Performance comparison of the Alcon Legacy 20000 straight and flared 0.9 mm Aspiration Bypass System tips.

Purpose: To compare the efficiency of surgical procedures using 2 phacoemulsification tips.

Setting: Wolfe Clinic, Marshalltown, Iowa, USA.

Methods: A randomized prospective study of 256 consecutive cases was conducted. The patients were adults having phacoemulsification by a modified in situ fracture technique. All cases were done by 1 surgeon using the Alcon Legacy 20000 phacoemulsification machine with high-vacuum cassettes and tubing. One of 2 45-degree Aspiration Bypass System (ABS) phacoemulsification tips was used. The straight tip has a 0.9 mm outside diameter (n = 127). The flared tip has a 0.76 mm outside diameter shaft that flares to a 1.02 mm tip (n = 129). Measurements at the time of surgery included metered phacoemulsification time, percentage power used, total phacoemulsification time, and milliliters of balanced salt solution (BSS(R)) used.

Results: No posterior capsule tear, vitreous loss, incision thermal damage, incision leak, or suture closure occurred. There were no cases of iris aspiration into the working end of the phacoemulsification needle; however, the iris was aspirated into the ABS opening of the flared tip in 1 case. Similar measurements for the straight and flared tips included, respectively, metered phacoemulsification time, 1.4 minutes each; mean power percentage, 41% and 39%; total phacoemulsification time, 2 minutes 11 seconds and 2 minutes 15 seconds; and overall BSS volume, 77 mL and 75 mL. The anterior capsule tear rates for straight (5.5%) and flared (1.6%) tips were similar.

Conclusions: The flared ABS phaco tip with a 0.76 mm shaft outside diameter provided the physical advantages of shaft diameter reduction and required ultrasonic energy expenditures, BSS volumes, and surgical times similar to those of the straight ABS ultrasonic tip with a 0.9 mm outside diameter.