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.

Clinical study of intelligent phacoemulsification for hard nucleus cataract extraction / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare the efficiency and safety of torsional phacoemulsification with or without intelligent phacoemulsification ( IP ) software in hard nucleus cataract extraction. METHODS: Ninety two eyes with Ⅳ - Ⅴ grades cataracts were enrolled in this randomized prospective study. Operated eyes were divided into two groups -those operated without IP software ( non- IP group, n =43) and those operated using IP software (IP group, n =49 ). The two groups were compared in terms of ultrasound time (UST) and cumulative dissipated energy (CDE). Post- operative outcome measures included the corneal edema and best-corrected visual acuity (BCVA) at 1,7d and 3mo postoperatively, corneal endothelial cell density and percentage of hexagonal cell at 7d and 3mo postoperatively. RESULTS: UST was measured as 52. 51±9. 64s in non-IP Group and 48. 79±7. 13s in IP Group (P = 0. 030). CDE was 15. 78±3. 73% in non-IP Group and 14. 29±2. 77% in IP Group ( P = 0. 026). At the first postoperative day, the rate of BCVA>0. 1 in non-IP Group was 56%, and the rate in IP Group was 79% (P= 0. 066). Corneal edema in non-IP Group was 2. 98±0. 77 scores, and in IP Group it was 2. 61±0. 64 scores (P = 0. 021). At the postoperative 7 and 30d, the BCVA and corneal edema were no differences between two groups. At the postoperative 7d, corneal endothelial cell density in non- IP Group were 2497. 95 ±211. 48 / mm2 , less than 2586. 26±154. 71 / mm 2 in IP Group (P= 0. 029);percentage of hexagonal cell in IP group was 48. 33±8. 69%,higher than 44. 19±9. 48% of non-IP group(P= 0. 030).CONCLUSION: In hard nucleus cataract extraction, the IP software can combine the advantages of the two kinds of ultrasonic modes, which is more effective with lower ultrasound energy and less injury for the corneal endothclium, and is helpful for the recovery of vision at early stage after surgeries.

Relationship between lens density measurements by Pentacam Scheimpflug imaging and torsional phacoemulsification parameters / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the relationship between the density values of the lens nucleus measured using Pentacam Scheimpflug imaging and torsional phacoemulsification dynamics such as the level of ultrasound energy, as well as the duration and amount of fluid used in patients with age-related nuclear cataract. METHODS: This was a prospective observer-masked study. Pentacam Scheimpflug imaging was performed following pupil dilation. The cataracts were automatically graded from 1 to 5 using pentacam nucleus densitometry (PND), also known as Pentacam nucleus staging (PNS) software by the same observer. After phacoemulsification, total Ultrasound ( U/S ) time, Cumulative dissipated energy ( CDE ) , Torsional U/S time, and Estimated fluid use were automatically calculated and displayed on the monitor of Infiniti OZiL IP phacoemulsification system. One-way analysis of variance ( ANOVA ) was used to assess differences between groups. The Tamhane test was used for multiple group analysis. Spearman correlation analysis was used to assess the relationship between lens density measured by PND and the dynamics of torsional phacoemulsification. P RESULTS:In the present study, 125 eyes from 125 patients were evaluated. Mean age was 69. 7 ± 9. 4y (range: 48 - 88y), and 61 men and 64 women were included. The highest and lowest values of U/S total time, torsional U/S time, CDE, and Estimated fluid use were 0. 70 - 158. 90s, 0. 70-158. 50s, 0. 11-42. 65, and 21-98 mL in groups, respectively. Significant differences were found among PND groups. When the relationship between phacoemulsification dynamics and PND values were evaluated, there were significant correlations between PND value and total ultrasound time (r=0. 767;P CONCLUSION:An objective degree of nucleus density obtained by PND scoring before cataract surgery may allow antecedent determination of intraoperative phacoemulsification parameters. Thus, individualized phacoemulsification parameters should be developed for each patient. This will lead to the use of a smaller amount of phacoemulsification energy, resulting in decreased in endothelial cell loss, quicker and better visual healing, and less steroid use.

Short-Term Outcome of Cataract Surgery Using Torsional-Mode Phacoemulsification for Patients with Low Endothelial Cell Counts

PURPOSE: To evaluate the short-term clinical outcome of cataract surgery using torsional mode phacoemulsification for patients with low endothelial cell density. METHODS: Fifty-seven eyes of 52 patients who underwent torsional phacoemulsification and intraocular lens insertion were included in the present study. Patients were divided into groups according to endothelial cell density (ECD). The control group was comprised of patients with more than 2500/mm2 of ECD and was compared with the low ECD group (LECD) comprised of patients with less than 1600/mm2 of ECD. The LECD group was further divided into a very low ECD group (VLECD) comprised of patients with less than 1000/mm2 of ECD, and a PK-VLECD group comprised of patients with less than 1000/mm2 of ECD after penetrating keratoplasty. Measurement of ECD, cell-size variation coefficient, hexagonality, and central corneal thickness were performed preoperatively and 1 month after surgery. RESULTS: The only one patient who had undergone penetrating keratoplasty with remaining low endothelial density and grade 4 nuclear sclerosis developed overt corneal edema after cataract surgery. No statistically significant differences in the change of endothelial cell characteristics and central corneal thickness before and after surgery were observed between the control and LECD group and between the VLECD and PK-VLECD group. CONCLUSIONS: Even in patients with low ECD, torsional phacoemulsification appears to have a similar effect on the short-term change of endothelial cells, suggesting cataract surgery can be conducted with a staged approach when the density of nucleus is moderate or less dense.

The Comparison between Torsional and Conventional Mode Phacoemulsification in Moderate and Hard Cataracts

PURPOSE: To compare the intraoperative performances and postoperative outcomes of cataract surgery performed with longitudinal phacoemulsification and torsional phacoemulsification in moderate and hard cataracts. METHODS: Of 85 patients who had senile cataracts, 102 eyes were operated on using the Infiniti Vision System. Preoperative examinations (slit lamp examination, mean central corneal thickness, and central endothelial cell counts) were performed for each patient. Cataracts were subdivided into moderate and hard, according to the Lens Opacities Classification System III grading of nucleus opalescence (NO). Eyes in each cataract group were randomly assigned to conventional and torsional phaco-mode. Intraoperative parameters, including ultrasound time (UST), cumulative dissipated energy (CDE), and the balanced salt solution plus (BSSP) volume utilized were evaluated. Best corrected visual acuity (BCVA) was checked on postoperative day 30; mean central corneal thickness and central endothelial cell counts were investigated on postoperative days 7 and 30. RESULTS: Preoperative BCVA and mean grading of NO showed no difference in both groups. Preoperative endothelial cell count and central corneal thickness also showed no significant difference in both groups. In the moderate cataract group, the CDE, UST, and BSSP volume were significantly lower in the torsional mode than the longitudinal mode, but they did not show any difference in the hard cataract group. Torsional group showed less endothelial cell loss and central corneal thickening at postoperative day seven in moderate cataracts but showed no significant differences, as compared with the longitudinal group, by postoperative day 30. CONCLUSIONS: Torsional phacoemulsification showed superior efficiency for moderate cataracts, as compared with longitudinal phacoemulsification, in the early postoperative stage.