Tip Position during Phaco

Coelho, Roberto Pinto; Raskin, Eduardo; Paula, Jayter Silva; Cruz, Antônio Augusto Velasco e

doi:10.1016/j.ophtha.2008.06.010

Cited by 4 publications

(3 citation statements)

References 5 publications

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“…We used the bevel-down orientation, which in our opinionrepresented in a coherent endothelial cell layercould result in a more homogenous energy distribution towards the endothelium, whereas bevel-up orientation, emitting energy directly towards the endothelium, is more likely to cause uneven and rather localized ECL (Raskin et al 2010;Rouhbakhshzaeri et al 2018). Current literature is not completely congruent on this aspect and ongoing investigations are further addressing this issue (Frohn et al 2002;Coelho et al 2005;Raskin et al 2010;Faramarzi et al 2011;Kaup et al 2016). Furthermore, the correct anatomical structures and proportions are essential for a reliable ex vivo model to correctly respect fluidics and energy distribution during phacoemulsification.…”

Section: Discussionmentioning

confidence: 98%

Effects of ultrasound energy on the porcine corneal endothelium – Establishment of a phacoemulsification damage model

Kunzmann

Wenzel

Bartz‐Schmidt

et al. 2019

Acta Ophthalmologica

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Purpose The purpose of this study was to establish a standardized in vitro phacoemulsification damage model for future investigations of the effects of phacoemulsification, surgical devices, protective ophthalmic viscoelastic devices (OVDs), irrigation solutions and other aspects related to cataract phacoemulsification surgery on the corneal endothelium using porcine eyes. Methods Thirty‐four porcine eyes were randomly assigned to three groups (phacoemulsification (n = 13), irrigation (n = 9), control (n = 12)). A total of 5 min of ultrasound energy with intermittent irrigation/aspiration was applied in the eyes of the phacoemulsification group. The eyes of the irrigation group received the identical treatment, but without the application of ultrasound energy. The control group was left untreated. All eyes were then prepared to split corneal buttons followed by 15 days of cultivation. Endothelial cell density (ECD) was assessed blinded on day 15. Results Endothelial cell density declined significantly more until day 15 in the phacoemulsification group (2567 ± 317/267 cells/mm² (median ± 25%/75%‐quartiles), −32.5 ± 7.0/6.4%) compared to the irrigation (3450 ± 350/383 cells/mm², −11.8 ± 5.3/2.6%; p < 0.001) and the control group (3650 ± 288/258 cells/mm², −10.2 ± 3.2/4.6%; p < 0.001). Conclusion The phacoemulsification damage model presented in this study is sensitive to phacoemulsification energy and may reliably be used to investigate various factors involved in phacoemulsification with regard to their influence on corneal endothelial cells. This method is able to replace animal experiments or in vitro cell culture experiments that often do not translate well to the in vivo situation in humans.

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Section: Discussionmentioning

confidence: 98%

Effects of ultrasound energy on the porcine corneal endothelium – Establishment of a phacoemulsification damage model

Kunzmann

Wenzel

Bartz‐Schmidt

et al. 2019

Acta Ophthalmologica

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“…The ultrasound tip was positioned with the bevel facing down to reduce effects of cavitation and minimize turbulence, which may help protect the endothelium and contribute to low ECL. 34 The irrigation ports were oriented to the side of the ultrasound tip and vacuum was engaged when ultrasound power was delivered ( Figure 7 ), improving efficiency of the phacoemulsification procedure and optimizing the use of ultrasound energy. The combination of FLACS and Centurion that resulted in small fragmentation size (200 µm) facilitated easier aspiration of the lens and could have also contributed to the reduction of CDE and ECL.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Femtosecond Laser-Assisted Cataract Surgery and Conventional Phacoemulsification on Endothelial Cell Density When Using Torsional Modality

Oka¹,

Sasaki²,

Injev³

2021

OPTH

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Purpose: To compare the effects of femtosecond laser assisted cataract surgery (FLACS) and manual phacoemulsification on cumulative dissipated energy (CDE), torsional amplitude, and endothelial cell density (ECD). Patients and Methods: This prospective, randomized study was conducted at Oka Eye Clinic (Fukuoka, Japan). Surgeries were performed using FLACS (with LenSx) or conventional technique in adults ≥20 years with grade 2-4 cataracts. Visits included preoperative, surgery day, and 5 postoperative visits (days 1, 4-10, 20-40, 60-120, and 150-210). Primary endpoint was CDE. Secondary endpoints included ECD percent change at day 150-210 versus preoperative visit and average torsional amplitude on surgery day. Exploratory endpoints included central corneal thickness and corrected distance visual acuity (CDVA). Superiority of FLACS to conventional technique was evaluated using t-tests based on a mixed model for repeated measures. Results: Full analysis set included 53 eyes per group. Mean cataract grade was 2.92±0.58 in FLACS and 2.94±0.57 in conventional group. FLACS versus conventional method had significantly lower mean CDE (0.213±0.334 versus 1.718±0.898%-seconds, respectively; P<0.0001), demonstrating superiority of FLACS. Low endothelial cell loss (ECL) was achieved with both FLACS and conventional methods (1.5±5.6% and 2.7±5.2%; P=0.260). Torsional amplitude was significantly lower for FLACS versus conventional method (19.6 ±16.0% versus 31.1±6.6%; P<0.0001). Central corneal thickness was comparable for both methods at all visits except day 1; CDVA was comparable for both methods at all postoperative visits. Conclusion: FLACS achieved significantly lower CDE compared with the conventional surgical method (P<0.0001). Low ECL was achieved with both FLACS (1.5%) and conventional (2.7%) methods.

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“…Several studies have also examined the impact of bevel tip position on clinical outcomes, with some conflicting results on whether ECC loss is greater in the bevel-up or bevel-down position [31,32]. More studies are needed to definitively determine the settings in which bevel-up versus bevel-down are favorable.…”

Section: Tip Selection and Positioningmentioning

confidence: 99%

Efficient use of ultrasound in cataract surgery

Chung

Afshari

2021

Current Opinion in Ophthalmology

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Purpose of reviewModern phacoemulsification machines apply ultrasound through a variety of settings and parameters to remove a cataract. Using these new technologies efficiently is critical for both reducing surgical times and improving postoperative outcomes. The present article reviews recent findings in phacodynamics to explore the optimum use of ultrasound in cataract surgery. Recent findingsIn studies seeking to determine the optimum parameters in both fluidics and power, increased power and aspiration does not necessarily equate to more efficiency. New developments, such as torsional ultrasound, micropulse, and burst mode have shown increased efficiency in randomized control trials and in-vitro compared with conventional ultrasound. Regarding vacuums, the venturi pump has demonstrated greater efficiency compared with the peristaltic pump. We also explore other parameters, such as chamber pressure and tip selection. Meta-analyses on femtosecond-laser assisted cataract surgery (FLACS) have shown similar long-term visual outcomes compared to conventional cataract surgery.

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Tip Position during Phaco

Cited by 4 publications

References 5 publications

Effects of ultrasound energy on the porcine corneal endothelium – Establishment of a phacoemulsification damage model

Effects of ultrasound energy on the porcine corneal endothelium – Establishment of a phacoemulsification damage model

Comparison of Femtosecond Laser-Assisted Cataract Surgery and Conventional Phacoemulsification on Endothelial Cell Density When Using Torsional Modality

Efficient use of ultrasound in cataract surgery

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