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

Session Details

Session Title: Cataract Surgery Equipment/Instrumentation/Surgical Devices

Session Date/Time: Monday 09/10/2017 | 16:30-18:00

Paper Time: 17:05

Venue: Room 4.4

First Author: : P.Malik INDIA

Co Author(s): :    T. Dewan   E. Sain                 

Abstract Details

Purpose:

To evaluate the effect of three different combinations of tip designs and infusion systems in torsional phacoemulsification (INFINITY and CENTURION) in patients with cataract. According to the manufacturer two unique improvements in Centurion are active fluid dynamic management system and use of an intrepid balanced tip. The study specifically aimed to evaluate the beneficial effect, if any, of change in tip design and infusion system individually and in combination on both perop parameters as well as endothelial health over 6 months.

Setting:

This randomised controlled trial was conducted at Department of Ophthalmology, Post Graduate Institute of Medical Education and Research & Dr Ram Manohar Lohia Hospital, New Delhi, India. This was an independent nonfunded study without any conflict of interest.

Methods:

126 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):IOP based infusion system and 450 Kelman miniflared ABS phaco tip and 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 reduction in Cumulative Dissipated Energy (p=0.001), Effective Fluid Usage (p<0.0005) as well as Total Aspiration Time (p=0.001) in comparison to both other groups. All three groups had comparable baseline Endothelial Cell Density(p=0.876 ), Central Corneal Thickness(p=0.561). On post operative evaluation although all groups were comparable till three months, by 6 months the percentage losses in endothelial cell density were significantly lower in group C as compared to other groups.

Conclusions:

Use of an IOP based phacoemulsification system in association with use of Intrepid balanced tip reduces the CDE, EFU and TAT in comparison to a gravity fed system with mini flare tip or IOP based system with mini flare tip while also providing better endothelial preservation thus favouring the use of an IOP fed system with Balanced tip.

Financial Disclosure:

NONE