Background Phacoemulsification acoenergy and shortening the phacotime can decrease this risk. Aim The aim of this work is to compare the safety and the efficiency of phacoemulsification using conventional and torsional ultrasound modalities for hard nucleus cataracts. Settings and design This was a prospective randomized interventional study. Patients and methods A total of 30 eyes of 29 patients having hard nuclear cataract (grades IV and V) were divided into two groups. Group A included 15 eyes whose cataract was operated on by conventional phacoemulsification using the Infiniti machine. Group B included 15 eyes whose cataract was operated on by torsional phacoemulsification using the OZil technology of the Infiniti machine. Intraoperative ultrasound time and cumulative dissipated energy were recorded. Postoperative central corneal thickness (CCT) was measured at days 1, 7, and 30, and specular microscopy was done at 1 month. Statistical analysis The collected data were coded, tabulated, and statistically analyzed. Results The mean ultrasound time and cumulative dissipated energy and the amount of irrigating fluid were significantly higher in group A. There was a highly significant decrease in endothelial cell count (ECC) in both groups. ECC was significantly lower in the conventional group than in the torsional group at 1 month postoperatively. CCT in both groups was significantly increased at day 1 and then decreased at 1 week and 1 month but was still significantly higher than the preoperative level. CCT became higher in the conventional group than in the torsional group at all follow-up times, but this was significant only at day 1 and week 1 and not significant at 1 month. Conclusion Both ultrasound modalities can be used in hard nucleus phacoemulsification. However, the torsional ultrasound proved to be safer. The choice between these technologies is of particular importance when operating eyes with low ECC.

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