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Sato T. Efficacy and safety of the eight-chop technique in phacoemulsification for patients with cataract. J Cataract Refract Surg 2023; 49:479-484. [PMID: 36700931 PMCID: PMC10358444 DOI: 10.1097/j.jcrs.0000000000001141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 12/13/2022] [Accepted: 12/18/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE The aim of this study was to estimate the efficacy of the 8-chop technique in phacoemulsification surgeries of patients with cataract. SETTING Sato Eye Clinic, Chiba-ken, Japan. DESIGN Prospective study. METHODS Patients were classified into 3 groups (Grade II, Grade III, and Grade IV; n = 50 each) according to the firmness of their lens nuclei. The Eight-chopper I was used for Grade II, Eight-chopper II for Grade III, and Lance-chopper for Grade IV. The best-corrected visual acuity, intraocular pressure (IOP), and endothelial cell density were evaluated at 7 and 19 weeks postoperatively. The primary outcome measures were the mean operative time, mean phaco time, cumulative dissipated energy (CDE), and volume of fluid used. RESULTS 150 cataract surgeries were performed. The operative time (minutes), phaco time (seconds), CDE, and volume of fluid used (milliliters) differed significantly among the 3 groups, increasing in the following order: Grade II, Grade III, and Grade IV ( P < .01). The corneal endothelial cell density did not decrease significantly in the 3 groups at 19 weeks postoperatively ( P = .09). The rate of endothelial cell loss was 0.9% ± 5.9%, 1.0% ± 10.3%, and 5.3% ± 11.1% in the Grade II, III, and IV groups at 19 weeks postoperatively, respectively. There were significant reductions in the IOP at 7 and 19 weeks postoperatively compared with the preoperative IOP in the 3 groups ( P < .01). CONCLUSIONS The 8-chop technique was effective and safe in phacoemulsification for patients with cataracts with lens nuclei of varying hardness.
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Affiliation(s)
- Tsuyoshi Sato
- From the Department of Ophthalmology, Sato Eye Clinic, Chiba-ken, Japan
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Sabur H, Eroglu SA, Azarsiz SS. Efficacy of Balanced Torsional Phacoemulsification Tip for Cataract Surgery. J Curr Ophthalmol 2022; 34:74-79. [PMID: 35620374 PMCID: PMC9128437 DOI: 10.4103/joco.joco_105_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 08/28/2021] [Accepted: 09/27/2021] [Indexed: 11/06/2022] Open
Abstract
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.
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Affiliation(s)
- Huri Sabur
- Department of Ophthalmology, Bergama Necla-Mithat Oztüre State Hospital, Izmir, Turkey
| | - Sayime Aydin Eroglu
- Deparment of Ophthalmology, Izmir Bakircay University Cigli Training and Research Hospital, Izmir, Turkey
| | - Salih Sertac Azarsiz
- Deparment of Ophthalmology, Izmir Bakircay University Cigli Training and Research Hospital, Izmir, Turkey
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Malik PK, Dewan T, Patidar AK, Sain E. 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. EYE AND VISION 2017; 4:22. [PMID: 28932753 PMCID: PMC5602781 DOI: 10.1186/s40662-017-0087-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 09/02/2017] [Indexed: 05/29/2023]
Abstract
Background To 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. Methods One 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. Results The 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. Conclusions Use 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 registration Trial registration No.: CTRI/2016/06/007022.
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Affiliation(s)
| | - Taru Dewan
- Dr Ram Manohar Lohia Hospital, New Delhi, India
| | | | - Ekta Sain
- Dr Ram Manohar Lohia Hospital, New Delhi, India
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Stagg BC, Gupta I, Cahoon J, Ronquillo C, Shi D, Zaugg B, Gardiner G, Barlow WR, Pettey JH, Aabid Farukhi M, Jensen J, Olson RJ. Bent versus straight tips in micropulsed longitudinal phacoemulsification. Can J Ophthalmol 2015; 50:354-9. [PMID: 26455970 DOI: 10.1016/j.jcjo.2015.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 04/02/2015] [Accepted: 06/12/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate bent and straight phacoemulsification tips to determine which tip is more efficient in removal of lens fragments, using micropulsed longitudinal ultrasound in phacoemulsification. DESIGN In vitro laboratory study. METHODS The John A. Moran Eye Center Laboratories, University of Utah, Salt Lake City, Utah, was the study setting. Pig lenses hardened in a manner comparable with dense human cataracts were cut into 2-mm cubes and removed with micropulsed longitudinal ultrasound using settings previously shown to be optimally efficient (6 milliseconds on and 6 milliseconds off for a bent tip). To verify this time as most efficient for a straight tip, we also tested times of 5, 6, and 7 milliseconds time on and off. The tips were either straight or with a 20-degree bend. Twenty cubes were used for each comparative run. RESULTS For the straight tip, 6 milliseconds on (1.56 ± 0.815 seconds) was significantly more efficient than 7 milliseconds on (2.45 ± 1.56 seconds, p = 0.001) and not significantly more efficient than 5 milliseconds on (1.69 ± 0.86 seconds, p = 0.43). Five milliseconds off time (1.45 ± 0.76s) was more efficient than 6 milliseconds (2.06 ± 1.37 seconds, p = 0.004) and 7 milliseconds off (2.18 ± 1.24s, p = 0.001). The straight tip was more efficient than the bent tip (1.38 ± 0.83 versus 2.93 ± 2.14 seconds, p = 0.006). CONCLUSIONS Results are contrary to accepted common belief. Micropulsed longitudinal phacoemulsification is more efficient with a straight rather than a bent tip.
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Affiliation(s)
- Brian C Stagg
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Isha Gupta
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Judd Cahoon
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Cecinio Ronquillo
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Dallas Shi
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Brian Zaugg
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Gareth Gardiner
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - William R Barlow
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Jeff H Pettey
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - M Aabid Farukhi
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Jason Jensen
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Randall J Olson
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah.
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Abstract
Purpose/aim of the study To present a phacoemulsification technique for hard cataracts and compare postoperative results using two different ultrasonic tip motions during quadrant removal. Materials and methods A phacoemulsification technique which employs in situ fracture and endocapsular debulking for hard cataracts is presented. The prospective study included 56 consecutive cases of hard cataract (LOCS III NC [Lens Opacification Classification System III, nuclear color], average 4.26), which were operated using the Infiniti machine and the Partial Kelman tip. Longitudinal tip movement was used for sculpting for all cases which were randomized to receive longitudinal or torsional/interjected longitudinal (Intelligent Phaco [IP]) strategies for quadrant removal. Measurements included cumulative dissipated energy (CDE), 3 months postoperative surgically induced astigmatism (SIA), and corneal endothelial cell density (ECD) losses. Results No complications were recorded in any of the cases. Respective overall and longitudinal vs IP means were as follows: CDE, 51.6±15.6 and 55.7±15.5 vs 48.6±15.1; SIA, 0.36±0.2 D and 0.4±0.2 D vs 0.3±0.2 D; and mean ECD loss, 4.1%±10.8% and 5.9%±13.4% vs 2.7%±7.8%. The differences between longitudinal and IP were not significant for any of the three categories. Conclusion The endocapsular phacofracture debulking technique is safe and effective for phacoemulsification of hard cataracts using longitudinal or torsional IP strategies for quadrant removal with the Infiniti machine and Partial Kelman tip.
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Demircan S, Gokce G, Atas M, Baskan B, Goktas E, Zararsiz G. The Impact of Reused Phaco Tip on Outcomes of Phacoemulsification Surgery. Curr Eye Res 2015; 41:636-42. [PMID: 25880893 DOI: 10.3109/02713683.2015.1039654] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate the impact of reused phaco tip on intraoperative performance and postoperative outcomes after 2.2 mm micro-coaxial torsional and transversal phacoemulsification. MATERIAL AND METHODS This prospective randomized study enrolled 136 eyes of 136 cataract patients; 68 eyes in torsional group (34 eyes with single use tip, 34 eyes with reused tip) and 68 eyes in transversal group (34 eyes with single use tip, 34 eyes with reused tip). Intraoperative measurements were total ultrasound (U/S) time, torsional U/S time, cumulative dissipated energy (CDE), estimated fluid use (EFU) in the torsional group and total phacoemulsification time (TPT), and effective phacoemulsification time (EPT) in transversal phacoemulsification. The central endothelial cell density (ECD) and the central corneal thickness (CCT) were evaluated preoperatively and postoperatively at 1 and 30 days using noncontact specular microscopy. RESULTS Intraoperative measurements in torsional phacoemulsification showed significant increase in total U/S time (p = 0.01), torsional U/S time (p = 0.01), and CDE (p = 0.01) with the reused tip. The EFU was similar in both tip groups (p = 0.36). The total U/S time, torsional U/S time, and CDE in torsional group were significantly increased with the reused tip for grade III (p = 0.03 for all parameters) and grade IV cataracts (p = 0.005 for torsional U/S time and CDE; p = 0.006 for total U/S time). Intraoperative measurements in transversal phacoemulsification showed no differences in TPT and EPT between tip groups (p > 0.05). The change in ECD and CCT in torsional and transversal phacoemulsification groups were similar in both tip groups (p > 0.05). CONCLUSIONS This study showed that sharpness of phaco tip edge increases the efficiency of torsional phacoemulsification for hard cataracts. This result does not mean that reused phaco tip may be used in soft and medium cataracts. As the timing of tip's change is a user-dependent procedure, a new single phaco tip should be used in each case if possible.
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Affiliation(s)
- Suleyman Demircan
- a Kayseri Training and Research Hospital, Eye Clinic , Kayseri , Turkey
| | - Gokcen Gokce
- b Department of Ophthalmology , Kayseri Military Hospital , Kayseri , Turkey , and
| | - Mustafa Atas
- a Kayseri Training and Research Hospital, Eye Clinic , Kayseri , Turkey
| | - Burhan Baskan
- a Kayseri Training and Research Hospital, Eye Clinic , Kayseri , Turkey
| | - Emre Goktas
- a Kayseri Training and Research Hospital, Eye Clinic , Kayseri , Turkey
| | - Gokmen Zararsiz
- c Department of Biostatistics , Erciyes University , Kayseri , Turkey
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Helvacioglu F, Yeter C, Sencan S, Tunc Z, Uyar OM. Comparison of two different ultrasound methods of phacoemulsification. Am J Ophthalmol 2014; 158:221-226.e1. [PMID: 24792106 DOI: 10.1016/j.ajo.2014.04.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/16/2014] [Accepted: 04/17/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the safety and efficacy of microcoaxial phacoemulsification surgeries performed with the OZil Intelligent Phaco torsional mode (Alcon Laboratories, Inc., Fort Worth, USA) and combined torsional/longitudinal ultrasound mode using 45 degree aperture angled tips. DESIGN Prospective randomized clinical trial. METHODS setting: Maltepe University, Istanbul. patient population: Eighty eyes of 80 cataract patients were randomly assigned to 2.2 mm microcoaxial phacoemulsification using the OZil Intelligent Phaco torsional mode (Group 1) or combined torsional/longitudinal ultrasound mode (Group 2). observation procedure: Intraoperative fluid and energy usage and postoperative examinations were evaluated. main outcome measures: Ultrasound time, cumulative dissipated energy, longitudinal and torsional ultrasound amplitudes, mean operation time, mean volume of fluid used, and surgical complications. RESULTS Both groups included 40 eyes. Mean ultrasound time, cumulative dissipated energy, and longitudinal and torsional ultrasound amplitudes in Group 1 were 58.21±33.81 seconds, 7.74±6.23, 0.45±0.30, and 26.30±12.60%, respectively, and these parameters in Group 2 were 64.75±30.23 seconds, 12.61±6.21, 26.32±5.85, and 40.98±8.33%, respectively. Cumulative dissipated energy and longitudinal and torsional amplitudes were found to be significantly lower in Group 1 (P=.001, P<.001, P<.001). Mean volumes of fluid used in Groups 1 and 2 were 73.30±19.87 cc and 107.07±21.82 cc, respectively (P<.001). CONCLUSION With the aid of a 45 degree aperture angled tip, the OZil Intelligent Phaco torsional mode provided more effective lens removal than the combined torsional/longitudinal ultrasound mode, with a lower cumulative dissipated energy and volume of fluid used.
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Packer M, Solomon JD. Impact of crystalline lens opacification on effective phacoemulsification time in femtosecond laser-assisted cataract surgery. Am J Ophthalmol 2014; 157:1323-4. [PMID: 24881838 DOI: 10.1016/j.ajo.2014.02.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 01/27/2014] [Accepted: 02/10/2014] [Indexed: 11/28/2022]
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Helvacioglu F, Sencan S, Yeter C, Tunc Z, Uyar MO. Outcomes of torsional microcoaxial phacoemulsification using tips with 30-degree and 45-degree aperture angles. J Cataract Refract Surg 2014; 40:362-8. [DOI: 10.1016/j.jcrs.2013.07.051] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Revised: 07/29/2013] [Accepted: 07/30/2013] [Indexed: 10/25/2022]
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