Unraveling Active Surge Mitigation Actuation: Optimizing Phacoemulsification with Active Sentry Handpiece

The purpose of this study is to determine which demographic and biometric factors, lens hardness, complications such as pseudoexfoliation syndrome (PEX) and intraoperative floppy iris syndrome (IFIS), and intraoperative metrics have the greatest influence on active surge mitigation (ASM) actuation during phacoemulsification using the Centurion Vision System with the Active Sentry handpiece.

The preoperative analysis considered age, sex, biometric data (obtained using IOLMaster 700 and the Pentacam), and lens hardness according to the Lens Opacification Classification System (LOCS) III. IFIS and PEX were also assessed. Intra-operative metrics during phacoemulsification included total case time, cumulative dissipated energy, total ultrasound time, and the number of ASM actuations.

Significant positive correlations were found between ASM and both LOCS III grade (p = 0.001) and age (p = 0.017), albeit a significant negative correlation was observed with anterior chamber depth (p = 0.005). No significant differences in the number of ASM actuations were observed between genders or in patients with PEX or IFIS. In multivariate analysis, an ASM of ≥1 significantly predicted higher LOCS III grade (odds ratio, 1.79; 95% confidence interval, 1.04-2.95), whereas greater anterior chamber depth reduced this likelihood (odds ratio, 0.311; 95% confidence interval, 0.100-0.960).

ASM actuation is more frequent with advanced lens hardness and old age, while a deep anterior chamber reduces actuations compared to a shallow one. Lens hardness affects ASM more than anterior chamber depth, and no significant correlation was found between PEX, IFIS, and ASM.