Comparison of Phacoemulsification and Aspiration Parameters in Cataract Surgery: Metal Tip vs. Hybrid Tip

Various tips are available for phacoemulsification in cataract surgery. Evidence-based data can inform ophthalmologists, especially inexperienced ones, on tip selection. We retrospectively evaluated the energy efficiency and other parameters of two ultrasonic phacoemulsification and aspiration tips across different nuclear hardness grades in 342 cataract patients (342 eyes) with nuclear hardness grades II to IV. Surgical procedures, ultrasound settings, and instrumentation were standardized. All surgeries were performed by one experienced doctor. We compared the metal INTREPID^® Balanced Tip (M-tip) with the INTREPID^® Hybrid Tip (P-tip), which has a polymer coating. The M-tip required significantly less total ultrasound time and cumulative dissipated energy (CDE) than the P-tip for grades III and IV, while the P-tip had a shorter aspiration time and less estimated fluid aspirated for grade II. No differences in corneal endothelial cell loss were observed. Lens rupture rates were low: 0.47% for the M-tip and 0.78% for the P-tip. Multiple regression analysis showed that CDE increased with nuclear hardness. These findings suggest that the M-tip is efficient for harder lenses, while the P-tip may be advantageous for softer lenses, informing optimal tip selection in cataract surgery. Further research is suggested to elucidate their clinical significance.