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,

Effect of IOP based infusion system with and without balanced phaco tip on cumulative dissipated energy and estimated fluid usage in comparison to gravity fed infusion in torsional phacoemulsification

Background:To evaluate the effect of three different combinations of tip designs and infusion systems in torsional phacoemulsification(INFINITI and CENTURION)in patients with cataract.According to the manufacturer,two unique improvements in the Centurion are:active fluid dynamic management system and use of an intrepid balanced tip.The study specifically aimed to evaluate the beneficial effects,if any,of change in tip design and infusion system individually and in combination on both per-operative parameters as well as endothelial health over 6 months.Methods:One hundred and twenty six consenting patients of grade 4.0-6.9 senile cataract were randomized into three groups for phacoemulsification:Group A(n=42):Gravity fed infusion system and 45° Kelman miniflared ABS phaco tip;Group B(n=42):intraocular pressure(IOP)based infusion system and 45° Kelman miniflared ABS phaco tip;Group C(n=42):IOP based infusion system and 45° Intrepid balanced phaco tip.The cumulative dissipated energy(CDE),estimated fluid usage(EFU)and total aspiration time(TAT)were compared peroperatively.The endothelial parameters were followed up postoperatively for six months.Results:The three arms were matched for age(p=0.525),gender(p=0.96)and grade of cataract(p=0.177).Group C was associated with significant reductions in CDE(p=0.001),EFU(p<0.0005)as well as TAT(p=0.001)in comparison to the other groups.All three groups had comparable baseline endothelial cell density(p=0.876)and central corneal thickness(p=0.561).On post-operative evaluation,although all groups were comparable till 3 months,by 6 months,the percentage losses in endothelial cell density were significantly lower in group C as compared to the other groups.Conclusions:Use of an IOP based phacoemulsification system in association with use of the Intrepid balanced tip reduces the CDE,EFU and TAT in comparison to a gravity fed system with a mini flared tip or IOP based system with a mini flared tip while also providing better endothelial preservation thus favouring the use of an IOP fed system with a balanced tip.