Two-speed phacoemulsification for soft cataracts using optimized parameters and procedure step toolbar with the...

Area of Science:

• Ophthalmology
• Surgical Technology
• Cataract Surgery

Background:

• Posterior capsule aspiration is a complication during cataract surgery.
• Efficient removal of soft nuclear quadrants is challenging.
• Existing techniques may not adequately prevent capsular events.

Purpose of the Study:

• To identify the cause of posterior capsule aspiration.
• To present a novel surgical technique using optimized parameters to prevent posterior capsule aspiration during soft cataract removal.

Main Methods:

• Prospective analysis of 4,062 consecutive cataract surgeries using the Alcon CENTURION machine.
• Video analysis of a posterior capsule aspiration event.
• Development and testing of a new surgical technique with empirically derived machine parameters for controlled soft quadrant aspiration.

Main Results:

• Two cases of posterior capsule aspiration occurred in 3,238 surgeries before the new technique.
• Video analysis revealed a rapid vortex effect leading to aspiration.
• The new technique, with slower aspiration pace and controlled parameters (aspiration flow 20 mL/min, vacuum 400 mmHg, torsional amplitude up to 20%), resulted in zero aspirations in 824 subsequent cases.
• A toolbar enabling instantaneous switching between soft and normal settings was developed.

Conclusions:

• A technique with a reduced aspiration pace for soft nuclear quadrants, utilizing integrated machine parameters, effectively prevents posterior capsule aspiration.
• The developed technique enhances intraoperative flexibility and surgeon control over aspiration flow, vacuum, and tip motion.
• This method offers a safer and more efficient approach to removing soft nuclear quadrants during cataract surgery.