Aqualase for cataract extraction

Abstract

Purpose To report our experience of using Aqualase technology for cataract extraction. Methods In total, 33 patients (20 females; mean age 71.4 years) underwent cataract surgery using Aqualase through a 3.2-mm corneal incision. Grade of nucleus, nuclear removal technique, and intraoperative complications were noted. Clinical parameters from postoperative visits were collected. Results Aqualase is capable of removing cataracts up to nuclear sclerosis 2 þ (out of 4) with relative ease. Nuclei graded 2 þ or greater were technically more difficult and conversion to ultrasound phacoemulsification was required in one case. Two posterior capsule ruptures occurred: one during nucleus removal (contact with the tip while aspirating without Aqualase) and one unrelated to Aqualase during aspiration of cortex. Of 25 patients seen on the first postoperative day, 22 had a clear cornea. A total of 96% patients without preoperative comorbidity achieved 6/9 or better postoperatively. One patient had transient postoperative uveitis. Conclusions Removal of softer cataracts with Aqualase has the theoretical advantage over phacoemulsification, by carrying less risk to the posterior capsule, since the handpiece has a smooth polymer tip that has no mechanical motion inside the eye. However, the tip should not be considered entirely capsule-friendly, as rupture is possible with the foot-pedal in position two (aspiration only). Although certain adjustments to the technique are required, the method is similar enough to phacoemulsification to ensure a brief learning curve. With increasingly firm cataracts, Aqualase becomes less effective and ultrasound phacoemulsification is still superior for such cases, in our experience.

Aqualase® Revisited: Endothelial Cell Loss Strongly Depends on Lens Density

“…This is the reason why Aqualase is well suited for refractive lens procedures and pediatric cataracts. Hughes et al [16] mentioned that Aqualase is especially effective in softer cataracts. Zhao et al [17] demonstrated with confocal microscopic evaluation of the cornea that Aqualase is a safe method for cataract extraction.…”

Comparison of central corneal edema and visual recovery between liquefaction and conventional phacoemulsification in soft cataracts

“…In order to reduce endothelial injury, the following alternatives have been developed: viscoelastic substances (12)(13)(14)(15) ; special surgical techniques such as, for example, nuclear prefracture; and new modalities of tip vibration at ultrasonic frequency, such as the White-star ® , Neosonix ® , dynamic rising time and torsional systems (1,2,5,6,(16)(17)(18)(19)(20)(21)(22)(23) . By the year 2000, an alternative technology was proposed for cataracts surgery (5,16,17) .…”

“…By the year 2000, an alternative technology was proposed for cataracts surgery (5,16,17) . This modality, named Aqualase ® , consists in the liquefaction of the lens core by jets of balanced saline solution (BSS) without tip vibration.…”

“…Therefore, the thermal energy release component is eliminated as a causal factor of postoperative corneal edema. This method is assumed to provide for safe and effective emulsification of lenses with cataracts up to grade 2, based on the brunescence criterion of the Lens Opacities Classification System, LOCS II (1,5,16,17) . Some findings suggest that liquefaction could not be a good option for harder cataract nuclei (16,17) .…”

“…Several studies have been performed comparing different surgical techniques and modes of modulating the physical parameters of the phacoemulsifier, with the objective of demonstrating the benefits of reducing conventional phacoemulsification-induced corneal edema, but very few studies have compared the technique of conventional phacoemulsification with liquefaction of the lens core by Aqualase ® (2,3,7,8,11,(15)(16)(17)(18)(19) . The purpose of this study is to assess central corneal edema and visual recovery after cataract surgery performed according to two approaches: conventional phacoemulsification and liquefaction by Aqualase ® .…”