Comparison of 45- degree Kelman and 45- degree balanced phaco tip designs in torsional microcoaxial phacoemulsification

AIMTo compare the intraoperative performance and postoperative outcome after microcoaxial torsional phacoemulsification using either a Kelman or balanced phaco tip.METHODSCataracts were treated using 2.2 mm microcoaxial torsional phacoemulsification using either a 45-degree mini-flared Kelman® or a 45-degree Intrepid® Balanced phaco tip. Intraoperative measurements included total ultrasound (US) time, cumulative dissipated energy (CDE), torsional US time, and balanced salt solution (BSS) use. The central endothelial cell density (ECD) and central corneal thickness (CCT) were evaluated preoperatively and postoperatively 1, 7, and 30d after surgery using noncontact specular microscopy.RESULTSThe 116 enrolled eyes (116 patients) were divided equally between the Kelman and balanced tip groups. Intraoperative measurements showed significantly less total US time, torsional US time, CDE, and BSS use in the balanced group than in Kelman group (P<0.05). The total US time, torsional US time, CDE, and BSS use were 17.45±14.53s, 16.63±13.97s, 6.38±5.26, and 48.21±17.21 mL in the Kelman group and 11.39 ± 9.60s, 10.90 ± 9.25s, 4.04 ± 3.42, and 41.36 ± 12.70 mL in the balanced group, respectively.CONCLUSIONTorsional phacoemulsification performed with a balanced tip provided more effective lens removal with less total US time, torsional time, CDE, and BSS use, as well as similar changes in ECD with a Kelman tip in all cataract grades. This special designed phaco tip for torsional phacoemulsification provides an alternative phaco tip for many surgeons' preference with straight phaco tip.

An evaluation of intraoperative and postoperative outcomes of torsional mode versus longitudinal ultrasound mode phacoemulsification:a Meta-analysis

AIM： To evaluate and compare the intraoperative parameters and postoperative outcomes of torsional mode and longitudinal mode of phacoemulsification. METHODS： Pertinent studies were identified by a computerized MEDLINE search from January 2002 to September 2013. The Meta-anaiysis is composed of two parts. In the first part the intraoperative parameters were considered： ultrasound time （UST） and cumulative dissipated energy （CDE）. The intraoperative values were also distinctly considered for two categories （moderate and hard cataract group） depending on the nuclear opacity grade. In the second part of the study the postoperative outcomes as the best corrected visual acuity （BCVA） and the endothelial cell loss （ECL） were taken in consideration. RESULTS： The UST and CDE values proved statistically significant in support of torsional mode for both moderate and hard cataract group. The analysis of BCVA did not present statistically significant difference between the two surgical modalities. The ECL count was statistically significant in support of torsional mode （P〈0.001）. CONCLUSION： The Meta -analysis shows the superiority of the torsional mode for intraoperative parameters （UST, CDE） and postoperative ECL outcomes.

Effect of torsional mode phacoemulsification on cornea in eyes with/without pseudoexfoliation

AIM: To evaluate the effect of torsional mode phacoemulsification on central corneal thickness, corneal endothelial cell density, and morphology in eyes with/without pseudoexfoliation(PEX) syndrome.METHODS: Fourty-two consecutive patients with and42 patients without PEX as a control group scheduled for cataract surgery was studied. Phacoemulsification, using OZi L IP system, was performed with quick chop technique. Using noncontact specular microscopy, the central endothelial cell density(ECD), coefficient of variation, percentage of hexagonal cells, and the central corneal thickness(CCT) were evaluated preoperatively and postoperatively at 1, 7 and 30 d.RESULTS: The ECD in PEX syndrome was statistically significantly lower than that in the control group preoperatively and postoperatively(P ≤0.001).Percentage change in ECD was statistically significantly higher in PEX than that in control group after surgery follow up(P ≤0.04).There was no statistically significant difference between both groups comparing percentage of hexagonal cells and coefficient of variation in the cell size before and after the surgery. At 1 and 7d after surgery, percentage change in CCT was statistically significantly higher in PEX group than that in the control group(P ≤0.041).CONCLUSION: Although torsional mode phacoemulsification and intraocular lens(IOL) implantation provided a safe and favorable surgical outcome in patients with/without PEX, torsional phacoemulsification led to significantly higher ECD loss in the PEX group than that in the control group during the whole follow up period.In addition, more corneal swelling in the PEX group than that in the control group during the early postoperative period has indicated that the corneal endothelium, in presence of PEX endotheliopathy, seems to be more susceptible to the effects of phacoemulsification surgeryin eyes with PEX. The increased risk of anterior chamber manipulations in patients with PEX should be taken into account for an increased risk of bullous keratopathy.

Comment on ＂Comparison of 45-degree Kelman and 45-degree balanced phaco tip designs in torsional microcoaxial phacoemulsification＂

Dear Editor,We read with interest the article ＂Comparison of 45-degree Kelman and 45-degree balanced phaco tip designs in torsional microcoaxial phacoemulsification＂ by Demircan et al. The authors describe the intraoperative and post-operative outcomes of phacoemulsification in terms of cumulative dissipated energy （CDE）, total ultrasound （US） time, torsional US time, total fluid use, percentage change in central corneal thickness and endothelial cell count in the two groups. A comparative evaluation has been made between the two groups involving the Kelman mini-flared tip and the Intrepid balanced phaco tip using the Infiniti Ozil IP Vision system （Alton Laboratories Inc., Fort Worth, TX, USA） as hasbeen explicitly mentioned in the article under the ＂Methods＂ section. However,