Comparing the effect of torsional and transversal phacoemulsification on visual outcome and corneal endothelial cells after surgery on brunescent cataracts

Session Details

Session Title: Cataract Surgery Outcomes / Femto

Session Date/Time: Monday 15/09/2014 | 08:00-10:30

Paper Time: 09:27

Venue: Auditorium

First Author: : S.Das INDIA

Co Author(s): :    M. Kurian   S. Nagappa   R. Shetty   B. Shetty   M. Sayee   M. Nicholson

Abstract Details

Purpose:

To compare the effects of different energy delivery modalities, that is torsional and transversal phacoemulsification, on corneal endothelial cell loss and central corneal thickness during phacoemulsification on brunescent cataracts

Setting:

Tertiary Care Eye Hospital

Methods:

In this prospective Randomized Controlled Trial, patients undergoing phacoemulsification for brunescent (LOCS III, NO5 or NO6) cataracts were assigned to either of three groups, “torsional phacoemulsification with Intelligent Phaco (IP)” group (n 39), “torsional phacoemulsification without IP” group (n 41) or the “transversal phacoemulsification” group (n 43). The flow parameters were kept comparable in the two machines. The energy parameters were decided after a pilot study during which the most effective phaco power levels for emulsifying brown cataracts was found. All surgeries were performed by a single highly experienced surgeon, through a 2.2 mm temporal limbal incision with the protection of a dispersive viscosurgical device. We compared the effective phacoemulsification time and nucleus management time intraoperatively, and the change from baseline in specular counts and central corneal thickness 6 weeks postoperatively. The pin-hole vision and the corneal clarity on slitlamp on the 1st postoperative day, the best corrected distant visual acuity at 6 weeks and the intraoperative complication rates were also noted

Results:

The parameters considered were the Nucleus Management Time, Effective Phaco Time (EPT), Best corrected Visual Acuity, Endothelial Cell counts and Central Corneal Thickness (CCT) at specified time intervals. The Complication rates were compared. The EPT was lower in both the “torsional (with or without IP)” groups compared to the transversal group (p=0.000). The nucleus management time was statistically lower in the “torsional with IP” group compared to the transversal group (p=0.35), while it was not significant when the “torsional without IP” group was compared with the transversal group. There was no statistically significant difference in best corrected visual acuity, corneal clarity on slitlamp, the endothelial cell loss or the central corneal thickness between any of the groups. Other than 6 cases of phaco tip clogging and 4 mild wound burns in the “torsional without IP” groups there were no other complications in any of the groups

Conclusions:

Despite the nucleus management time and the effective phaco time being statistically higher in the transversal group compared to the “torsional with IP” group, there was no difference in visual acuity, endothelial cell loss or central corneal thickness. This is not surprising as these surgeries were performed by an extremely experienced surgeon. This may not be true for a less experienced, beginning surgeon. The high incidence of tip clogging leading to wound burns in the “torsional without IP” group shows that the “IP” system plays a major role in improving performance of the torsional phacoemulsification system

Financial Interest:

NONE