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Scott RA, Holtmeyer CJ, Parker TM, Scott WJ, Olson RJ. A comparison of venturi and peristaltic based phacoemulsification efficiency in routine femtosecond laser cataract surgery. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00235-7. [PMID: 39182514 DOI: 10.1016/j.jcjo.2024.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 07/10/2024] [Accepted: 07/23/2024] [Indexed: 08/27/2024]
Abstract
OBJECTIVE To compare the efficiency of venturi and peristaltic pump phacoemulsification systems in patients undergoing routine laser cataract surgery. DESIGN Single center, nonrandomized clinical study. PARTICIPANTS The study compared consecutive eyes with moderate nuclear sclerosis undergoing routine laser cataract surgery at the Outpatient Eye Center, Mercy Health System, Springfield, MO, USA. METHODS Each surgery used the same femtosecond laser settings. Surgeries were performed with either a venturi or peristaltic vacuum system by a single surgeon (WJS). The EFX, percent power, ultrasound time (UST), the total time that the phaco tip was in the eye (phaco tip in/out time, PIOT), and the surgery time (speculum in/out time) were recorded. Exclusions and intraoperative complications were also analyzed. RESULTS 995 eyes were included in the study. The EFX in the venturi eyes (1.7 ± 1.3; n = 521) compared to peristaltic eyes (2.1 ± 1.4; n = 474) was lower (p < 0.0001). Similarly, the UST in the eyes performed with the venturi system versus the peristaltic system was reduced (32.4 ± 22.3 s vs 40.7± 25.7 s; p < 0.0001). The PIOT in the venturi group compared to the peristaltic group was less (71.1 ± 31.1 sec vs 79.1 ± 36.1 s; p = 0.0002). The case time (speculum in/out time) was lower for the venturi eyes (307.2 ± 68.8 s vs. 311.6 ± 53.6 s; p = 0.268). CONCLUSION In eyes undergoing routine laser cataract surgery, the use of the venturi pump system was more efficient compared to the peristaltic pump system based on energy use and time, and there was no significant difference in complications.
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Affiliation(s)
- Rachel A Scott
- Department of Ophthalmology, University of Colorado, Denver, Colorado, United States
| | - Caleb J Holtmeyer
- Department of Pathology and Genomic Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Travis M Parker
- Department of Ophthalmology, University of Missouri-Columbia, Columbia, Missouri, United States
| | - Wendell J Scott
- Mercy Eye Specialists, Springfield, Missouri, United States.
| | - Randall J Olson
- The John Moran Eye Center, Department of Ophthalmology, University of Utah, Salt Lake City, Utah, United States
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Lazaar H, Sefrioui M, Boutaj T, Azarkan B, El Hachimi R, Benchekroun S, Amazouzi A, Cherkaoui LO. Pattern of Preferred Cataract Surgery Practices in Morocco: A Survey-Based Study. Cureus 2024; 16:e55690. [PMID: 38586760 PMCID: PMC10997968 DOI: 10.7759/cureus.55690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
Aim and methodology The aim of the study was to describe the preferred cataract surgery practices among Moroccan ophthalmologists and compare them with practices in other countries. An online survey consisting of 29 multiple-choice questions was sent to Moroccan ophthalmologists. The questions were centered on the preferred cataract surgical practices of the participants. All the data obtained were collected and analyzed. Results A total of 276 participants responded to the survey. Of these, 178 (64,50%) were in the age group of 31-50 years. The visual acuity for which the operative indication was made was 4/10 for 144 (52.4%) participants). The most popular type of anesthesia was topical, reported by 172 (62.4%). Stop-and-chop was the most used technique for routine cataract surgeries, while hydroprolapse of the nucleus was the leading technique for soft cataracts. The two measures are considered crucial for postoperative endophthalmitis prophylaxis: Povidone-iodine instillation into the conjunctival sac and intracameral antibiotics were performed by 267 (97%) and 276 (100%) participants, respectively. Nonsteroidal anti-inflammatory drugs were prescribed by only 128 (46.5%) surgeons. Conclusion This study provides some insight into the present cataract surgery techniques in Morocco, which might differ considerably from one country to another. Studies in various countries need to be undertaken to develop a consensus and reach some evidence-based patterns. This study may serve as a guide for young surgeons starting their careers based on what the standard procedures are among their seniors and peers.
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Affiliation(s)
- Hamza Lazaar
- Ophthalmology A, Hopital Des Specialités, Faculté de Médecine et de Pharmacie de Rabat, Rabat, MAR
| | - Meryem Sefrioui
- Ophthalmology A, Hopital Des Specialités, Faculté de Médecine et de Pharmacie de Rabat, Rabat, MAR
| | - Taha Boutaj
- Ophthalmology A, Hopital Des Specialités, Faculté de Médecine et de Pharmacie de Rabat, Rabat, MAR
| | - Boutayna Azarkan
- Ophthalmology A, Hopital Des Specialités, Faculté de Médecine et de Pharmacie de Rabat, Rabat, MAR
| | - Rim El Hachimi
- Ophthalmology A, Hopital Des Specialités, Faculté de Médecine et de Pharmacie de Rabat, Rabat, MAR
| | - Saad Benchekroun
- Ophthalmology A, Hopital Des Specialités, Faculté de Médecine et de Pharmacie de Rabat, Rabat, MAR
| | - Abdellah Amazouzi
- Ophthalmology A, Hopital Des Specialités, Faculté de Médecine et de Pharmacie de Rabat, Rabat, MAR
| | - Lalla Ouafa Cherkaoui
- Ophthalmology A, Hopital Des Specialités, Faculté de Médecine et de Pharmacie de Rabat, Rabat, MAR
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Ricks RG, Cardenas IA, Ungricht EL, Olson RJ, Pettey JH. Effect of Modified Peristaltic Phacoemulsification Device on Efficiency and Post-Occlusion Pressure Surge. Clin Ophthalmol 2023; 17:2341-2347. [PMID: 37600145 PMCID: PMC10438468 DOI: 10.2147/opth.s416604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/03/2023] [Indexed: 08/22/2023] Open
Abstract
Purpose To evaluate efficiency of grooving, nuclear fragment removal, and changes in pressure control in the Oertli Faros using traditional peristaltic and Speed and Precision (SPEEP) features. The SPEEP mode uses novel peristaltic technology permitting independent control of flow and vacuum. Methods A porcine lens model was used with an enclosed chamber simulating the anterior segment. Grooving efficiency is evaluated with flow rates of 10, 30, and 50 mL/min using whole lenses. Lens cubes were emulsified at 20, 40, 60, 80, and 100% power with both SPEEP and non-SPEEP modes. Surge was evaluated with pressure gauges placed on the irrigation tubing and aspiration tubing. Pressure readings were recorded per the following: fluid and vacuum were initiated for 15 seconds, vacuum tubing was occluded for 5 seconds, tubing patency was then re-introduced for 15 seconds. Differences between sensors were recorded. Results No significant increase in efficiency was seen with increasing flow rate from 30 to 50 mL/min using SPEEP. No significant differences were shown in lens fragment removal in SPEEP and non-SPEEP modes at any power tested. Pressure difference measurements were not significantly different with SPEEP and non-SPEEP modes. Conclusion We showed that lower flow rates show comparable efficiency of grooving when using the SPEEP mode. The SPEEP function did not show increased efficiency in nuclear fragment removal when compared to traditional mode. Surge control was also comparable with both SPEEP and non-SPEEP modes. We suggest that the SPEEP function included in the Oertli Faros may have some advantages.
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Affiliation(s)
- Reiker G Ricks
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Ivan A Cardenas
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Emilie L Ungricht
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Randall J Olson
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Jeff H Pettey
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
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Peterson JS, Christensen MR, Cooper C, Mamalis C, Bernhisel AA, Zaugg B, Barlow WR, Ungricht E, Olson RJ, Pettey JH. Optimization of Phacoemulsification Tip Gauge on the Oertli CataRhex3 in an in vitro Setting. Clin Ophthalmol 2022; 16:1091-1097. [PMID: 35422610 PMCID: PMC9005135 DOI: 10.2147/opth.s355094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/17/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the effect of each of the tip sizes available for the Oertli CataRhex3® phacoemulsification machine on efficiency. Methods Porcine lenses were fixed in formalin for 2 hours, then cut into 3.0 mm cubes. We studied three Oertli tips, all of which had a 30-degree bevel: easyTip 2.2 mm (20G), easyTip 2.8 mm (19G), and CO-MICS (21G). For the 19G and 20G tips, vacuum was set at 600 mmHg, irrigation rate at 50 mL/min, continuous power 70%, and bottle height 85 cm. For the 21G tip, vacuum was set at 450 mmHg; irrigation and power settings were identical to those used for the easyTip tips. We measured time to removal and chatter events to determine efficiency. Results Results from 20 trials for each tip showed that the larger the gauge size, the more quickly lens fragments were removed. Chatter events demonstrated an increasing trend with smaller tip gauge. The 19G tip used an average time to fragment removal of 2.8 seconds; the 20G, 3.2 seconds; and the 21G, 4.6 seconds. Increasing tip diameter from 21G to 20G decreased emulsification time by 33% (P = 0.02). Increasing the diameter from 21G to 19G further decreased time to emulsification by 42% (P = 0.003). The 21G tip had a mean 1.4 events/cube; 20G, 0.35 events; and 19G, 0.1 events. Differences in mean chatter events for each tip were each statistically significant. Conclusion These data suggest that when evaluated by chatter events and emulsification time, the 2.8 mm (19G) easyTip proves to have greatest efficiency.
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Affiliation(s)
- John S Peterson
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
- University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
| | - Michael R Christensen
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
- Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond, VA, 23298, USA
| | - Caitlynn Cooper
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
- University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
| | - Christina Mamalis
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
| | - Ashlie A Bernhisel
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
| | - Brian Zaugg
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
| | - William R Barlow
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
| | - Emilie Ungricht
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
- University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
| | - Randall J Olson
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
| | - Jeff H Pettey
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
- Correspondence: Jeff H Pettey, Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, 65 Mario Capecchi Drive, Salt Lake City, UT, 84132, USA, Tel +1 801 581 2352, Fax +1 801 581 3357, Email
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Abstract
PURPOSE OF REVIEW Modern phacoemulsification machines apply ultrasound through a variety of settings and parameters to remove a cataract. Using these new technologies efficiently is critical for both reducing surgical times and improving postoperative outcomes. The present article reviews recent findings in phacodynamics to explore the optimum use of ultrasound in cataract surgery. RECENT FINDINGS In studies seeking to determine the optimum parameters in both fluidics and power, increased power and aspiration does not necessarily equate to more efficiency. New developments, such as torsional ultrasound, micropulse, and burst mode have shown increased efficiency in randomized control trials and in-vitro compared with conventional ultrasound. Regarding vacuums, the venturi pump has demonstrated greater efficiency compared with the peristaltic pump. We also explore other parameters, such as chamber pressure and tip selection. Meta-analyses on femtosecond-laser assisted cataract surgery (FLACS) have shown similar long-term visual outcomes compared to conventional cataract surgery. SUMMARY Though conventional cataract surgery remains highly effective, surgeons have increasing options for customizing their ultrasound settings and phacoemulsification techniques.
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Ramshekar A, Heczko J, Bernhisel A, Barlow W, Zaugg B, Olson R, Pettey J. Optimizing Tip Diameter in Phacoemulsification of Varying Lens Sizes: An in vitro Study. Clin Ophthalmol 2021; 15:4475-4484. [PMID: 34819719 PMCID: PMC8607188 DOI: 10.2147/opth.s333903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/11/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose We assessed the effect of two lens cube sizes, three tip sizes, and two ultrasound (US) approaches on phacoemulsification efficiency and chatter. Methods After porcine lens nuclei were soaked in formalin, we divided them into cubes measuring 2.0 mm or 3.0 mm. We collected efficiency and chatter data for 30-degree bent 19 G, 20 G, and 21 G tips with a continuous torsional US system; and for straight 19 G, 20 G, and 21 G tips with a micropulse longitudinal US system. Results The average time needed for removal was always higher for the 3.0 mm lens cube than for the 2.0 mm lens cube. Statistically significant differences were observed between the 19 G and 21 G tips with micropulse longitudinal US using a 2.0 mm cube and a 3.0 mm cube, and with continuous transversal US using a 2.0 mm lens cube and a 3.0 mm cube. We did not observe significant differences between 19 G and 20 G tips with either cube size in either US system. However, we noted identical trends for both cube sizes with both US approaches; 19 G tips performed better than 20 G and 21 G tips. Conclusion Regardless of the lens size, 19 G needles were the most efficient, and had both the fewest outliers and the smallest standard deviations.
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Affiliation(s)
- Aniket Ramshekar
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA.,University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
| | - Joshua Heczko
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
| | - Ashlie Bernhisel
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
| | - William Barlow
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
| | - Brian Zaugg
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
| | - Randall Olson
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
| | - Jeff Pettey
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
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Bernhisel AA, Cahoon JM, Sella R, Zaugg B, Barlow WR, Stagg BC, Afshari NA, Olson RJ, Pettey JH. Optimum on-time and off-time combinations for micropulse phacoemulsification in venturi vacuum mode. J Cataract Refract Surg 2019; 45:1797-1800. [PMID: 31856992 DOI: 10.1016/j.jcrs.2019.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 06/28/2019] [Accepted: 07/01/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE To measure the time to fragment removal and number of chatter events using various combinations of micropulse on times and off times (measured in milliseconds) of longitudinal ultrasound (US) using a venturi-based phacoemulsification system. SETTING John A. Moran Eye Center, University of Utah, Salt Lake City, USA. DESIGN Experimental study. METHODS Pig lenses were hardened with formalin and cut into 2.0 mm cubes. The time to fragment removal (efficiency) and frequency of fragments bouncing off the tip (chatter) were measured with the venturi-based system. Micropulse longitudinal US was tested. Parameters were combinations of 5, 6, and 7 milliseconds on, with 5, 6, and 7 milliseconds off. Twenty runs each of 9 combinations were completed. RESULTS There was a statistically significant difference between on/off duty cycle combinations. The 6 on/7 off group had higher efficiency than the 5 on/6 off and 7 on/7 off groups. Six on/5 off was more efficient than 5 on/6 off. When data were pooled and on times alone were used, 6 milliseconds on time was more efficient than 5 or 7 milliseconds. No efficiency differences in off times were found. No significant chatter differences were observed. CONCLUSIONS Using micropulse longitudinal US in venturi vacuum mode, 6 milliseconds on was the most efficient on time. Five, 6, and 7 milliseconds off times had similar efficiency. These data suggest that the most efficient setting with lowest US energy use is 6 milliseconds on and 7 milliseconds off.
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Affiliation(s)
- Ashlie A Bernhisel
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, USA; Department of Ophthalmology, Shiley Eye Institute at University of California San Diego Health, San Diego, USA
| | - Judd M Cahoon
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, USA; Stein Eye Institute, University of California Los Angeles, USA
| | - Ruti Sella
- Department of Ophthalmology, Shiley Eye Institute at University of California San Diego Health, San Diego, USA
| | - Brian Zaugg
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, USA
| | - William R Barlow
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, USA
| | - Brian C Stagg
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, USA; Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina, USA
| | - Natalie A Afshari
- Department of Ophthalmology, Shiley Eye Institute at University of California San Diego Health, San Diego, USA
| | - Randall J Olson
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, USA
| | - Jeff H Pettey
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, USA.
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Stutz LA, Heczko JB, Bird BA, Thomson RS, Bernhisel AA, Barlow WR, Zaugg B, Olson RJ, Pettey JH. Optimization of the Oertli CataRhex 3 ® phacoemulsification machine. Clin Ophthalmol 2019; 13:633-639. [PMID: 31354230 PMCID: PMC6585395 DOI: 10.2147/opth.s196281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of this study was to determine optimal bottle height, vacuum, aspiration rate, and power settings of the Oertli CataRhex 3® phacoemulsification machine. Methods Porcine lens nuclei were hardened with formalin and cut into 2.0 mm cubes. Lens cubes were emulsified using the easyTip® 2.2 mm at 30°. Fragment removal time (efficiency) and fragment bounces off the tip (chatter) were measured. Settings tested included bottle height of 60, 80, 100 and 120 cm; aspiration rate of 40, 45, and 50 mL/min; vacuum of 400, 500, and 600 mmHg; and power of 50, 60, 70, 80, 90, and 100%. Results Efficiency and chatter increased in a linear fashion with increasing vacuum to 600 mmHg (P=0.017, P=0.046, respectively). The most efficient aspiration rate was 50 mL/min, although this finding lacked statistical significance (P=0.66). Increasing power increased efficiency up to 80% without increasing chatter (P=0.042, P=0.71, respectively). Compared to all other power settings, chatter was increased at 100% (P=0.014). Conclusion The most efficient machine settings were vacuum at 600 mmHg, aspiration rate at 50 mL/min, and power at 80%.
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Affiliation(s)
- Lance A Stutz
- University of Texas Southwestern Medical School, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Joshua B Heczko
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT 84132, USA,
| | - Brian A Bird
- University of Nevada Reno, School of Medicine, Reno, NV 89557, USA
| | - Rhett S Thomson
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT 84132, USA, .,University of Utah, School of Medicine, Salt Lake City, UT 84132, USA
| | - Ashlie A Bernhisel
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT 84132, USA,
| | - William R Barlow
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT 84132, USA,
| | - Brian Zaugg
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT 84132, USA,
| | - Randall J Olson
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT 84132, USA,
| | - Jeff H Pettey
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT 84132, USA,
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Boulter T, Bernhisel A, Mamalis C, Zaugg B, Barlow WR, Olson RJ, Pettey JH. Phacoemulsification in review: Optimization of cataract removal in an in vitro setting. Surv Ophthalmol 2019; 64:868-875. [PMID: 31276738 DOI: 10.1016/j.survophthal.2019.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/17/2019] [Accepted: 06/17/2019] [Indexed: 10/26/2022]
Abstract
Phacoemulsification, initially used in the late 1960s, continues to be the standard of care for cataract removal. An animal model was developed so that, in a controlled research setting, all the various machines, handpieces, tips, and settings could be investigated. As a general rule, the higher power, vacuum, and aspiration settings lead to optimally efficient phacoemulsification. In addition, both new phacoemulsification platforms and newly developed devices have been shown to improve efficiency. As a result, we recommend that the integration of these recent developments should be considered in future investigations.
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Affiliation(s)
- Tyler Boulter
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, USA
| | - Ashlie Bernhisel
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA; Department of Ophthalmology, Shiley Eye Institute at University of California San Diego Health, San Diego, California, USA
| | - Christina Mamalis
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Brian Zaugg
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - William R Barlow
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Randall J Olson
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Jeff H Pettey
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.
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10
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Thomson RS, Bird BA, Stutz LA, Heczko JB, Bernhisel AA, Barlow WR, Zaugg B, Olson RJ, Pettey JH. The effect of increasing power when grooving using phacoemulsification. Clin Ophthalmol 2019; 13:611-615. [PMID: 31043766 PMCID: PMC6469737 DOI: 10.2147/opth.s194731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To determine optimal power settings on the Centurion Vision System during the grooving step in cataract surgery. METHODS Intact porcine lenses hardened by formalin and placed in a chamber designed to simulate the anterior chamber of the eye were used to test longitudinal power at 40%, 70%, and 100% and torsional power at 0%. Flow rate was set at 40 mL/min. Vacuum was set at 400 mmHg, intraocular pressure was set at 50 mmHg, and a balanced phacoemulsification tip with a 20 degree tip and a 30 degree bevel was used. Efficiency (time to groove the lens in half) was determined. RESULTS Increasing longitudinal power from 40% to 70% increased efficiency by 28% (P<0.05), and by 32% (P<0.05) when increasing longitudinal power from 40% to 100%. There was no statistically significant increase in efficiency from 70% to 100%. CONCLUSION For the tested variables, a longitudinal power of 70% was determined to be most efficient during the grooving step of cataract surgery for equivalent 3-4+ nuclei. Further increases in power demonstrated no statistically significant improvement in efficiency.
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Affiliation(s)
- Rhett S Thomson
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT 84132, USA,
- University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Brian A Bird
- University of Nevada Reno School of Medicine, Reno, NV 89557, USA
| | - Lance A Stutz
- University of Texas Southwestern Medical School, Dallas, TX 75390, USA
| | - Joshua B Heczko
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT 84132, USA,
| | - Ashlie A Bernhisel
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT 84132, USA,
| | - William R Barlow
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT 84132, USA,
| | - Brian Zaugg
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT 84132, USA,
| | - Randall J Olson
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT 84132, USA,
| | - Jeff H Pettey
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT 84132, USA,
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Hida WT, de Medeiros AL, de Araújo Rolim AG, Motta AFP, Kniggendorf DV, de Queiroz RLF, Chaves MAPD, Carricondo PC, Nakano CT, Nosé W. Prospective randomized comparative study between venturi and peristaltic pumps in WhiteStar Signature ® phacoemulsification machine. Clin Ophthalmol 2018; 13:49-52. [PMID: 30643379 PMCID: PMC6311335 DOI: 10.2147/opth.s177978] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare intraoperative parameters between venturi and peristaltic pump in WhiteStar Signature® phacoemulsification machine using the bevel-down technique. Setting Hospital Oftalmológico de Brasília, Brasília, Federal District, Brazil. Design Prospective, comparative, patient-masked study. Methods Three hundred eyes were randomly assigned to have a phacoemulsification procedure with WhiteStar Signature® using either peristaltic (n=150 eyes) or venturi (n=150 eyes) pumps by a single surgeon (WTH). Elliptical ultrasound setting and prefracture (prechop or preslice) techniques were used in all cases. Cataract nucleus density was graded using lens opacities classification system III and Pentacam Nucleus Staging classification. Clinical measurements included preoperative- and postoperative- corrected visual acuity, preoperative and 2-month postoperative endothelial cell counts, and preoperative and 1-day postoperative central corneal thickness. Intraoperative measurements at the end of the case were phaco time, fluid used, total case time, and Efx energy. Results There were no statistically significant differences between groups regarding age, cataract density, and phaco time (P>0.05). Intraoperatively, we observed significantly less ultrasound energy (P=0.011), case time (P=0.0001), and balanced saline solution (P=0.001) usage in the venturi group. Clinically, both fluidic settings can provide similar clinical outcomes and visual recovery, regarding corrected distance visual acuity, endothelial cell count, and central corneal thickness. Conclusion Our data show that to minimize fluid use, case time, and energy with the prefracture technique, the venturi pump was the most efficient system and was statistically superior to peristaltic pump.
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Affiliation(s)
- Wilson Takashi Hida
- Cataract Sector, Hospital Oftalmológico de Brasília, Brasília, Federal District, Brazil, .,Cataract Sector, Centro de Estudos Oftalmológicos Renato Ambrósio, Brasília, Brazil, .,Cataract Sector, Universidade de São Paulo, São Paulo, Brazil,
| | - André Lins de Medeiros
- Cataract Sector, Hospital Oftalmológico de Brasília, Brasília, Federal District, Brazil, .,Cataract Sector, Centro de Estudos Oftalmológicos Renato Ambrósio, Brasília, Brazil,
| | - André Gustavo de Araújo Rolim
- Cataract Sector, Hospital Oftalmológico de Brasília, Brasília, Federal District, Brazil, .,Cataract Sector, Centro de Estudos Oftalmológicos Renato Ambrósio, Brasília, Brazil,
| | - Antonio Francisco Pimenta Motta
- Cataract Sector, Centro de Estudos Oftalmológicos Renato Ambrósio, Brasília, Brazil, .,Cataract Sector, Universidade de São Paulo, São Paulo, Brazil,
| | - Danilo Varela Kniggendorf
- Cataract Sector, Hospital Oftalmológico de Brasília, Brasília, Federal District, Brazil, .,Cataract Sector, Centro de Estudos Oftalmológicos Renato Ambrósio, Brasília, Brazil,
| | - Rodrigo Lafetá Franco de Queiroz
- Cataract Sector, Hospital Oftalmológico de Brasília, Brasília, Federal District, Brazil, .,Cataract Sector, Centro de Estudos Oftalmológicos Renato Ambrósio, Brasília, Brazil,
| | - Mário Augusto Pereira Dias Chaves
- Cataract Sector, Hospital Oftalmológico de Brasília, Brasília, Federal District, Brazil, .,Cataract Sector, Centro de Estudos Oftalmológicos Renato Ambrósio, Brasília, Brazil,
| | - Pedro Carlos Carricondo
- Cataract Sector, Hospital Oftalmológico de Brasília, Brasília, Federal District, Brazil, .,Cataract Sector, Centro de Estudos Oftalmológicos Renato Ambrósio, Brasília, Brazil,
| | - Celso Takashi Nakano
- Cataract Sector, Centro de Estudos Oftalmológicos Renato Ambrósio, Brasília, Brazil, .,Cataract Sector, Hospital Santa Cruz, São Paulo, Brazil
| | - Walton Nosé
- Cataract Sector, Universidade Federal de São Paulo, São Paulo, Brazil
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Bird BA, Thomson RS, Stutz LA, Heczko JB, Bernhisel AA, Barlow WR, Zaugg B, Pettey JH, Olson RJ. Effect of increasing flow when grooving during phacoemulsification. J Cataract Refract Surg 2018; 44:623-626. [PMID: 29773457 DOI: 10.1016/j.jcrs.2018.01.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 12/22/2017] [Accepted: 01/09/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE To determine optimum flow settings on the Centurion Vision System during the grooving step in cataract surgery. SETTING John A. Moran Eye Center Laboratory, University of Utah, Salt Lake City, Utah, USA. DESIGN Experimental study. METHODS Intact porcine lenses hardened by formalin and placed in a chamber designed to simulate the anterior chamber of the eye were used to test flow rate settings at 20 mL/min, 40 mL/min, and 60 mL/min. Vacuum was set at 400 mm Hg, longitudinal power at 80%, torsional power at 80%, and intraocular pressure at 50 mm Hg. A balanced phaco tip with a 20-degree tip and a 30-degree bevel was used. Efficiency (time to groove the lens in half) was determined. RESULTS Increasing flow from 20 to 40 mL/min during grooving increased efficiency by 17% (P = .05), with no significant improvement shown at 60 mL/min. CONCLUSIONS A flow rate of 40 mL/min was determined to be most efficient during the grooving step of cataract surgery. Further increases in flow rate showed no statistically significant improvement in efficiency, and with only 17% improvement flow rates less than 40 mL/min might be almost as efficient and might be safer.
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Affiliation(s)
- Brian A Bird
- From the University of Nevada Reno School of Medicine (Bird), Reno, Nevada, Department of Ophthalmology and Visual Sciences (Thomson, Heczko, Bernhisel, Barlow, Zaugg, Pettey, Olson), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, and the University of Texas Southwestern Medical Center (Stutz), Dallas, Texas, USA
| | - Rhett S Thomson
- From the University of Nevada Reno School of Medicine (Bird), Reno, Nevada, Department of Ophthalmology and Visual Sciences (Thomson, Heczko, Bernhisel, Barlow, Zaugg, Pettey, Olson), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, and the University of Texas Southwestern Medical Center (Stutz), Dallas, Texas, USA
| | - Lance A Stutz
- From the University of Nevada Reno School of Medicine (Bird), Reno, Nevada, Department of Ophthalmology and Visual Sciences (Thomson, Heczko, Bernhisel, Barlow, Zaugg, Pettey, Olson), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, and the University of Texas Southwestern Medical Center (Stutz), Dallas, Texas, USA
| | - Joshua B Heczko
- From the University of Nevada Reno School of Medicine (Bird), Reno, Nevada, Department of Ophthalmology and Visual Sciences (Thomson, Heczko, Bernhisel, Barlow, Zaugg, Pettey, Olson), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, and the University of Texas Southwestern Medical Center (Stutz), Dallas, Texas, USA
| | - Ashlie A Bernhisel
- From the University of Nevada Reno School of Medicine (Bird), Reno, Nevada, Department of Ophthalmology and Visual Sciences (Thomson, Heczko, Bernhisel, Barlow, Zaugg, Pettey, Olson), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, and the University of Texas Southwestern Medical Center (Stutz), Dallas, Texas, USA
| | - William R Barlow
- From the University of Nevada Reno School of Medicine (Bird), Reno, Nevada, Department of Ophthalmology and Visual Sciences (Thomson, Heczko, Bernhisel, Barlow, Zaugg, Pettey, Olson), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, and the University of Texas Southwestern Medical Center (Stutz), Dallas, Texas, USA
| | - Brian Zaugg
- From the University of Nevada Reno School of Medicine (Bird), Reno, Nevada, Department of Ophthalmology and Visual Sciences (Thomson, Heczko, Bernhisel, Barlow, Zaugg, Pettey, Olson), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, and the University of Texas Southwestern Medical Center (Stutz), Dallas, Texas, USA
| | - Jeff H Pettey
- From the University of Nevada Reno School of Medicine (Bird), Reno, Nevada, Department of Ophthalmology and Visual Sciences (Thomson, Heczko, Bernhisel, Barlow, Zaugg, Pettey, Olson), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, and the University of Texas Southwestern Medical Center (Stutz), Dallas, Texas, USA
| | - Randall J Olson
- From the University of Nevada Reno School of Medicine (Bird), Reno, Nevada, Department of Ophthalmology and Visual Sciences (Thomson, Heczko, Bernhisel, Barlow, Zaugg, Pettey, Olson), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, and the University of Texas Southwestern Medical Center (Stutz), Dallas, Texas, USA.
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13
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Wright AJ, Thomson RS, Bernhisel AA, Zaugg B, Barlow WR, Pettey JH, Olson RJ. Effect of chamber stabilization software on efficiency and chatter in a porcine lens model. J Cataract Refract Surg 2017; 43:1464-1467. [PMID: 29223237 DOI: 10.1016/j.jcrs.2017.08.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/30/2017] [Accepted: 08/04/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the effects of the use of programmable chamber stabilization software (Chamber Stabilization Environment) settings on efficiency and chatter in a porcine lens model. SETTING John A. Moran Eye Center Laboratory, University of Utah, Salt Lake City, Utah, USA. DESIGN Experimental study. METHODS Porcine eyes were dissected and the lenses extracted. The lenses were then hardened and processed for the experiment. Phacoemulsification of the lens fragments was performed with the Whitestar Signature Pro with the Whitestar handpiece and a 0.9 mm straight Dewey tip with a 30-degree bevel. All arms of the study were run in peristaltic mode with 50 mL/minute aspiration, 100 cm bottle height, and on 100% power. The chamber stabilization software setting was used for each of the 4 study arms with a maximum vacuum of 500 mm Hg. Arm 1 included 20 runs with the up time set to 2000 milliseconds. Arm 2 was performed with similar settings but with an up time of 0 millisecond. Arms 3 and 4 were run with up times of 1000 milliseconds and 500 milliseconds, respectively. RESULTS The mean efficiency time of each run was as follows: 0 millisecond = 1.4 seconds, 500 milliseconds = 0.95 seconds, 1000 milliseconds = 0.88 seconds, 2000 milliseconds = 0.93 seconds. When compared with 0 millisecond, each of the other arms were significantly faster. Chatter events were comparable between the study arms. CONCLUSION The chamber stabilization software does not decrease efficiency when compared with full vacuum on if at least 500 milliseconds of up time is maintained.
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Affiliation(s)
- Alex J Wright
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Rhett S Thomson
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Ashlie A Bernhisel
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Brian Zaugg
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - William R Barlow
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Jeff H Pettey
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Randall J Olson
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.
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14
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Shi DS, Jensen JD, Kramer GD, Zaugg B, Stagg BC, Pettey JH, Barlow WR, Olson RJ. Comparison of Vacuum and Aspiration on Phacoemulsification Efficiency and Chatter Using a Monitored Forced Infusion System. Am J Ophthalmol 2016; 169:162-167. [PMID: 27349412 DOI: 10.1016/j.ajo.2016.06.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 06/15/2016] [Accepted: 06/16/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the effect of vacuum and aspiration rates on phacoemulsification efficiency and chatter using a monitored forced infusion system. DESIGN In vitro animal study. METHODS SETTING John A. Moran Eye Center, University of Utah, Salt Lake City, Utah. PROCEDURES Formalin-soaked porcine lenses were divided into 2 mm cubes (tip diameter, 0.9 mm). Vacuum levels were tested at 200, 300, 400, and 500 mm Hg; aspiration rates at 20, 35, and 50 mL/min. Torsional power was set at 60% and intraocular pressure at 50 mm Hg. RESULTS Increasing vacuum increased efficiency regardless of aspiration rates (R(2) = 0.92; P = .0004). Increasing aspiration further increased efficiency when vacuum was at 400 and 500 mm Hg (P = .004 for 20 vs 35 mL/min, P = .0008 for 35 vs 50 mL/min). At 200 and 300 mm Hg, efficiency only improved when increasing aspiration to 35 mL/min (P < .0001 with 20 vs 35 + 50 mL/min). Chatter improved with increasing vacuum, up to 400 mm Hg (P = .003 for 200 vs 300 mm Hg and P = .045 for 300 vs 500 mm Hg). A similar trend of improved chatter was seen with increasing levels of aspiration. CONCLUSIONS Vacuum improved efficiency up to 500 mm Hg independent of flow. Flow has an additive effect on efficiency through 50 mL/min, when vacuum is at 400 mm Hg or higher, and only up to 35 mL/min at vacuums less than 400 mm Hg. Chatter correlated with both vacuum and flow such that increasing either parameter decreases chatter, up to 400 mm Hg with vacuum.
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Affiliation(s)
- Dallas S Shi
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Jason D Jensen
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Gregory D Kramer
- 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
| | - Brian C Stagg
- 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
| | - William R Barlow
- 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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15
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Gardiner GL, Garff K, Gupta I, Kramer GD, Farukhi MA, Stagg BC, Zaugg B, Olson RJ. Effect of pulsing ultrasound on phacoemulsification efficiency. J Cataract Refract Surg 2015; 41:2560-4. [PMID: 26703507 DOI: 10.1016/j.jcrs.2015.06.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 06/02/2015] [Accepted: 06/08/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate pulse type technology used to remove lens fragments during phacoemulsification. SETTING John A. Moran Eye Center Laboratories, University of Utah, Salt Lake City, Utah, USA. DESIGN Experimental study. METHODS Lens nuclei soaked in 10 mL of 10% neutral buffered formalin for 2 hours were placed in 10 mL of balanced salt solution. Lenses were cut into 2 mm × 2 mm cubes; no more than 36 hours later, cubes were randomly selected for testing. Two aspiration and 2 vacuum settings were assessed at moderate- and high-flow and vacuum (30 mL/min and 300 mm/Hg, low-flow vacuum; 50 mL/min and 500 mm/Hg, high-flow vacuum), with continuous 50 milliseconds on and off (long pulse) and 6 milliseconds on and off (micropulse) ultrasound. RESULTS There was a significant difference in efficiency favoring micropulse compared with combined long pulse and continuous pulse in high-flow vacuum at 80% power (P = .018) and between combined long pulse and continuous pulse versus micropulse in high-flow vacuum at 20% power (P = .019). Low-flow vacuum micropulse was more efficient than continuous (19.7%) (P < .0001) and long pulse (22.7%) (P < .0001). Continuous and long pulses were not significantly different from one other. There was a significant difference in chatter rates between high-flow vacuum and low-flow vacuum when all results were compared (P < .0001), with no additional significant differences found. CONCLUSION Micropulse technology was better than continuous and long pulse at moderate but not high-flow and vacuum settings. At the higher setting, chatter was observed less often, with all modalities more efficient than the lower setting.
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Affiliation(s)
- Gareth L Gardiner
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Kevin Garff
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Isha Gupta
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Gregory D Kramer
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - M Aabid Farukhi
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Brian C Stagg
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Brian Zaugg
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Randall J Olson
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.
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16
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Gilbert M, Zaugg B, Stagg B, Olson RJ. Safety Profile of Venturi Versus Peristaltic Phacoemulsification Pumps in Cataract Surgery Using a Capsular Surrogate for the Human Lens. Am J Ophthalmol 2015; 160:179-4.e1. [PMID: 25892125 DOI: 10.1016/j.ajo.2015.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 04/09/2015] [Accepted: 04/10/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the risk of capsular rupture of the human lens during cataract surgery from contact by phacoemulsification needles using different vacuum pumps, ultrasound modalities, and contact angles. DESIGN Experimental laboratory investigation. METHODS The John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, was the setting for this study. A Signature (Abbott Medical Optics, Inc) phacoemulsification machine was used in peristaltic and Venturi vacuum modes with transversal and micropulsed ultrasound. Contact was made with a capsular surrogate to achieve tip occlusion or tip contact only. Breakage rates were calculated by analyzing the capsular surrogate under a surgical microscope. RESULTS Venturi and peristaltic pump modes had similar risk of capsular rupture, regardless of whether the data were analyzed with tip occlusion data included (44.2% peristaltic vs 40.2% Venturi, P = .047) or excluded from the analysis (66.3% peristaltic vs 60.3% Venturi, P = .013). Transversal ultrasound was significantly more likely to cause capsular rupture than micropulsed ultrasound (69.8% vs 56.8%, P < .0001). Tip contact was significantly more likely than tip occlusion to cause capsular rupture (63.3% vs 0%, P < .0001). CONCLUSIONS There is no significant difference in risk of capsular rupture using Venturi rather than peristaltic vacuum pumps, while transversal seemed to increase the risk when compared to micropulsed ultrasound. Tip occlusion is not a risk factor for capsular rupture, as all breaks in the capsular surrogate occurred with tip contact.
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Affiliation(s)
- Michael Gilbert
- 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
| | - Brian Stagg
- 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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