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Phaco with torsional or longitudinal ultrasound may result in high endothelial cell loss
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Biaxial small-incision phacoemulsification with torsional or longitudinal ultrasound may result in significant endothelial cell loss, according to a study.
“The risk for high endothelial cell loss should be considered when phacoemulsification of moderate to hard nuclear cataract is performed using either method,” the study authors said.
The prospective randomized clinical trial included 70 eyes of 70 patients with high-density nuclear cataracts. Thirty-five eyes of 35 patients with a mean age of 69.6 years underwent biaxial small-incision phacoemulsification with torsional ultrasound, and 35 eyes of 35 patients with a mean age of 72.6 years had surgery with longitudinal ultrasound.
The Ozil torsional handpiece (Alcon) and 0.9-mm mini-flared 30° Kelman Advanced Bypass System tips were used for both procedures.
Corrected distance visual acuity, endothelial cell density and central corneal thickness were evaluated preoperatively and at 1 day, 1 month and 3 months postoperatively.
Total ultrasound time, cumulative dissipated energy, percentage total equivalent power in position 3 and balanced salt solution volume were also evaluated.
Mean ultrasound time was insignificantly longer in the torsional ultrasound group. Mean cumulative dissipated energy and balanced salt solution volume were insignificantly lower in the torsional group. Both groups had similar mean percentage total equivalent power in position 3.
Both groups had similar central corneal thickness measurements preoperatively and at all follow-up points.
Corrected distance visual acuity was 0.02 logMAR in both groups at 3 months.
Also at 3 months, mean endothelial cell loss was 38.6% in the torsional group and 35.4% in the longitudinal group; the between-group difference was insignificant.
No intraoperative or postoperative complications and no cases of corneal burn were reported.
Perspective
Back to TopAmar Agarwal, MS, FRCS, FRCOphth
This study analyzes biaxial phacoemulsification and endothelial cell loss. We started phakonit in 1998, which is now known as biaxial phaco. In 2005, we first performed a sub-1-mm cataract surgery with 0.7-mm phaco needles and irrigating choppers. For this we need gas-forced infusion so that surge does not occur. This is an interesting and good paper, but the instruments used are a 19-gauge irrigating chopper and a 20-gauge phaco needle. Both should be 22 gauge. Also, no gas-forced infusion was done using an air pump which is mandatory. That is the reason for the endothelial cell loss, not the biaxial phaco.
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