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Journal ArticleDOI

Impact of intelligent phacoemulsification software on torsional phacoemulsification surgery

12 Sep 2012-Clinical Ophthalmology (Dove Press)-Vol. 6, pp 1493-1498

AbstractBACKGROUND The purpose of this study was to compare phacoemulsification energy parameters during torsional phacoemulsification with or without the use of intelligent phacoemulsification (IP) software. METHODS One hundred and twenty-eight eyes with nuclear grades ranging from 1 to 5 were enrolled in this randomized prospective study. Operated eyes were divided into two groups, ie, those operated on using IP software (Group 1, n = 67) and those operated on without IP software (Group 2, n = 61). The two groups were compared in terms of ultrasound energy level, ultrasound energy time, aspiration time, and amount of fluid used during surgery. RESULTS Operated eyes were further grouped according to soft (grade 1 and 2, n = 37), medium (grade 3, n = 46), and hard (grade 4 and 5, n = 31) nuclear densities. Both the study and the control groups were similar in distribution of nuclear density (P > 0.05). Cumulative dissipated energy was measured as 14.06 ± 9.92 in Group 1 and 14.22 ± 10.99 in Group 2 (P = 0.92). Total ultrasound time was 49 seconds in Group 1 and 52 seconds in Group 2 (P = 0.58). Although the torsional amplitude used was similar (P = 0.86) when IP was either on (71%) or off (68.4%), aspiration time was found to be 4 minutes 17 seconds in Group 1 (P = 0.86) and 5 minutes and 17 seconds in Group 2 (P = 0.007). Total fluid used was measured as 91 cc (P = 0.86) in Group 1 and 109 cc (P = 0.02) in Group 2. CONCLUSION The new IP software did not cause a difference in ultrasound energy levels. However, the new software was found to be advantageous in regards to fluid use and aspiration time.

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Journal ArticleDOI
01 May 2019-Medicine
TL;DR: Torsional and burst mode is a safe and effective surgical method for treating hard cataracts and the postoperative best-corrected visual acuities of the 2 groups were comparable.
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.

3 citations


Journal ArticleDOI
01 Jan 2017
TL;DR: Compared to the Infiniti with IP mode, cataract surgery with the Centurion without IP mode is likely to be performed with less phacoemulsification energy and higher efficiency.
Abstract: Purpose: To compare the efficiency and safety of two phacoemulsification systems, the Infiniti with intelligent phacoemulsification (IP) and the Centurion without IP, in terms of intraoperative metrics of phacoemulsification and the occurrences of adverse events and intraoperative tip obstruction. Design: Comparative case series. Methods: A consecutive series of 340 eyes (151 eyes with the Infiniti, 189 eyes with the Centurion) was evaluated. A 2.4 mm sclerocorneal incision was used with the Infiniti, and a 2.0 mm incision was used with the Centurion. Phacoemulsification of the nucleus was performed using the phaco chop technique, with the IP function of the Infiniti turned on and the IP mode of the Centurion turned off. From among the parameters displayed on the panels of both devices, ultrasound (US) time, cumulative dissipated energy (CDE), aspiration time, and estimated balanced salt solution (BSS) aspiration volume were investigated and compared between the devices. Results: A comparison of all subjects found significant differences between the two devices in mean CDE (p=0.02) and mean aspiration time (p=0.003), but not in mean US time (p=0.43) or mean estimated BSS aspiration volume (p=0.07). For grade 3 nuclei, all parameters of mean US time (p=0.0044), mean CDE (p ≤ 0.001), mean aspiration time (p<0.001), and mean estimated BSS aspiration volume (p=0.001) showed significant differences favoring the Centurion. Conclusions: Compared to the Infiniti with IP mode, cataract surgery with the Centurion without IP mode is likely to be performed with less phacoemulsification energy and higher efficiency.

Cites background or methods from "Impact of intelligent phacoemulsifi..."

  • ...If the nucleus was too soft to split, it was graded 1 or 2, if it could be split easily, it was graded 3, and if it was so hard that the base did not split, it was graded 4 or 5 [7]....

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  • ...However, fragments of nucleus sometimes became clogged inside the phaco tip [5,7] Then, the Ozil® Intelligent Phaco (IP) software was added to the Infiniti in 2009 [5]....

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References
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Journal ArticleDOI
Yizhi Liu1, M. Zeng1, Xialin Liu1, Lixia Luo1, Zhaohui Yuan1, Yuanlin Xia1, Yangfa Zeng1 
TL;DR: The torsional mode may provide more effective lens removal with a lower level of phacoemulsification time and energy.
Abstract: Purpose To compare the intraoperative and short-term postoperative outcomes of cataract surgery performed with torsional mode and conventional ultrasound mode using the Infiniti Vision System (Alcon Laboratories). Setting Cataract Service, Zhongshan Ophthalmic Center, Sun-Yat-Sen University, Guangzhou, China. Methods In this randomized comparative study, 525 eyes were assigned to phacoemulsification by torsional mode or conventional ultrasound (US) mode. The surgery was performed by an experienced surgeon, and the outcomes were evaluated by an examiner who was masked to treatment assignments. Primary outcome measures were US time (UST), cumulative dissipated energy (CDE), and surgical complications. Patients were seen 1, 7, and 30 days after surgery. Postoperative outcome measures were the final best corrected visual acuity (BCVA) and the change in corneal clarity, central corneal thickness (CCT), and endothelial cell count. Results The US group had 262 eyes and the torsional group, 263 eyes. All patients completed the follow-up visits. In the eyes with nucleus density grades of 1, 2, 3, and 4, the mean UST was 10.25 seconds ± 7.4 (SD), 25.14 ± 5.5 seconds, 36.45 ± 8.3 seconds, and 61.44 ± 17.8, respectively, in the US group and 8.32 ± 6.8 seconds, 18.45 ± 7.2 seconds, 29.48 ± 12.4 seconds, and 48.39 ± 20.3 seconds, respectively, in the torsional group ( P P P P >.01). At 1 day and 7 days, the mean CCT was 625 ± 80 μm and 568 ± 37 μm, respectively, in the US group and 601 ± 35 μm and 559 ± 40 μm, respectively, in the torsional group ( P P >.01). At 7 days and 30 days, the mean central corneal endothelial cell count was 2135 ± 858 cells/mm 2 and 2084 ± 527 cells/mm 2 , respectively, in the US group and 2004 ± 656 cells/mm 2 and 1953 ± 615 cells/mm 2 , respectively, in the torsional group ( P Conclusion The torsional mode may provide more effective lens removal with a lower level of phacoemulsification time and energy.

161 citations


Journal ArticleDOI
TL;DR: Torsional phacoemulsification was more effective than longitudinal phacoEmulsification in the amount of applied fluid and the quantity of US energy expended and with the torsional method, it was possible to maintain a constant ratio of amount of fluid flow to quantity ofUS energy used, regardless of nucleus density.
Abstract: Purpose To compare phacoemulsification parameters of torsional and longitudinal ultrasound modes. Setting Ophthalmology Department, Military Health Service Institute, Warsaw, Poland. Methods This prospective study evaluated eyes 1, 7, and 30 days after phacoemulsification with an Infiniti Vision System using the torsional or longitudinal ultrasound (US) mode. Cataract classification was according to the Lens Opacities Classification System II. Nucleus fragmentation was by the phaco-chop and quick-chop methods. Primary outcome measures were phaco time, mean phaco power, mean torsional amplitude, and aspiration time. Total energy, defined as cumulative dissipated energy (CDE) × aspiration time, and the effective coefficient, defined as aspiration time/phaco time, were also calculated. Results Four hundred eyes were evaluated. The CDE was statistically significantly lower in the torsional mode for nucleus grades I, II, and III (P .05). Aspiration time was statistically significantly shorter in the torsional mode than in the longitudinal mode for nucleus grades III and IV (P Conclusions Torsional phacoemulsification was more effective than longitudinal phacoemulsification in the amount of applied fluid and the quantity of US energy expended. With the torsional method, it was possible to maintain a constant ratio of amount of fluid flow to quantity of US energy used, regardless of nucleus density.

56 citations


Journal ArticleDOI
TL;DR: Torsional phacoemulsification using an angled tip required less surgeon‐generated tip travel and less time, suggesting that nuclear material may be more efficiently approximated to and aspirated through the tip aperture throughout the phacoemsulsification process.
Abstract: Purpose To compare surgeon-generated tip travel and surgical time of longitudinal and torsional phacoemulsification with straight and angled tips. Setting Private practice, Marshalltown, Iowa, USA. Method The study analyzed surgical videos of 46 phacoemulsification cases performed by 1 surgeon. Based on the tip and type of ultrasound (US) used, the cases were prospectively assigned to 1 of 4 groups and operated on consecutively: straight tip/longitudinal US, straight tip/torsional US, angled tip/longitudinal US, and angled tip/torsional US. Digital Video Measurement System software (Caltex Scientific) was used to measure the phacoemulsification tip's travel during the removal of all 4 nuclear quadrants and the removal of quadrants 2 and 3 (2+3) and to determine surgical time. The cumulative travel distance and surgical time of the 4 groups were compared using analysis of variance. Results The angled tip/torsional US combination reduced tip travel by more than 40% compared with the straight tip/longitudinal US when comparing travel to aspirate all 4 quadrants and quadrants 2+3. Surgical time in the removal of all 4 quadrants and quadrants 2+3 was significantly lower in the angled tip/torsional US group than in the other groups. Conclusions Torsional phacoemulsification using an angled tip required less surgeon-generated tip travel and less time, suggesting that nuclear material may be more efficiently approximated to and aspirated through the tip aperture throughout the phacoemulsification process. Shorter cumulative tip travel and less procedure time imply increased nuclear followability, fewer reacquisition movements, and increased phacoemulsification efficiency and safety.

53 citations


"Impact of intelligent phacoemulsifi..." refers background in this paper

  • ...The use of curved Kelman phaco tips are reported to provide an advantage in torsional phaco surgery.(4) However, in hard cataracts, curved tips may have a tendency to be blocked during the surgery....

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Journal ArticleDOI
TL;DR: The torsional mode was as safe as the longitudinal mode in phacoemulsification for age‐related cataract as well as conventional longitudinal mode, according to Conference on Harmonisation‐E9 Guidelines.
Abstract: Purpose To compare the intraoperative and postoperative outcomes of conventional longitudinal phacoemulsification and torsional phacoemulsification. Setting Department of Ophthalmology, University of Leipzig, Germany. Design Randomized single-center clinical trial. Methods Eyes with senile cataract were randomized to have phacoemulsification using the Infiniti Vision System and the torsional mode (OZil) or conventional longitudinal mode. Primary outcomes were corrected distance visual acuity (CDVA) and central endothelial cell density (ECD), calculated according to the Conference on Harmonisation-E9 Guidelines in which missing values were substituted by the median in each group (primary analysis) and the loss was then calculated using actual data (secondary analysis). Secondary outcomes were ultrasound (US) time, cumulative dissipated energy (CDE), and percentage total equivalent power in position 3. Postoperative follow-up was at 3 months. Results The mean preoperative CDVA was 0.41 logMAR in the torsional group and 0.38 logMAR in the longitudinal group, improving to 0.07 logMAR postoperatively in both groups. The mean ECD loss was 7.2% ± 4.6% in the torsional group (72 patients) and 7.1% ± 4.4% in the longitudinal group (76 patients), with no statistically significant differences in the primary analysis (P = .342) or secondary analysis (P = .906). The mean US time, CDE, and percentage total equivalent power in position 3 were statistically significantly lower in the torsional group (98 patients) than in the longitudinal group (94 patients) (P Conclusion The torsional mode was as safe as the longitudinal mode in phacoemulsification for age-related cataract. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

50 citations


Journal ArticleDOI
TL;DR: The new torsional software significantly decreased occlusion time and balanced salt solution use over standard torsion software, particularly with denser cataracts, and the net result was a relatively better safety cataract surgery profile.
Abstract: Purpose To evaluate the efficiency profile of new torsional phacoemulsification software. Setting Eye Institute of Utah, Salt Lake City, Utah, USA. Design Comparative case series. Methods Routine cataract surgeries were performed using standard torsional (Ozil) and new torsional (Ozil IP) software. The new software uses occasional pulses of longitudinal energy that are operator specified and system controlled to manage potential occlusion. The new software was compared with the previous standard software, which did not include this option. The video monitor system was recorded in high definition. Measurement of cumulative dissipated energy, balanced salt solution use, and amount of time spent in occlusion were measured in a frame-by-frame review of the recorded videos. Data were categorized for analysis by software group and cataract grade (1 to 4). Results The study comprised 59 eyes that had cataract removal using the new torsional software and 59 eyes using the standard torsional software. Cumulative dissipated energy was not statistically significantly different between the 2 groups. Balanced salt solution use, time spent in occlusion, and the mean longest continuous occlusion were significantly lower with the new torsional software; these differences were greater as the cataract grade increased. Conclusions The new torsional software significantly decreased occlusion time and balanced salt solution use over standard torsional software, particularly with denser cataracts. The net result was a relatively better safety cataract surgery profile. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

18 citations


"Impact of intelligent phacoemulsifi..." refers background in this paper

  • ...Cionni et al showed that the occlusion time, which they calculated using video overlay, was reduced in hard cataracts.(5) In the same study, they observed that the amount of fluid used was also reduced....

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