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Study: Greater endothelial cell loss from ultrasound vs. fluid-based phaco

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Performing cataract surgery using a fluid-based method of phacoemulsification appears to result in significantly less corneal endothelial cell loss compared with conventional ultrasound phacoemulsification, according to a study by researchers in France.

"The fluid-based method was safer than conventional ultrasound in cataract surgery, with a nuclear opalescence graded up to 4.9 in the LOCS III (Lens Opacities Classification System III) classification," the study authors said.

Jêrôme Richard, MD, and colleagues compared in vivo corneal endothelial cell loss from phacoemulsification performed with the Alcon Infiniti vision system using either AquaLase or conventional ultrasound. The study included 42 eyes of 42 patients randomly assigned to one of the two phaco modalities, with 21 eyes in each group.

In all cases, surgeons used a divide-and-conquer technique performed through a 3.2-mm clear corneal incision and capsular bag IOL implantation, according to the study.

Both groups had similar nuclear opalescence preoperatively, averaging 4.5 on the LOCS III scale. Only eyes with cataracts of nuclear opalescence graded up to 4.9 on the LOCS III scale were included in the study, the authors noted.

At 3 months follow-up, endothelial cell density averaged 1,867 cells/mm² for eyes in the ultrasound group and 2,031 cells/mm² for eyes in the fluid-based phaco group.

The researchers found that the fluid-based phaco group had significantly less mean endothelial cell loss at 1 month follow-up (P < .001).

At 1 week, follow-up, endothelial cell loss averaged 498 cells/mm² (20.6%) in the ultrasound group and 302 cells/mm² (13.3%) in the fluid-based phaco group.

At 1 month, endothelial cell loss averaged 589 cells/mm² (24.3%) in the ultrasound group and 254 cells/mm² (11.2%) in the fluid-based phaco group. At 3 months, such cell loss averaged 555 cells/mm² (22.9%) in the ultrasound group and 247 cells/mm² (10.9%) in the fluid-based phaco group, according to the study, published in the January issue of Cornea.