Effect of balanced phacoemulsification tip on the outcomes of torsional phacoemulsification using an active-fluidics system.

Purpose: To compare the outcomes of torsional phacoemulsification with a new balanced tip (Intrepid) and a conventional tip (Kelman) using a single active-fluidics torsional phacoemulsification machine (Centurion).

Setting: Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

Design: Prospective comparative case-control study.

Methods: Patients with senile cataract had torsional phacoemulsification with the Kelman conventional tip or the new Intrepid balanced tip using the active-fluidics torsional machine. Intraoperative parameters, such as cumulative dissipated energy (CDE), total ultrasound (US) time, torsion use time, torsion amplitude, aspiration time, and fluid use, were noted and compared. Endothelial cell loss and central corneal thickness (CCT) changes were evaluated at 1 month.

Results: The new tip showed significantly less CDE, total US time, torsion amplitude, aspiration time, and fluid use (8.55 ± 6.9 [SD], 33.59 ± 28.12 seconds, 37.8 ± 13.42, 173.19 ± 47.26 seconds, and 66.59 ± 20.44 mL, respectively) than the conventional tip (13.47 ± 10.65, 42.8 ± 33.46 seconds, 42.58 ± 16.38, 202.25 ± 71.28 seconds, and 97.14 ± 36.86 mL, respectively) (P < .01), especially in higher grades of cataract. Anterior capsulorhexis margin tear occurred in 2 patients with the new tip. There were no corneal burns in either group. The mean endothelial cell loss and the percentage change in CCT were not significantly different at 1 month.

Conclusions: The new balanced tip performed phacoemulsification more efficiently, especially in hard cataracts requiring higher energy and prolonged phacoemulsification time.