Intraoperative performance and postoperative outcome comparison of longitudinal, torsional, and transversal phacoemulsification machines

• Published in: Journal of cataract and refractive surgery Vol. 38; no. 2; pp. 234 - 241
• Main Authors: Christakis, Panos G., BSc, Braga-Mele, Rosa M., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.02.2012; Elsevier
• Subjects: Aged; Biological and medical sciences; Corneal Edema - physiopathology; Corneal Edema - prevention & control; Female; Humans; Intraoperative Complications; Lens Implantation, Intraocular; Male; Medical sciences; Ophthalmology; Phacoemulsification - instrumentation; Postoperative Complications; Pseudophakia - physiopathology; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the eye and orbit; Treatment Outcome; Viscosupplements - administration & dosage; Visual Acuity - physiology; Performance evaluation; Postoperative; Prognosis; Treatment; Surgery; Evolution; Intraoperative; Ophthalmology; Phacoemulsification; Performance; Comparative study
• ISSN: 0886-3350; 1873-4502
• DOI: 10.1016/j.jcrs.2011.08.035

Purpose To compare the intraoperative performance and postoperative outcomes of 3 phacoemulsification machines that use different modes. Setting Kensington Eye Institute, Toronto, Ontario, Canada. Design Comparative case series. Methods This chart and video review comprised consecutive eligible patients who had phacoemulsification by the same surgeon using a Whitestar Signature Ellips-FX (transversal), Infiniti-Ozil-IP (torsional), or Stellaris (longitudinal) machine. Results The review included 98 patients. Baseline characteristics in the groups were similar; the mean nuclear sclerosis grade was 2.0 ± 0.8. There were no significant intraoperative complications. The torsional machine averaged less phacoemulsification needle time (83 ± 33 seconds) than the transversal (99 ± 40 seconds; P =.21) or longitudinal (110 ± 45 seconds; P =.02) machines; the difference was accentuated in cases with high-grade nuclear sclerosis. The torsional machine had less chatter and better followability than the transversal or longitudinal machines ( P <.001). The torsional and longitudinal machines had better anterior chamber stability than the transversal machine ( P <.001). Postoperatively, the torsional machine yielded less central corneal edema than the transversal ( P <.001) and longitudinal ( P =.04) machines, corresponding to a smaller increase in mean corneal thickness (torsional 5%, transversal 10%, longitudinal 12%; P =.04). Also, the torsional machine had better 1-day postoperative visual acuities ( P <.001). Conclusions All 3 phacoemulsification machines were effective with no significant intraoperative complications. The torsional machine outperformed the transversal and longitudinal machines, with a lower mean needle time, less chatter, and improved followability. This corresponded to less corneal edema 1 day postoperatively and better visual acuity. Financial Disclosure Dr. Braga-Mele was a consultant to Abbott Medical Optics, Alcon Laboratories, Bausch & Lomb, and Allergan at the time the study was performed. Neither author has a financial or proprietary interest in any material or method mentioned.