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.

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,

Retrospective Analysis of the Performance of a New-Generation Dual Pump Phaco System Using Two Sizes of Phaco Tips in Cases with Different Nuclear Hardness

Purpose: To evaluate the performance of a phacoemulsification system in terms of effective (EPT) and total phaco time (TPT) using 20G and 21G phaco tips. Methods: Retrospective comparative study including 143 consecutive cataractous eyes undergoing phacoemulsification cataract surgery with the Visalis 500 device. The 20G and 21G phaco tips were used in 46 and 97 eyes, respectively. The EPT and TPT values were evaluated. Results: Median TPT was 11.25 s and 17.50 s in the 20G and 21G groups, respectively (p = 0.0011). Median EPT values were 3.15 s and 5.00 s in the 20G and 21G groups, respectively (p = 0.0032). TPT and EPT were significantly lower in 3/3+ cataract eyes compared to 4/4+ using both tips (p < 0.001). Conclusions: The Visalis 500 allows cataract surgery with reduced TPT and EPT, even in hard cataracts. The use of the 20G phaco tip provides an additional benefit in terms of reduction of phaco time.

新型超声乳化探头Micro Tip的临床应用

目的探讨超声乳化白内障手术达到对眼球仅仅是微损伤的手术方法。方法应用新型超声乳化探头Ｍｉｃｒｏ Ｔｉｐ对９８例Ⅳ级核以上的白内障患者进行超声乳化白内障手术，采用高负压低能量的参数，观察其对眼部的损伤情况。结果术后裸眼视力均在０．５以上，２８．６％达１．０以上。无术中并发症。术后仅２例（２％）发现轻度角膜水肿，且均在１周内吸收。结论使用ＭｉｃｒｏＴｉｐ的新型探头，有利于减少超声乳化手术对眼内组织的损伤。

超声乳化针头影响白内障超声乳化吸出术效率和安全性的研究进展

白内障超声乳化吸出术以其手术切口小、时间短和术后散光小、视力恢复良好等诸多优点受到白内障手术医师的青睐,但是超声能量在碎核的同时对眼内组织可造成一定的损伤。超声乳化针头全堵时超声能量使用效率最高,而全堵解除后产生前房涌动易损伤角膜内皮和晶状体后囊膜,核块脱落可延长手术时间。超声乳化针头的物理特性在一定程度上影响着超声能量和抽吸作用,其良好设计和轻微改进可以明显提高手术的效率和安全性。现就超声乳化针头对白内障超声乳化吸出术效率和安全性的影响做一简要综述。

比较21G弯头和直头在横向劈核微切口同轴超声乳化手术中的应用(英文)

目的:比较在微切口同轴扭动超声乳化使用直头和弯头的术中表现和术后结果。方法:白内障患者行2.2mm横向劈核微切口同轴超声乳化术中使用30°直头或弯头进行治疗。术中检查分析包括平均超声功率,总超声乳化时间,有效的超声乳化时间。使用非接触镜显微镜评估术前和术后1d,7d和30d的中央内皮细胞密度和角膜中央厚度。结果:此研究共纳入白内障患者190例190眼,95眼为弯头组,95眼为直头组。术中检查显示弯头组总超声乳化时间和有效的超声乳化时间较直头组显著降低(P<0.05)。弯头组总超声乳化时间和有效的超声乳化时间中位数分别为25.9(13.5-45.0)s(四分位间距)和18.0(9.0-30.0)s,直头组分别为38.8(16.5-73.5)s和26.0(11.0-49.0)s。结论:横向劈核微切口同轴超声乳化术中,相比较直头,使用弯头可以更加有效的摘除晶体,在所有阶段中除了第四阶段,总超声乳化时间和有效的超声乳化时间更短。

圆钝超声乳化针头在白内障超声乳化吸除术中的应用

目的探讨圆钝超声乳化针头在白内障超声乳化吸除术中对手术效率和安全性的影响。设计前瞻性队列研究。研究对象2014年10月至2015年12月在郑州大学第二附属医院诊断为年龄相关性白内障并行白内障超声乳化吸除术的患者342例(406眼)。方法根据Emery核硬度分级标准将术眼分为非硬核组(Ⅲ级及以下)和硬核组(Ⅳ级及以上),两组术眼分别随机分为圆钝针头组(圆钝超声乳化针头)和锋利针头组(锋利超声乳化针头),并使用相应超声乳化针头进行手术。主要指标手术总时间、平均超声能量、累积超声时间、有效超声时间、后囊膜破裂率及术后第1天较术前中央角膜厚度增加量。结果非硬核组及硬核组中,两超声乳化针头组的患者年龄、性别等基本信息均无统计学差异(P均>0.05)。非硬核组中,两超声乳化针头组术中各项指标均无统计学差异(P均>0.05)。硬核组中,圆钝针头组较锋利针头组使用更多的平均超声能量(42.2%±5.1%、38.9%±6.4%,P=0.004)及有效超声时间(15.53 s±3.47 s、13.34 s±3.18 s,P=0.001),其余术中指标均无统计学差异(P均>0.05)。总体后囊膜破裂率为4.18%,非硬核组和硬核组分别为3.79%、5.17%。非硬核组中圆钝针头组的后囊破裂率(1.42%)明显小于锋利针头组(6.52%)(P=0.035),硬核组中圆钝针头组的后囊破裂率(1.78%)亦小于锋利针头组(9.26%),但差异无统计学意义(P=0.225)。非硬核组中两超声乳化针头组中央角膜厚度增加量无统计学差异(78.5μm±50.6μm,71.6μm±53.3μm,P=0.263),硬核组中圆钝针头组中央角膜厚度增加量(220.8μm±36.3μm)大于锋利针头组(198.4μm±53.1μm)(P=0.011)。结论圆钝超声乳化针头在白内障超声乳化吸除术中可减少后囊破裂的发生,但对硬核者增加了超声能量和有效超声时间。