Comparison of cumulative dissipated energy between the Infiniti and Centurion phacoemulsification systems

Chen, Ming; Anderson, Erik; Hill, Geoffrey; Chen, John J.; Patrianakos, Thomas

doi:10.2147/opth.s88225

Cited by 47 publications

(49 citation statements)

References 11 publications

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“…For this reason, it would be highly desirable for different phacoemulsification machines to declare tip actual or at least nominal elongation, as the absence of such information makes any comparison impossible. 8,[11][12][13][14][15] In summary, our data demonstrate that actual tip elongation may differ as much as 60% in the absence of a feedback control mechanism that could significantly improve tip elongation accuracy regardless of resistance. Tip elongation consistency improves efficiency by reducing US energy dispersion.…”

Section: Discussionmentioning

confidence: 71%

Testing a Novel Device for Accurate Ultrasound Delivery During Crystalline Lens Phacoemulsification Surgery

Rossi

Saffioti²,

Angelini³

et al. 2020

Trans. Vis. Sci. Tech.

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To assess whether the use of a patented, novel feedback device intended to accurately control phacoemulsification tip elongation is effective under varying machine settings and material resistance. Methods: Sculpt mode phaco (550-mm Hg Venturi pump; elongations, 35 and 70 μm) and quadrant settings (550-mm Hg Venturi pump; elongations, 15, 30, and 60 μm) were used in agar gel of incremental density (1%, 2%, 3%, and 6% in demineralized water). Dispersed lens fragments were also simulated with 6% agar gel spherules (2-5 mm in diameter; 550-mm Hg vacuum, and 60-μm elongation). Actual phaco tip elongation was measured on voltage readings from the piezoelectric crystals and compared to nominal elongation with feedback control off and on. Results: Mismatch between nominal and actual elongation when feedback control was off in sculpt mode varied between-13.51 μm and-23.07 μm of nominal elongation; in quadrant mode, mismatch varied between-2.79 μm and-20.41 μm. When the feedback control system was switched on, mismatch varied between-0.02 μm and +0.43 μm (P < 0.001 for all matchings). When the feedback system was off, the elongation mismatch among the 1%, 3%, and 6% agar was also statistically significant (P < 0.001). Elongation was 44.72 ± 4.16 μm with feedback control off and 60.02 ± 1.63 μm with it on (nominal elongation 60 μm; P < 0.001) when emulsifying agar 6% gel fragments. Dispersion of elongation data was also significantly wider when feedback control was turned off. Conclusions: A novel feedback control system effectively controls elongation accuracy regardless of the resistance offered by incremental agar gel concentrations. Translational Relevance: Implementing feedback control in phaco handpieces dramatically improves surgical accuracy. The translational value of this research relies on its immediate applicability to routine cataract surgery, resulting in a more appropriate use of ultrasound energy.

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Section: Discussionmentioning

confidence: 71%

Testing a Novel Device for Accurate Ultrasound Delivery During Crystalline Lens Phacoemulsification Surgery

Rossi

Saffioti²,

Angelini³

et al. 2020

Trans. Vis. Sci. Tech.

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“…An attempt was made to use more stable modalities like an air pump or pressurised irrigation bottle with gas with some benefits. However, as the gas infusion pressure does not necessarily vary in response to the changing aspiration flow rate, the effect is the same as raising the bottle height [ 4 , 11 ]. More recent machines maintain IOP by using a compliant irrigation bag, which is squeezed in response to the aspiration flow rate and estimated incision leakage.…”

Section: Discussionmentioning

confidence: 99%

“…More recent machines maintain IOP by using a compliant irrigation bag, which is squeezed in response to the aspiration flow rate and estimated incision leakage. Centurion uses an Active Fluidics Technology as compared to a gravity fed infusion system in the Infiniti [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…When Centurion was launched by Alcon, the company claimed dramatic reduction of cumulative dissipated energy (CDE) in comparison to the earlier Infiniti; the claims have been verified by some independent studies [ 4 ]. The balanced tip in the Centurion has been shown to lead to lower CDE, however, a major difference also lies in the infusion system of the two platforms [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Effect of IOP based infusion system with and without balanced phaco tip on cumulative dissipated energy and estimated fluid usage in comparison to gravity fed infusion in torsional phacoemulsification

et al. 2017

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BackgroundTo evaluate the effect of three different combinations of tip designs and infusion systems in torsional phacoemulsification (INFINITI and CENTURION) in patients with cataract. According to the manufacturer, two unique improvements in the Centurion are: active fluid dynamic management system and use of an intrepid balanced tip. The study specifically aimed to evaluate the beneficial effects, if any, of change in tip design and infusion system individually and in combination on both per-operative parameters as well as endothelial health over 6 months.MethodsOne hundred and twenty six consenting patients of grade 4.0–6.9 senile cataract were randomized into three groups for phacoemulsification: Group A (n = 42): Gravity fed infusion system and 450 Kelman miniflared ABS phaco tip; Group B (n = 42): intraocular pressure (IOP) based infusion system and 450 Kelman miniflared ABS phaco tip; Group C (n = 42): IOP based infusion system and 450 Intrepid balanced phaco tip. The cumulative dissipated energy (CDE), estimated fluid usage (EFU) and total aspiration time (TAT) were compared peroperatively. The endothelial parameters were followed up postoperatively for six months.ResultsThe three arms were matched for age (p = 0.525), gender (p = 0.96) and grade of cataract (p = 0.177). Group C was associated with significant reductions in CDE (p = 0.001), EFU (p < 0.0005) as well as TAT (p = 0.001) in comparison to the other groups. All three groups had comparable baseline endothelial cell density (p = 0.876) and central corneal thickness (p = 0.561). On post-operative evaluation, although all groups were comparable till 3 months, by 6 months, the percentage losses in endothelial cell density were significantly lower in group C as compared to the other groups.ConclusionsUse of an IOP based phacoemulsification system in association with use of the Intrepid balanced tip reduces the CDE, EFU and TAT in comparison to a gravity fed system with a mini flared tip or IOP based system with a mini flared tip while also providing better endothelial preservation thus favouring the use of an IOP fed system with a balanced tip.Trial registrationTrial registration No.: CTRI/2016/06/007022.

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“…der kumulativen Energie. Der geringere Flüssigkeitsverbrauch soll auch das Endothel schützen [3,4]. Beim Ver- gleich der unterschiedlichen Phakohandgriffspitzen Kelman Tipp und Balanced Tipp konnte bei der mikrokoaxialen torsionalen Phakoemulsifikation kein Unterschied im Endothelzellverlust gezeigt werden [15], jedoch wurde die gleiche Flüssigkeitssteuerung verwendet und nicht auf den Unterschied der aktiven und der standardisierten Flüssigkeitssteuerung eingegangen.…”

Section: Diskussionunclassified

Effektivität und Sicherheit eines modifizierten Tipdesigns bei der torsionalen Phakoemulsifikation

Schmidt¹,

Hubich²,

Vetter³

et al. 2018

Klin Monatsbl Augenheilkd

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Compared to torsional phacoemulsification with a mini-flared Kelman Tip and gravity fluidics, torsional phacoemulsification with a modified tip design and active fluidics is 38% more effective regarding the cumulative dissipated energy. Endothelial cell loss occurs to a similar extend using both systems. The postoperative changes in cell size (polymegathism), number of hexagonal cells (pleomorphism) and corneal thickness (pachymetry) were similar among both systems. We conclude, that the intraoperative stress on the endothelium is equivalent with both systems used.

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Comparison of cumulative dissipated energy between the Infiniti and Centurion phacoemulsification systems

Cited by 47 publications

References 11 publications

Testing a Novel Device for Accurate Ultrasound Delivery During Crystalline Lens Phacoemulsification Surgery

Testing a Novel Device for Accurate Ultrasound Delivery During Crystalline Lens Phacoemulsification Surgery

Effect of IOP based infusion system with and without balanced phaco tip on cumulative dissipated energy and estimated fluid usage in comparison to gravity fed infusion in torsional phacoemulsification

Effektivität und Sicherheit eines modifizierten Tipdesigns bei der torsionalen Phakoemulsifikation

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