Torsional and burst mode phacoemulsification for patients with hard nuclear cataract

Abstract

This article aims to evaluate the outcomes of torsional and burst mode phacoemulsification in hard nuclear cataracts. Eighty eyes with grade IV or V nuclear opalescence were treated with phacoemulsification and intraocular lens implantation using conventional mode (Group A, n = 40) or torsional and burst mode phacoemulsification (Group B, n = 40). For good visualization of anterior capsule, trypan blue was injected to the anterior chamber before continuous circular capsulorhexis. The mean cumulative dissipated energy and ultrasound time were recorded. The best-corrected visual acuity, endothelial cell density, and central corneal thickness were measured before and at 1 month after surgery. The cumulative dissipated energy and ultrasound time of Group B were significantly less than that of Group A. The postoperative best-corrected visual acuities of the 2 groups were comparable. At 1 month after surgery, the changes in the endothelial cell density were significantly greater in Group A than in Group B, and the changes in the central corneal thickness were not significantly different between the 2 groups. Torsional and burst mode is a safe and effective surgical method for treating hard cataracts.

Effect of Pulse Mode Phacoemulsification on Corneal Endothelium Using Different Frequencies

“…4,6 Yang et al compared the conventional continuous mode of phaco with torsional and burst combination mode. 10 This study showed that Burst mode reduced the cumulative dissipation of energy during phacoemulsification of hard cataract. Besides, the torsional mode decreased the ultrasonic energy and saved the phaco power.…”

“…Technology advances and the development of various techniques in phaco procedure provide a safe way to operate different types of cataracts with different nuclear hardness. 10 The main goal of these developments is to reduce the ultrasound power delivered in the anterior chamber, which results in protection of endothelial cells and better visual acuity afterward. Phaco power is determined by a frequency which is the speed of needle movement (cycle per second) and stroke length.…”

“Chopper Shield” Technique to Protect Corneal Endothelium During Phacoemulsification Surgery for Rock Hard Cataracts

“…2,3 Various modalities used to minimize ultrasound energy and reduce damage to surrounding ocular structures during phacoemulsification include direct phaco chop, crater and chop, power modulations in the form of torsional, variable pulse and burst modes, and phaco tips with decreased amplitude near the incision. [4][5][6][7][8][9][10][11][12][13] In order to minimize endothelial cell loss associated with mechanical trauma, maneuvers such as endocapsular or deeper plane phacoemulsification of totally separated small nuclear fragments, hypothermic perfusion, employment of fluidics to provide a stable anterior chamber, anterior chamber maintainer, replenishing anterior chamber with ophthalmic viscosurgical device (OVD), and use of femtosecond laser or manual prechopping techniques have been described. 2,4,11,[14][15][16][17] However, these modalities do not ensure the prevention of hard nuclear fragments from coming into physical contact with the corneal endothelium during surgery, thereby causing focal endothelial cell loss and precipitating corneal edema in the early postoperative period.…”

Therapeutic Efficacy of Difluprednate 0.05% Versus Prednisolone Acetate 1% in Controlling Inflammation and Macular Oedema Following Phacoemulsification: An Optical Coherence Tomography-Based Study

“…The latest, safest and most popular cataract extraction technique performed worldwide is phacoemulsification with posterior chamber intraocular lens implantation [ 1 ]. It involves minimal ultrasonic power and surgical tissue manipulation, lesser postoperative inflammation and early visual restoration [ 1 ].…”

“…The latest, safest and most popular cataract extraction technique performed worldwide is phacoemulsification with posterior chamber intraocular lens implantation [ 1 ]. It involves minimal ultrasonic power and surgical tissue manipulation, lesser postoperative inflammation and early visual restoration [ 1 ]. However, the mechanical and ultrasonic energy induces breakdown of the ocular blood-aqueous barrier and thereby can potentially cause inflammation which manifests as conjunctival hyperemia, anterior chamber (AC) reaction, raised intraocular pressure (IOP) and cystoid macular oedema (CME) [ 2 ].…”