Corneal endothelial cell loss during phacoemulsification: Bevel-up versus bevel-down phaco tip

Abstract

No author has a financial or proprietary interest in any material or method mentioned.

Subconjunctival and topical application of recombinant tissue plasminogen activator in rabbits

“…Preoperative parameters include older age, constricted pupil, firmness of the nucleus, and shorter axial length (AL) (1)(2) . Intraoperative factors include the incision size and design, Descemet membrane detachment, toxic intraoperative medications, phacoemulsification technique, and the type of ophthalmic viscosurgical device (OVD) used (1)(2)(3)(4) .…”

“…presence of air bubbles, release of free radicals), low surgeon experience, and postoperative inflammation (3)(4)(5)(6) . To reduce the energy applied, aspects related to the phacoemulsifier such as ultrasound modes, special tips, microprocessors, and high-vacuum systems must be considered.…”

“…Several new phacoemulsification strategies and new devices were developed to preserve the corneal endothelium by attenuating the deleterious effects of US (8) . Some surgeons have attempted to alleviate the corneal load by varying the position of the phacoemulsification tip (4,9) . The purpose of this study was to compare intraoperative and clinical parameters using the mini-flared 45-degree Kelman tip (Alcon Laboratories, Inc.), the reversed mini-flared 30-degree Kelman tip (Alcon Laboratories, Inc.), and the Sidewinder 45-degree Kelman tip (Mastel Precision Surgical, Inc.).…”

Bevel tip position and corneal damage during phacoemulsification

“…Recently, Faramarzi et al 1 reported on bevel-up versus bevel-down phaco tip during phacoemulsification. We disagree with the authors that it was the first study to consider this subject.…”

“…Using the stop-and-chop technique, Faramarzi et al 1 concluded that better occlusion of the phaco tip with the bevel-down position and fear of posterior capsule damage may force placement of the phaco tip close to the posterior surface of the cornea, leading to endothelial cell damage. We used the phaco chop technique 5 and concluded that the bevel-down tip position had fewer negative effects on the corneal endothelium and facilitated attachment of the lens fragments.…”