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Kim, Lee, Kim, Kim, and Tchah: Clinical Effects of an Improved Pump Reaction Rate and Automatic Occlusion Sensing System in Phacoemulsification
Original Article

J Korean Ophthalmol Soc 2018;59(11):1017-1023.

Published online: 25 September 2018

DOI: https://doi.org/10.3341/jkos.2018.59.11.1017

Clinical Effects of an Improved Pump Reaction Rate and Automatic Occlusion Sensing System in Phacoemulsification

You Na Kim, MD, Jin Ah Lee, MD, Jae Yong Kim, MD, PhD, Myoung Joon Kim, MD, PhD, Hung Won Tchah, MD, PhD

Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Address reprint requests to Hung Won Tchah, MD, PhD Department of Ophthalmology, Asan Medical Center, #88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: 82-2-3010-3674, Fax: 82-2-470-6440 E-mail: hwtchah@amc.seoul.kr

Received 14 February 2018       Revised 22 March 2018       Accepted 30 October 2018

Copyright © 2018 Korean Ophthalmological Society

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

A recently introduced phacoemulsification system, the WhiteStar Signature® PRO, has demonstrated improved nucleus followability and cutting efficiency via an improved pump regulator with a higher reaction response and an automatic occlusion sensing system. In this study, we compared various phacoemulsification parameters between the new system and an older version of the device.

Methods

A total of 80 eyes of 68 patients with cataracts who had undergone phacoemulsification by a single surgeon were included in this study. Forty eyes of patients underwent phacoemulsification using the older Signature® system (WhiteStar); these patients were classified as the control group. Another 40 eyes of patients underwent phacoemulsification with the newer enhanced system, the WhiteStar Signature® PRO; these patients were assigned to the experimental group. During the operation, operative parameters, including the effective phaco time (parameter of effective phaco time with a specific coefficient for the transversal movement expressed in seconds, EFX), ultrasound time (seconds [s]), effective phacoemulsification time (EPT, s), average phacoemulsification power (AVG, %), and balanced salt solution usage, were measured to determine the performance enhancement offered by the updated system. Central corneal thickness was measured before and after surgery to compare corneal edema. The relationships between the two groups were analyzed using an independent t-test.

Results

The Signature PRO® system showed a lower EFX (p < 0.001), a shorter EPT (p < 0.001), and a smaller AVG (p < 0.001). Postoperative corneal thickness did not differ significantly between the two groups.

Conclusions

Comparing the efficacy of the improved reaction speed of the device and automatic occlusion sensing system in performing phacoemulsification, the updated Signature PRO® system demonstrated superior followability and cutting efficiency regardless of nuclear cataract hardness.

Keywords: Automatic occlusion sensing, Central corneal thickness, Effective phacoemulsification time, Handpiece

References

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Figure 1.
Change of preoperative and post-operative central corneal thickness (CCT) (μ m). This graph features changes of CCT between two phacoemulsification systems. A solid line shows the mean CCT values in the group using enhanced device group (Signature PRO® system) and a dotted line shows the mean CCT values in the control group (Signature® system). Using independent t-test, there is no statistically significant difference between two systems (p > 0.05) in total and subgroup analysis. (A) Total group. (B) Soft nucleus subgroup. (C) Hard nucleus subgroup. Preop = pre-operative examination; POD = post-operative day; w= week; mo = month.
jkos-59-1017f1.tif
Table 1.
Phacoemulsification settings in two systems
  Control group (Signature® system) Enhanced device group (Signature PRO® system)
Surgical step and settings    
 Sculpting and chopping: low Venturi setting    
  Vaccuum (mmHg) 200 400
  Power (%) 30 30
  Bottle height (cm) 106 106
 Quadrant removal: high Venturi setting    
  Vaccuum (mmHg) 270 600
  Power (%) 30 30
  Bottle height (cm) 106 106
 Irrigation and aspiration    
  Aspiration (mL/minutes) 29 29
  Vacuum (mmHg, peristaltic) 500 500
  Bottle height (cm) 92 92
Table 2.
Demographics of preoperative conditions
  Control group (Signature® system) Enhanced device group (Signature PRO® system) p-value*
Eyes (n) 40 40  
Age (year) 68.40 ± 11.72 70.35 ± 10.00 0.425
NO (LOCS III) 3.44 ± 1.01 3.43 ± 1.08 0.957
Axial length (mm) 23.37 ± 1.34 23.78 ± 1.12 0.143
Anterior chamber depth (mm) 2.64 ± 0.49 2.65 ± 0.30 0.875
Best corrected visual acuity (logMAR) 0.37 ± 0.39 0.45 ± 0.58 0.483
Endothelial cell count (cell/mm2) 2,747.60 ± 312.72 2,599.10 ± 462.86 0.097
Central corneal thickness (μ m) 547.73 ± 28.70 550.25 ± 39.32 0.744

Values are presented as mean ± standard deviation unless otherwise indicated. NO = nucleus opalescence; LOCS III = the lens opacities classification system III.

* Independent t-test; p < 0.05 considered stastistically significant.

Table 3.
Comparisons of surgical parameters during phacoemulsification
  Control group (Signature® system) Enhanced device group (Signature PRO® system) p-value
Surgical parameters      
 EFX 2.11 ± 1.75 0.40 ± 0.61 <0.001*
 Ultrasonic/phaco time (seconds) 58.79 ± 33.87 44.31 ± 42.22 0.095
 Effective phaco time (seconds) 4.22 ± 3.49 0.80 ± 1.22 <0.001*
 Average phaco power (%) 7.28 ± 4.03 1.23 ± 1.21 <0.001*
 Irrigated BSS (mL) 95.75 ± 56.89 131.00 ± 52.84 0.005*

Values are presented as mean ± standard deviation unless otherwise indicated. EFX = parameter of effective phaco time with a specific coefficient for the transversal movement expressed in seconds; BSS = balanced salted solution.

* Independent t-test; p < 0.05 considered stastistically significant.

Table 4.
Comparisons of surgical parameters during phacoemulsification in soft and hard nucleus group
  Soft nucleus
 Hard nucleus
Control group (Signature® system) Enhanced device group (Signature PRO® system) p-value Control group (Signature® system) Enhanced device group (Signature PRO® system) p-value
Surgical parameters
 EFX 1.34 ± 0.86 0.13 ± 0.17 <0.001* 3.05 ± 2.09 0.77 ± 0.79 <0.001*
 Ultrasonic/phaco time (seconds) 45.85 ± 31.04 28.71 ± 29.66 0.065 74.61 ± 30.97 7 65.43 ± 48.08 0.504
 Effective phaco time (seconds) 2.68 ± 1.72 0.26 ± 0.35 <0.001* 6.11 ± 4.18 1.53 ± 1.57 <0.001*
 Average phaco power (%) 7.28 ± 4.03 1.23 ± 1.21 <0.001* 8.06 ± 3.46 2.12 ± 1.27 <0.001*
 Irrigated BSS (mL) 82.27 ± 36.15 124.13 ± 49.03 0.002* 112.22 ± 72.72 2 140.29 ± 57.81 0.214

Values are presented as mean ± standard deviation unless otherwise indicated. EFX = parameter of effective phaco time with a specific coefficient for the transversal movement expressed in seconds; BSS = balanced salted solution.

* Independent t-test; p < 0.05 considered stastistically significant.

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