 pulses/second. Studied parameters were percent power: 60%, 80%, and 100%, and percent on times: 50%, 60%, 70%, and 80%. Efficiency was the total time for a cube to be emulsified. Chatter was the number of times the lens fragment bounced off the tip. ResultsThere was no significant difference in efficiency between 50%, 60%, and 70 % on-time settings (p = 0.17 and 0.08, respectively); however, there was significant increase in efficiency when the on time was increased from 70% to 80% (p = 0.03). Increasing power from 60% to 100% showed a statistically significant efficiency increase (p = 0.001). There was no significant change in chatter with increasing on time; however, there was a statistically significant increase in chatter with every power level increase. ConclusionIncreasing on-time percent does not improve efficiency under torsional long-pulse US. There is no significant change in chatter with increasing on-time percent. Increasing power increases efficiency despite chatter increase. Long-pulse US does not appear to influence torsional action in a clinically meaningful way.

Microinterventional endocapsular nucleus disassembly: novel technique and results of first-in-human randomised controlled study

AimTo assess the safety and efficacy of microinterventional endocapsular nuclear fragmentation in moderate to severe cataracts.MethodsThis was a prospective single-masked multisurgeon interventional randomised controlled trial (ClinicalTrials.gov NCT02843594) where 101 eyes...

Effectivity and Safety of a Modified Tip Design in Torsional Phacoemulsification

Torsional mode phacoemulsification results in more effective fragmentation of the nucleus due to a different movement of the phacotip. In this clinical study, we investigated the influence of a modified tip design and active fluidics on the efficacy of phacoemulsification and safety for the corneal endothelium. We conducted a prospective randomized 2 : 1 study in which 40 patients were operated on with the mini-flared Kelman Tip using the Infiniti® System (group 1), and 20 patients were operated on with the Intrepid® Balanced Tip and the Centurion® System. We analyzed the intraoperative cumulative dissipated energy and also the density of the corneal endothelium measured with an endothelial microscope (CEM 530, Nidek) pre- and postoperatively. Both groups did not differ preoperatively in age, sex, axial length of the globe or corneal endothelium cell density nor cataract density (LOCS3). All surgeries were uneventful. The cumulative dissipated energy in group 1 (mini-flared Kelman tip, Infiniti System) was 38% higher than in group 2 (balanced tip, Centurion System; p < 0.05). The endothelial cell loss was 8% in group 1 and 10.3% in group 2 (p > 0.05). The cell size (polymegathism) increased in both groups significantly with + 37 µm in group 1 (p < 0.05) und + 54 µm in group 2 (p < 0.05). There was no statistically significant difference between both groups (p > 0.05). The number of hexagonal cells (pleomorphism) and corneal thickness did not differ in both groups either pre- nor postoperatively. Compared to torsional phacoemulsification with a mini-flared Kelman Tip and gravity fluidics, torsional phacoemulsification with a modified tip design and active fluidics is 38% more effective regarding the cumulative dissipated energy. Endothelial cell loss occurs to a similar extend using both systems. The postoperative changes in cell size (polymegathism), number of hexagonal cells (pleomorphism) and corneal thickness (pachymetry) were similar among both systems. We conclude, that the intraoperative stress on the endothelium is equivalent with both systems used.

Effect of IOP based infusion system with and without balanced phaco tip on cumulative dissipated energy and estimated fluid usage in comparison to gravity fed infusion in torsional phacoemulsification

BackgroundTo evaluate the effect of three different combinations of tip designs and infusion systems in torsional phacoemulsification (INFINITI and CENTURION) in patients with cataract. According to the manufacturer, two unique improvements in the Centurion are: active fluid dynamic management system and use of an intrepid balanced tip. The study specifically aimed to evaluate the beneficial effects, if any, of change in tip design and infusion system individually and in combination on both per-operative parameters as well as endothelial health over 6 months.MethodsOne hundred and twenty six consenting patients of grade 4.0–6.9 senile cataract were randomized into three groups for phacoemulsification: Group A (n = 42): Gravity fed infusion system and 450 Kelman miniflared ABS phaco tip; Group B (n = 42): intraocular pressure (IOP) based infusion system and 450 Kelman miniflared ABS phaco tip; Group C (n = 42): IOP based infusion system and 450 Intrepid balanced phaco tip. The cumulative dissipated energy (CDE), estimated fluid usage (EFU) and total aspiration time (TAT) were compared peroperatively. The endothelial parameters were followed up postoperatively for six months.ResultsThe three arms were matched for age (p = 0.525), gender (p = 0.96) and grade of cataract (p = 0.177). Group C was associated with significant reductions in CDE (p = 0.001), EFU (p < 0.0005) as well as TAT (p = 0.001) in comparison to the other groups. All three groups had comparable baseline endothelial cell density (p = 0.876) and central corneal thickness (p = 0.561). On post-operative evaluation, although all groups were comparable till 3 months, by 6 months, the percentage losses in endothelial cell density were significantly lower in group C as compared to the other groups.ConclusionsUse of an IOP based phacoemulsification system in association with use of the Intrepid balanced tip reduces the CDE, EFU and TAT in comparison to a gravity fed system with a mini flared tip or IOP based system with a mini flared tip while also providing better endothelial preservation thus favouring the use of an IOP fed system with a balanced tip.Trial registrationTrial registration No.: CTRI/2016/06/007022.