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Mini-flared Kelman tip, reverse tip, and sidewinder tip with torsional phaco: a prospective randomized comparative

Wilson Takashi Hida¹, Patrick Frensel Tzelikis¹, Celso Takashi Nakano²

¹Brasilia Ophthalmologic Hospital, Brasilia, DF, Brazil.

Arquivos Brasileiros De Oftalmologia

|February 26, 2015

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The mini-flared 45-degree Kelman tip demonstrated greater efficiency in torsional phacoemulsification, requiring less phaco time and balanced salt solution. All tested phaco tips proved effective for microincision cataract surgery.

Area of Science:

Ophthalmology
Surgical Technology
Cataract Surgery

Background:

Cataract surgery is a common procedure to restore vision.
Phacoemulsification is a standard technique, with ongoing innovation in surgical tips.
Torsional phacoemulsification offers potential advantages in efficiency and safety.

Purpose of the Study:

To compare the surgical efficiency of three distinct phaco tip designs.
To evaluate tip performance in torsional phacoemulsification using the bevel-down technique.
To assess clinical and intraoperative outcomes across different microcoaxial cataract surgery tips.

Main Methods:

Prospective, comparative, masked study involving 150 patients undergoing cataract surgery.
Randomized assignment to three phaco tip groups: mini-flared 45-degree, reversed mini-flared 30-degree, and Sidewinder 30-degree Kelman tips.

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Evaluation of intraoperative parameters (phaco time, energy, fluid usage) and postoperative outcomes (visual acuity, corneal health, cell counts).

Main Results:

No significant differences in cumulative dissipated energy, case time, torsional time, or aspiration time among the three tips.
The mini-flared 45-degree Kelman tip showed a statistically significant reduction in phaco time compared to the other two tips.
Reduced balanced salt solution (BSS) volume was observed with the mini-flared 45-degree and reversed mini-flared 30-degree tips versus the Sidewinder tip.

Conclusions:

All three phaco tip designs were effective and safe for microincision cataract surgery with no intraoperative complications.
The mini-flared 45-degree Kelman tip demonstrated superior efficiency by requiring less phaco time during torsional phacoemulsification.
Tip selection may influence fluid usage and operative time, though visual and cellular outcomes were comparable postoperatively.