Bead-flow pattern: quantitation of fluid movement during torsional and longitudinal phacoemulsification.

Purpose: To develop a bead-flow pattern for visualizing and comparatively quantifying fluid movement using a torsional or longitudinal ultrasound (US) phaco handpiece.

Setting: Magill Laser Center, Medical University of South Carolina, Charleston, South Carolina, USA.

Methods: Visualization and quantification of intraocular fluid dynamics were evaluated by injecting neutrally buoyant, collagen-coated polystyrene beads (diameter, 125 to 212 microm) into the phacoemulsification irrigation flow. Using the anterior chamber of a cadaver or porcine eye or a laboratory test chamber, the bead-flow pattern was video recorded. Qualitative comparisons between longitudinal and torsional phacoemulsification were made using video-processing software to track the beads frame by frame. The time (quantitative) required to aspirate a bolus of beads from the anterior chamber (clearance time) was measured and compared between the 2 modalities. Aspiration efficiency was calculated to compare operating conditions in a test chamber using high-speed videography; conditions included irrigation/aspiration (I/A) only (0% power) and clinically relevant fluidic parameters and power modulations with torsional, longitudinal, or a combination of powers applied.

Results: Qualitative and quantitative analyses of the fluidic patterns of bead flow in the peripheral anterior chamber and near the aspirating tip opening indicated that torsional fluidics behave closer to the I/A-only configuration than longitudinal phacoemulsification, with the latter repelling more bead material in front of the aspiration tip. Bead clearance time was approximately 50% faster with torsional than with longitudinal US, regardless of the power setting.

Conclusion: Bead flow-pattern evaluation is a feasible approach to future studies of fluid movement in the anterior chamber.