Comparison of Clinical Outcomes between High and Low Fluid-Dynamic Parameters during Phacoemulsification

Won Jae Heo; Jin Young Lee; Hong Kyun Kim

doi:10.3341/jkos.2015.56.12.1860

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Heo, Lee, and Kim: Comparison of Clinical Outcomes between High and Low Fluid-Dynamic Parameters during Phacoemulsification

Original Article

J Korean Ophthalmol Soc 2015;56(12):1860-1866.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.12.1860

Comparison of Clinical Outcomes between High and Low Fluid-Dynamic Parameters during Phacoemulsification

Won Jae Heo, M.D¹, Jin Young Lee, M.D², Hong Kyun Kim, M.D, PhD^1,

¹Department of Ophthalmology, Kyungpook National University School of Medicine^¹, Daegu, Korea

²Metro Eye Center, Daegu, Korea

Address reprint requests to Hong Kyun Kim, MD, PhD Department of Ophthalmology, Kyungpook National University Hospital, #130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea Tel: 82-53-200-5816, Fax: 82-53-426-6552 E-mail: okeye@knu.ac.kr

Received 29 May 20158 July 2015 Accepted 25 September 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 between high and low fluid-dynamic parameter settings during phacoemulsification.

Methods

In this retrospective study we analyzed 183 consecutive eyes with senile cataracts that underwent cataract surgery be-tween October 2010 and January 2015. The phacoemulsifications were performed with high and low fluidic parameter settings, which were designated by different fluid heights, aspiration flow rates, and vacuum settings. We measured and compared the in-traoperative factors including fluid consumption, cumulative dissipated energy (CDE), ultrasound time, intraoperative complica-tions, and pupil size changes during the phacoemulsification. Central corneal thickness (CCT), endothelial cell density (ECD), uncorrected visual acuity (UCVA), and best corrected visual acuity (BCVA) were measured and compared preoperatively and postoperatively.

Results

There was no statistically significant difference in the fluid consumption, CDE, or ultrasound time during phacoemulsifi-cation between the 2 groups. The frequencies of intraoperative complications were not statistically significant. UCVA, BCVA, and ECD were not statistically significantly different between the 2 groups during the postoperative follow-up. The low parameter group showed the lower increase in CCT on postoperative day 30.

Conclusions

The phacoemulsifications with low fluid-dynamic parameter resulted in less damage to intraocular tissue without any significantly different postoperative findings. The phacoemulsification with low fluid-dynamic parameter setting is more ad-vantageous due to stable and safe aspects.

Keywords: Cataract surgery, Fluid-dynamic parameters, Phacodynamics, Phacoemulsification

References

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Figure 1.

Analysis of the the pupil size changes. The pupil size changes were analyzed with the ratio of the horizontal length of pupil (*) and the length between the limbus of cornea (arrows) using Image J program.

Table 1.

High and low fluid-dynamic parameter^*

Group	Mode	Fluid height (cm)	Aspiration flow (mL/min, mode)	Vacuum (mm Hg, mode)
Low parameter	Sculpting	70	22, linear	90, fixed
Chopping & quadrant	70	27, linear	240, linear
removal
High parameter	Sculpting	90	22, linear	90, fixed
Chopping & quadrant	110	38, linear	380, linear
removal
^* Infiniti system^Ⓡ (Alcon, Fort Worth, TX, USA).

Table 2.

Patient baseline characteristics

	Low parameter group	High parameter group	p-value
Eyes	118	65
Age (years)	69.9 ± 9.6	70.0 ± 8.5	0.946^*
Gender (male:female)	63:55	28:37	0.182^†
Lens opacity
Nuclear opalescence (NO)	3.46 ± 0.50	3.52 ± 0.50	0.399^*
Nuclear color (NC)	3.46 ± 0.50	3.52 ± 0.50	0.399^*
Cortical (C)	2.53 ± 1.35	2.35 ± 1.43	0.400^*
Posterior subcapsular (P)	1.75 ± 1.73	1.88 ± 1.74	0.647^*
UCVA (log MAR)	0.53 ± 0.18	0.59 ± 0.15	0.411^*
BCVA (log MAR)	0.43 ± 0.19	0.48 ± 0.18	0.520^*
Endothelial cell density (cells/mm²)	2,511.6 ± 351.9	2,530.3 ± 305.4	0.651^*
Central corneal thickness (μ m)	530.9 ± 31.6	528.1 ± 35.1	0.658^*

Values are presented as mean ± SD unless otherwise indicated. UCVA = uncorrected visual acuity; BCVA = best corrected visual acuity.^* Independent two sample t-test; ^† Chi-square test.

Table 3.

Comparison of intraoperative parameters and outcomes

	Low parameter group	High parameter group	p-value
Fluid consumption (mL)	105.3 ± 72.5	101.3 ± 57.1	0.783^*
Ultrasound time (seconds)	52.9 ± 31.1	48.8 ± 28.9	0.421^*
CDE (seconds)	16.0 ± 8.9	15.2 ± 9.3	0.562^*
Nucleus fragmentation method (prechop:phaco chop)	28:90	17:48	0.715^†
Intraoperative complication
Iris incarceration (number of eyes)	8 (6.8%)	8 (12.3%)	0.205^*
PC rupture	0	0
Radial tear during CCC	0	0
Mean decrease of the pupil size (%) ± SD	11.70 ± 7.25	17.25 ± 4.81	0.043^*

Values are presented as mean ± SD unless otherwise indicated. CDE = cumulative dissipated energy; PC rupture = posterior capsule rupture; CCC = continuous curvilinear capsulorhexis; SD = standard deviation.^* Independent two sample t-test; ^† Chi-square test.

Table 4.

Comparison of postoperative parameters and outcomes

	Examination time	Low parameter group	High parameter group	p-value^*
UCVA (log MAR)	POD 7	0.169 ± 0.092	0.180 ± 0.093	0.606
POD 30	0.141 ± 0.065	0.150 ± 0.084	0.602
BCVA (log MAR)	POD 7	0.094 ± 0.060	0.103 ± 0.054	0.572
POD 30	0.065 ± 0.039	0.077 ± 0.045	0.302
Decrease of ECD (%)	POD 30	8.19 ± 6.12	10.28 ± 6.87	0.063
Increase of CCT (%)	POD 30	1.55 ± 1.47	3.62 ± 2.21	0.026

Values are presented as mean ± SD unless otherwise indicated. UCVA = uncorrected visual acuity; BCVA = best corrected visual acuity; POD = postoperative day; ECD = endothelial cell density; CCT = central corneal thickness.^* Independent two sample t-test.

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