Impact of low versus high fluidic settings on the efficacy and safety of phacoemulsification

Abstract

. Purpose: To compare intraoperative efficiency and postoperative outcomes of cataract surgery with low and high fluidic settings. Methods: In this prospective, randomized, single‐blinded study, 114 eyes of 57 patients were operated with low fluidic settings for one eye (group I) and high fluidic settings for the other eye (group II). Efficiency was judged as metred surgery time, effective phacoemulsification time (EPT) and the amount of balanced salt solution used. Visual outcome and endothelial cell count were determined 1 week and 18 months postoperatively. Results: The overall effective phacoemulsification energy was statistically significantly lower (p = 0.003) in group II than in group I. Conquest of the nuclei was achieved with about two‐thirds of the energy needed in group I, with 6.59 ± 4.79 effective ultrasound energy compared with 3.99 ± 3.18 (p = 0.001). Overall, about 12% more solution was used in group II than in group I. Median visual acuity was 1.0 for both groups 18 months after surgery. The mean endothelial cell loss was 5.0% in eyes in group I compared with 6.3% in eyes in group II (p > 0.5). Conclusion: Switching from low fluidic settings with a conventional coaxial 20G phacoemulsification tip to higher fluidic settings with a microcoaxial phaco tip statistically significantly decreases EPT. As only marginally more solution was used with the higher aspiration flow, occlusion must be accomplished more often with high than with low fluidics. Aspiration of the quadrants was therefore more efficient with high fluidic settings. The enhanced pump speed did not result in more tissue damage.

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

“…This is consistent with previous studies confirming the relationship between phaco tip and phacoemulsification efficiency [22]. In any case, the EPT values achieved with both 20G and 21G tips in our series were consistently lower than those reported for conventional phacoemulsification cataract surgery with other platforms [12] [13], as previously mentioned. Schriefl et al [12] showed that a significant decrease in EPT was achievable with a 21G phaco tip by switching from low to high fluidic settings.…”

“…Specifically, median values of EPT of 3.15 and 5.00 s were found when using the 20G and 21G phaco tips, respectively. These values are consistently lower than those reported for conventional phacoemulsification cataract surgery with other platforms [12] [13]. Likewise, the EPT values obtained in our series are close tothose reported by other authors combining femtosecond laser cataract surgery platforms with phaco systems [14]- [16].…”

“…In any case, the EPT values achieved with both 20G and 21G tips in our series were consistently lower than those reported for conventional phacoemulsification cataract surgery with other platforms [12] [13], as previously mentioned. Schriefl et al [12] showed that a significant decrease in EPT was achievable with a 21G phaco tip by switching from low to high fluidic settings. However, high fluidic settings can lead to more iatrogenic effects on ocular tissue [23].…”

<p>Optimization of the Oertli CataRhex 3^&reg; phacoemulsification machine</p>

“…Somewhat surprisingly, increasing the aspiration rate did not statistically improve efficiency in this series. This is in contrast to our previous work9,10,13–15 and clearly is a feature of the fluidics system which is likely an inherent safety feature 16. Complications with phaco on the mature and dense lenses frequently encountered in outreach settings are common 17,18.…”

Comparison of Phacoemulsification Cataract Surgery with Low versus Standard Fluidic Settings and the Impact on Postoperative Parameters

“…Concerns have been expressed about the fluidics in the eye during phacoemulsification and the impact on long-term postoperative complications. However, few studies have investigated these issues (1)(2)(3).…”