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Enhancing Phacoemulsification Safety: How Low Fluidic Settings Influence Active Surge Mitigation Actuation.

Biljana Kuzmanović Elabjer1,2,3, Tea Štrbac1, Iva Ćubela1

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Clinical Ophthalmology (Auckland, N.Z.)
|September 17, 2025
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Summary

Active Surge Mitigation (ASM) helps maintain stable anterior chamber conditions during phacoemulsification. Patient age, lens thickness, and ultrasound time influence ASM activation, enhancing surgical safety with low intraocular pressure fluidics.

Keywords:
ASM actuationactive sentry handpiecelow IOP settingssurge events

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Area of Science:

  • Ophthalmology
  • Surgical Technology

Background:

  • Maintaining stable anterior chamber (AC) dynamics is crucial during phacoemulsification to ensure surgical safety.
  • Low intraocular pressure (IOP) fluidics may reduce stress on ocular tissues by minimizing post-occlusion surge.
  • Active Surge Mitigation (ASM) is a feature designed to dynamically adjust fluidics and minimize surge events.

Purpose of the Study:

  • To evaluate factors influencing ASM activation during phacoemulsification at low IOP settings.
  • To assess the impact of demographic, biometric, and intraoperative parameters on ASM usage.
  • To determine the effectiveness of ASM in conjunction with low IOP fluidics for stable AC maintenance.

Main Methods:

  • Retrospective study at a university eye clinic.
  • Collected preoperative data: age, gender, biometric data, lens hardness, Pseudoexfoliation Syndrome (PEX), Intraoperative Floppy Iris Syndrome (IFIS).
  • Recorded intraoperative metrics: total case time, cumulative dissipated energy (CDE), ultrasound time (U/S time), and ASM actuations at low IOP (30 mmHg), vacuum (575 mmHg), and flow (28 cc/min).

Main Results:

  • ASM actuations were not normally distributed (median=1, mean=2.4).
  • Significant positive correlations found between ASM actuations and patient age (P=0.014), lens thickness (P=0.039), and U/S time (P=0.015).
  • No significant differences in ASM activation were observed based on anterior chamber depth (ACD), gender, PEX, or IFIS.

Conclusions:

  • Surge events are rare at low IOP settings during phacoemulsification.
  • ASM activation is significantly influenced by patient age, lens thickness, and U/S time.
  • Low IOP fluidics combined with ASM ensures stable and safe chamber dynamics across various patient profiles.