Comparison of Clinical Outcomes between Torsional and Longitudinal Phacoemulsification

Ju Hee Noh; Moon Sun Jung

doi:10.3341/jkos.2015.56.7.1028

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Noh and Jung: Comparison of Clinical Outcomes between Torsional and Longitudinal Phacoemulsification

Original Article

J Korean Ophthalmol Soc 2015;56(7):1028-1037.

Published online: 27 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.7.1028

Comparison of Clinical Outcomes between Torsional and Longitudinal Phacoemulsification

Ju Hee Noh, M.D, Moon Sun Jung, M.D, PhD

Department of Ophthalmology, Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea

Address reprint requests to Moon Sun Jung, MD, PhD Department of Ophthalmology, Soonchunhyang University Cheonan Hospital, #44 Suncheonhyang 4-gil, Dongnam-gu, Cheonan 330-721, Korea Tel: 82-41-570-2260, Fax: 82-41-570-2261 E-mail: greenizy@lycos.co.kr

∗ This study was presented as a poster at the 110th Annual Meeting of the Korean Ophthalmological Society 2013.

∗ This work was supported by the Soonchunhyang University Research Fund.

Received 5 December 201422 January 2015 Accepted 20 May 2015

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 the clinical outcomes during phacoemulsification when using recently improved longitudinal (Stellaris^®, Bausch & Lomb, Rochester, NY, USA) and torsional (Infiniti Ozil^®, Alcon, Fort Worth, TX, USA) ultrasound.

Methods:

The present study included 74 eyes of 59 patients undergoing cataract surgery. Operated eyes with mild cataract (nuclear sclerosis grade 1 and 2), moderate cataract (nuclear sclerosis grade 3) and hard cataract (nuclear sclerosis grade 4 and 5) were compared in terms of the total phacoemulsification (phaco) time, average phaco power, total phaco energy and amount of fluid used during cataract surgery between the 2 modalities. Endothelial cell density, corneal edema, central corneal thickness (CCT), surgically induced astigmatism (SIA) and best-corrected visual acuity (BCVA) were also evaluated preoperatively and up to 3 month postoperatively.

Results:

In mild cataracts, the operative parameters and corneal changes were similar between the 2 modalities. In moderate cataracts, the total phaco time was significantly higher in the torsional group than the longitudinal group, but the average phaco power, total phaco energy, and amount of fluid were not significantly different. In patients with hard cataract, the torsional group showed higher total phaco time (27.50 ± 17.77 sec vs. 97.08 ± 12.67 sec), average phaco power, total phaco energy, persistent corneal edema at 1 week postoperatively and more endothelial cell loss at 3 month postoperatively (16.33 ± 15.50% vs. 38.71 ±26.49%). Postoperative CCT, SIA and BCVA were not significantly different in hard cataracts between the 2 modalities.

Conclusions:

In mild and moderate cataracts, the efficiency of phaco and corneal changes were similar between the 2 modalities. However, recently improved longitudinal phaco showed superior efficiency for hard cataracts and induced less endo-thelial cell loss than torsional phaco.

Keywords: Cataract surgery, Longitudinal, Nuclear density, Phacoemulsification, Torsional

References

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Figure 1.

Operative parameters in relation to nuclear sclerosis.

Table 1.

Characteristics of the subjects in the two groups

	Longitudinal (n = 35)	Torsional (n = 39)	p-value^∗
Sex (n)
Male:female	16:19	17:22	0.391
Eye (n)
Right:left	14:21	23:16	0.091
Age (years)	70.06 ± 11.99	67.21 ± 14.07	0.361
NS grade (n, %)
Grade 1-2 Grade 3	11 (31.43)13 (37.14)	10 (25.64) 18 (46.15)	0.381
Grade 4-5	11 (31.43)	11 (28.21)

Values are presented as mean ± SD unless otherwise indicated. NS = nuclear sclerosis.

^∗ Independent t-test.

Table 2.

Comparison of BCVA, CCT, ECD and endothelial cell loss between the two groups

	Longitudinal (n = 35)	Torsional (n = 39)	p-value^∗
BCVA (log MAR)
Preoperative	0.73 ± 0.54	0.92 ± 0.63	0.222
Postoperative
1 month	0.15 ± 0.24	0.21 ± 0.35	0.885
3 months	0.15 ± 0.28	0.17 ± 0.28	0.819
CCT (μ m)
Preoperative	536.28 ± 38.86	528.65 ± 34.73	0.430
Postoperative
1 day	565.89 ± 53.25	566.41 ± 62.48	0.906
1 week	544.46 ± 45.12	542.74 ± 53.59	0.992
1 month	534.43 ± 42.85	536.41 ± 46.81	0.962
3 months	536.33 ± 44.09	533.60 ± 45.23	0.949
ECD (cell/mm²)
Preoperative	2,551 ± 329	2,432 ± 485	0.346
Postoperative
1 week	2,197± 336	2,028 ± 621	0.355
1 month	2,259 ± 372	1,902 ± 799	0.035
3 months	2,190 ± 515	1,878 ± 817	0.075
ECL (%)
Postoperative
1 week	12.96 ± 12.37	14.25 ± 19.09	0.729
1 month	12.48 ± 11.14	16.33 ± 21.05	0.410
3 months	13.17 ± 11.13	17.40 ± 20.96	0.326

Values are presented as mean ± SD unless otherwise indicated.

BCVA = best-corrected visual acuity; CCT = central corneal thickness; ECD = endothelial cell density; ECL = endothelial cell loss.

^∗ Independent t-test.

Table 3.

Operative parameters in the two groups

	Longitudinal (n = 35)	Torsional (n = 39)	p-value^§
Ultrasound time (second)
Mild cataract^∗	14.90 ± 9.17	17.88 ± 6.22	0.445
Moderate cataract^†	19.55 ± 8.78	28.38 ± 11.21	0.005
Hard cataract^‡	27.50 ± 17.77	97.08 ± 12.67	0.028
Average phaco power (%)
Mild cataract^∗	18.20 ± 3.74	21.38 ± 4.81	0.097
Moderate cataract^†	21.73 ± 3.82	23.76 ± 4.46	0.209
Hard cataract^‡	22.00 ± 4.50	26.00 ± 3.38	0.027
Total phaco energy
Mild cataract^∗	3.20 ± 2.10	4.25 ± 1.75	0.274
Moderate cataract^†	4.82 ± 2.44	9.90 ± 5.02	0.178
Hard cataract^‡	6.80 ± 5.37	26.08 ± 9.09	0.008
Fluid volume used (mL)
Mild cataract^∗	89.13 ± 32.86	74.83 ± 19.34	0.364
Moderate cataract^†	83.25 ± 34.52	68.44 ± 14.24	0.458
Hard cataract^‡	91.75 ± 28.43	101.17 ± 38.31	0.561

Values are presented as mean ± SD unless otherwise indicated.

^∗ Nuclear sclerosis (NS) grade 1-2;

^† NS grade 3;

^‡ NS grade 4-5;

^§ Independent t-test.

Table 4.

Postoperative corneal edema in the two groups

POD	Corneal edema grade
POD	None^∗	Trace^†	Mild^‡	Moderate^§	Severe^∏	p-value^#
1 day	Longitudinal	20	9	4	1	0	0.532
1 day	Torsional	18	9	7	3	0	0.532
1 week	Longitudinal	33	1	0	0	0	0.066
1 week	Torsional	33	3	1	0	0	0.066
1 month	Longitudinal	34	0	0	0	0	1.000
1 month	Torsional	37	0	0	0	0	1.000
3 months	Longitudinal	34	0	0	0	0	1.000
3 months	Torsional	37	0	0	0	0	1.000

POD = postoperative day.

^∗ Clear cornea;

^† Minimal corneal edema in relation to incision site;

^‡ Corneal edema affecting less than 25% of the cornea with clear iris details;

^§ Corneal edema affecting more than 25% of the cornea with hazy iris details;

^∏ Corneal edema affecting more than 50% of the cornea with no view of iris details;

^# Independent t-test.

Table 5.

Postoperative changes of BCVA, CCT, ECD, ECL and corneal edema in cases with hard cataract

		Hard cataract
	Longitudinal (n = 11)	Torsional (n = 11)	p-value^∗
BCVA (log MAR)
Preoperative	1.07 ± 0.61	1.34 ± 0.61	0.313
Postoperative
1 month	0.29 ± 0.34	0.26 ± 0.40	0.902
3 months	0.28 ± 0.41	0.30 ± 0.52	0.840
CCT (μ m)
Preoperative	538.75 ± 28.54	529.11 ± 20.81	0.435
Postoperative
1 day	589.14 ± 36.72	608.57 ± 79.67	0.569
1 week	568.00 ± 37.26	547.75 ± 22.26	0.353
1 month	539.20 ± 41.37	532.75 ± 17.61	0.781
3 months ECD (cell/mm²)	538.67 ± 37.28	533.04 ± 37.32	0.661
Preoperative	2,490 ± 250	2,430± 430	0.694
Postoperative
1 week	2,158 ± 300	1,496 ± 717	0.075
1 month	2,153 ± 441	1,296 ± 564	0.006
3 months	2,107 ± 304	1,321 ± 828	0.033
ECL (%)
Postoperative
1 week	13.56 ± 11.59	36.33 ± 30.92	0.136
1 month	15.00 ± 12.64	45.86 ± 20.29	0.003
3 months	16.33 ± 15.50	38.71 ± 26.49	0.042
Corneal edema
Postoperative
1 day	1.18 ± 0.87	1.73 ± 1.01	0.190
1 week	0.00 ± 0.00	0.56 ± 0.73	0.020
1 month	0.00 ± 0.00	0.00 ± 0.00	1.000
3 months	0.00 ± 0.00	0.00 ± 0.00	1.000

Values are presented as mean ± SD unless otherwise indicated.

BCVA = best-corrected visual acuity; CCT = central corneal thickness; ECD = endothelial cell density; ECL = endothelial cell loss.

^∗ Mann-Whitney U-test.

Table 6.

Comparison of surgically induced astigmatism

POD	Total (n = 74)				Hard cataract (n = 22)
POD	Longitudinal	Torsional	p-value^∗	Longitudinal	Torsional	p-value^†
1 day	0.80 ± 0.51	0.97 ± 0.61	0.456	0.90 ± 0.75	1.06 ± 0.67	0.403
1 week	0.76 ± 0.50	0.89 ± 0.64	0.383	0.81 ± 0.70	0.94 ± 0.74	0.324
1 month	0.53 ± 0.44	0.60 ± 0.50	0.447	0.61 ± 0.51	0.68 ± 0.53	0.536
3 months	0.51 ± 0.47	0.56 ± 0.44	0.549	0.57 ± 0.67	0.64 ± 0.61	0.281

Values are presented as mean ± SD unless otherwise indicated. POD = postoperative day.

^∗ Independent t-test;

^† Mann-Whitney U-test.

Table 7.

Associations of endothelial cell loss (%) at post-operative 1 month with predisposing factors by multiple linear regression analyses (adjusted R² =0.535)

	β ± SE	p-value
Sex	0.011 ± 0.128	0.971
Age	0.009 ± 0.102	0.964
Preoperative ECD	0.020 ± 0.237	0.569
Nuclear sclerosis	0.415 ± 1.466	0.002
Total phaco energy	0.503 ± 0.191	0.001
Amount of fluid	-0.049 ± 0.080	0.730

Values are presented as mean ± SD unless otherwise indicated.

SE = standard errors; ECD = endothelial cell density.

Table 8.

Comparison of parameters between the two groups in 15 patients with bilateral cataract surgery

	Longitudinal	Torsional	p-value^∗
Operative parameter
Ultrasound time (second)	19.43 ± 17.38	38.21 ± 28.51	0.045
Average phaco power (%)	20.00 ± 4.11	25.14 ± 4.54	0.003
Total phaco energy	4.86 ± 4.89	14.36 ± 15.65	0.026
Fluid volume used (mL)	85.63 ± 24.75	88.38 ± 34.81	0.918
BCVA (log MAR)
Preoperative	0.63 ± 0.49	0.65 ± 0.51	0.611
Postoperative
1 month	0.15 ± 0.28	0.16 ± 0.32	0.769
3 months	0.14 ± 0.32	0.17 ± 0.32	0.860
CCT (μ m)
Preoperative	533.94 ± 30.19	527.94 ± 40.06	0.247
Postoperative
1 day	558.00 ± 36.40	554.44 ± 59.15	0.721
1 week	534.62 ± 34.25	523.92 ± 47.89	0.244
1 month	539.60 ± 45.41	526.10 ± 56.91	0.207
3 months	537.45 ± 42.26	526.15 ± 50.32	0.268
ECL (%)
Postoperative
1 day	4.71 ± 4.60	7.71 ± 10.28	0.266
1 week	11.73 ± 10.42	15.73 ± 21.52	0.505
1 month	11.77 ± 8.70	18.31 ± 22.02	0.228
3 months	14.25 ± 8.24	17.71 ± 20.21	0.351
Corneal edema
Postoperative
1 day	0.63 ± 0.86	0.75 ± 0.88	0.580
1 week	0.00 ± 0.00	0.07 ± 0.25	0.334
1 month	0.00 ± 0.00	0.00 ± 0.00	1.000
3 months	0.00 ± 0.00	0.00 ± 0.00	1.000

Values are presented as mean ± SD unless otherwise indicated. BCVA = best-corrected visual acuity; CCT = central corneal thickness; ECL = endothelial cell loss.

^∗ Mann-Whitney U-test.

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