Sung A Lim; Hyung Bin Hwang; Hyun Seung Kim

doi:10.3341/jkos.2013.54.10.1508

Journal List > J Korean Ophthalmol Soc > v.54(10) > 1009499

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Lim, Hwang, and Kim: Comparison of Clinical Outcomes Between Torsional Phacoemulsification of Infiniti® and Longitudinal Phacoemulification of Stellaris® Through 2.2 mm Microincision

Original Article

J Korean Ophthalmol Soc 2013;54(10):1508-1513.

Published online: 3 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.10.1508

Comparison of Clinical Outcomes Between Torsional Phacoemulsification of Infiniti® and Longitudinal Phacoemulification of Stellaris® Through 2.2 mm Microincision

Sung A Lim, MD, Hyung Bin Hwang, MD, Hyun Seung Kim, MD, PhD

Department of Ophthalmology & Visual Science College of Medicine, The Catholic University of Korea, Seoul, Korea

Address reprint requests to Hyun Seung Kim, MD, PhD, Department of Ophthalmology, The Catholic University of Korea Yeouido St. Mary's Hospital, #10 63-ro, Yeongdeungpo-gu, Seoul 150-713, Korea, Tel: 82-2-3779-1243, Fax: 82-2-761-6869, E-mail: sara514@catholic.ac.kr

Received 17 November 2012 Revised 11 April 2013 Accepted 24 August 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare clinical outcomes of a 2.2 mm microcoaxial cataract surgery, using torsional mode and longitudinal mode.

Methods

In this comparative study, patients with bilateral cataract were assigned to get microcoaxial cataract surgery by torsional mode of infiniti in one eye and longitudinal mode of Stellaris® in the other eye. Primary outcome measures were US time (UST), cumulative dissipated energy (CDE), mean amount of balanced salt solution (BSS) used and surgical complications. Patients were seen 1, 7, 30, and 60 days after surgery. Postoperative outcome measures were the final best corrected visual acuity (BCVA), central corneal thickness (CCT), endothelial cell count and surgically induced astigmatism (SIA).

Results

The study evaluated 68 eyes of 34 patients (nuclear opalescence (NO)2: 40 eyes, and NO3: 28 eyes). CDE was significantly lower in torsional mode (3.52 ± 2.93) than in longitudinal mode (6.20 ± 3.32) (p = 0.001). Torsional mode (60.88 ± 21.18 ml) had more BSS use than longitudinal mode (34.58 ± 13.54 ml) (p < 0.001). There were no significant differences in postoperative BCVA, CCT change, endothelial change, and SIA (p > 0.05).

Conclusions

The torsional mode may provide lower level of phacoemulsification energy than the longitudinal mode and Torsional mode is considered effective and safe phacoemulsification. However the surgical outcomes were not significantly different in 2.2 mm microcoaxial cataract surgery of moderate cataract. So surgeon can choose any phaco machine based on experience and preference.

Keywords: Cataract surgery, CDE (cumulative dissipated energy), Phacoemulsification, 2.2 mm MICS (microincisional cataract surgery)

References

1. Hoffman RS, Fine IH, Packer M. New phacoemulsification technology. Curr Opin Ophthalmol. 2005; 16:38–43.

2. Storr-Paulsen A, Norregaard JC, Ahmed S. . Endothelial cell damage after cataract surgery: divide-and-conquer versus pha- co-chop technique. J Cataract Refract Surg. 2008; 34:996–1000.

3. Davison JA, Cionni RJ, Snowdon JR. . Simultaneous surgeon and side-view video analysis comparing in situ fracture and stop- and-chop phacoemulsification. J Cataract Refract Surg. 2005; 31:274–9.

4. Walkow T, Anders N, Klebe S. Endothelial cell loss after phacoemulsification: relation to preoperative and intraoperative parameters. J Cataract Refract Surg. 2000; 26:727–32.

5. Fishkind W, Bakewell B, Donnenfeld ED. . Comparative clinical trial of ultrasound phacoemulsification with and without the WhiteStar system. J Cataract Refract Surg. 2006; 32:45–9.

6. Wong T, Hingorani M, Lee V. Phacoemulsification time and power requirements in phaco chop and divide and conquer nucleofractis techniques. J Cataract Refract Surg. 2000; 26:1374–8.

7. Kim DH, Wee WR, Lee JH, Kim MK. The comparison between torsional and conventional mode phacoemulsification in moderate and hard cataracts. Korean J Ophthalmol. 2010; 24:336–40.

8. Liu Y, Zeng M, Liu X. . Torsional mode versus conventional ultrasound mode phacoemulsification: randomized comparative clinical study. J Cataract Refract Surg. 2007; 33:287–92.

9. Holladay JT, Cravy TV, Koch DD. Calculating the surgically induced refractive change following ocular surgery. J Cataract Refract Surg. 1992; 18:429–43.

10. Hayashi K, Hayashi H, Nakao F, Hayashi F. Risk factors for corneal endothelial injury during phacoemulsification. J Cataract Refract Surg. 1996; 22:1079–84.

11. Reuschel A, Bogatsch H, Barth T, Wiedemann R. Comparison of endothelial changes and power settings between torsional and longitudinal phacoemulsification. J Cataract Refract Surg. 2010; 36:1855–61.

12. Werblin TP. Long-term endothelial cell loss following phacoemulsification: model for evaluating endothelial damage after intraocular surgery. Refract Corneal Surg. 1993; 9:29–35.

13. Kreisler KR, Mortenson SW, Mamalis N. Endothelial cell loss following “modern” phacoemulsification by a senior resident. Ophthalmic Surg. 1992; 23:158–60.

14. Bissen-Miyajima H. Ophthalmic viscosurgical devices. Curr Opin Ophthalmol. 2008; 19:50–4.

15. Berdahl JP, Jun B, DeStafeno JJ, Kim T. Comparison of a torsional handpiece through microincision versus standard clear corneal cataract wounds. J Cataract Refract Surg. 2008; 34:2091–5.

16. Polack FM, Sugar A. The phacoemulsification procedure. II. Corneal endothelial changes. Invest Ophthalmol. 1976; 15:458–69.

Figure 1.

Change of preoperative and postpoerative central corneal thickness µm).

Figure 2.

Change in corneal endothelial cell density (cells/mm²).

Table 1.

Patients demographics

	Infiniti® Torsionl Mode (n = 36)	Stellaris® Longitudinal Mode (n = 36)	p-value
Age (years)	67.5 ± 10.04	67.5 ± 10.04	−
Range	43 to 81	43 to 81	−
Sex (female : male)	28 : 6 (n = 34)	28 : 6 (n = 34)
Nucleus density (NSG2/NSG3)	17/17	17/17
Laterality (Rt./Lt.)	16/18	17/17
BCVA (log MAR)	0.45 ± 0.32	0.34 ± 0.17	0.590
Axial length (mm)	23.48 ± 1.86	23.42 ± 1.58	0.352
Anterior chamber depth (mm)	2.66 ± 0.48	2.75 ± 0.81	0.465
Corneal thickness (μm)	567.56 ± 33.12	564.41 ± 33.91	0.785
Endothelial cell count (cells / mm²)	2634.5 ± 275.1	2663.0 ± 297.5	0.985

Values are presented as mean ± SD.

Table 2.

Comparision of mean surgical parameter between Infiniti® torsional mode and Stellaris® logitudial mode

	Infiniti® Torsionl Mode (n = 36)	Stellaris® Longitudinal Mode (n = 36)	p-value
Power	100% Torsional	30% Linear
Phaco time (sec)	14.35 ± 5.47	15.72 ± 6.49	0.568
CDE	3.52 ± 2.93	6.22 ± 7.02	0.001
Total Used BSS volume (ml)	60.88 ± 21.18	34.58 ± 13.54	<0.001

Values are presented as mean ± SD.

CDE = cumulative dissipated energy.

Table 3.

Comparision of mean surgical induced astigmatism between Infiniti® torsional mode and Stellaris® logitudial mode (postop-preop)

Postoperative time	Infiniti® Torsionl Mode (n = 36)	Stellaris® Longitudinal Mode (n = 36)	p-value
1 day	0.39 ± 23	0.41 ± 31	0.126
1 week	0.33 ± 26	0.37 ± 28	0.108
1 month	0.29 ± 23	0.31 ± 26	0.145
2 months	0.12 ± 0.23	0.18 ± 0.24	0.193

Values are presented as mean ± SD.

TOOLS

Similar articles