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Can Torsional Phaco Decrease the Risk for Corneal Decompensation in Fuchs Endothelial Dystrophy: RCT University Eye Clinic azMaastricht April 7-9 2010 Boston M. Doors, MD; Tos T.J.M. Berendschot, PhD; Carroll A.B. Webers, MD, PhD; Rudy M.M.A. Nuijts MD, PhD The authors have received research funding from Alcon

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Can Torsional Phaco Decrease the Risk for Corneal Decompensation in Fuchs Endothelial Dystrophy: RCT. M. Doors, MD; Tos T.J.M. Berendschot, PhD; Carroll A.B. Webers, MD, PhD; Rudy M.M.A. Nuijts MD, PhD. The authors have received research funding from Alcon. University Eye Clinic az Maastricht. - PowerPoint PPT Presentation

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Page 1: Can Torsional Phaco Decrease the Risk for Corneal Decompensation in Fuchs  Endothelial Dystrophy: RCT

Can Torsional Phaco Decrease the Risk for Corneal Decompensation in Fuchs

Endothelial Dystrophy: RCT

University Eye ClinicazMaastricht

April 7-9 2010 Boston

M. Doors, MD; Tos T.J.M. Berendschot, PhD; Carroll A.B. Webers, MD, PhD; Rudy M.M.A. Nuijts MD, PhD

The authors have received research funding from Alcon

Page 2: Can Torsional Phaco Decrease the Risk for Corneal Decompensation in Fuchs  Endothelial Dystrophy: RCT

Torsional vs Longitudinal

• Goal phaco technology:– Reducing US power and improving its efficiency

• Longitudinal repulsion• Torsional rotary oscillations no repulsion • 2 studies comparing torsional vs longitudinal

mode in healthy eyes1,2

– Torsional mode: • Lower US time and CDE• CCT significantly thinner at 1 day and 1 week

postoperatively • Faster visual recovery• Less endothelial cell loss

1Liu, JCRS 2007;2872 Zeng, BJO 2008;1092

Page 3: Can Torsional Phaco Decrease the Risk for Corneal Decompensation in Fuchs  Endothelial Dystrophy: RCT

Purpose and Methods

• To compare the effect of torsional and longitudinal phaco on CT and corneal volume in patients with Fuchs’ endothelial dystrophy

• RCT: torsional (n=26) vs longitudinal (n=26) • Inclusion:

– Patient with FED needing cataract surgery > 40 years old

• Exclusion:– Previous corneal/intraocular surgery and other

visually significant ocular diseases (AMD)

Page 4: Can Torsional Phaco Decrease the Risk for Corneal Decompensation in Fuchs  Endothelial Dystrophy: RCT

Methods• Randomisation:

– Nucleus density grade (LOCS II)– Stage of Fuchs’ disease– Age

• Phacoemulsification with soft shell technique• Investigator and patient blinded for treatment• Visante OCT

– Pachymetry map• Pentacam

– Corneal volume

Page 5: Can Torsional Phaco Decrease the Risk for Corneal Decompensation in Fuchs  Endothelial Dystrophy: RCT

Results• Follow-up visits: 1 day, 1 week, 1 month,

3 months, 6 months• Preliminary results: mean follow-up 5.5 ± 1.2

months (range 1-6 months)• Mean age: 72.4 ± 7.8 years• 20 Men, 32 Female

PreoperativelyCCT 655 μm

1 day Postoperatively

CCT 733 μm

Page 6: Can Torsional Phaco Decrease the Risk for Corneal Decompensation in Fuchs  Endothelial Dystrophy: RCT

Longitudinal vs. TorsionalPreoperative

Longitudinal (n=26)

Mean ± SD

Torsional (n=26)

Mean ± SD P-value

Stadium Fuchs 1.77 ± 0.77 1.73 ± 0.78 0.858

Nucleus Density (0-3) 1.81 ± 0.90 1.62 ± 0.90 0.443

OCT CCT (μm) 593 ± 50 591 ± 52 0.917

OCT 12 o’clock CT (μm) 695 ± 49 685 ± 65 0.513

OCT 6 o’clock CT (μm) 642 ± 43 639 ± 53 0.821

PC mean volume (mm3) 60.6 ± 4.3 60.8 ± 5.2 0.843

Page 7: Can Torsional Phaco Decrease the Risk for Corneal Decompensation in Fuchs  Endothelial Dystrophy: RCT

Longitudinal (n=22)Mean ± SD

Torsional (n=23)Mean ± SD P-value

Total US time (mm:ss) 01:29 ± 00:44 00:57 ± 00:25 0.003

CDE 24.37 ± 16.65 11.45 ± 6.14 0.001

BSSuse quad removal (ml) 85.8 ± 38.0 62.6 ± 22.1 0.010

US equivalent position 3 17.6 ± 4.9 19.3 ± 2.6 0.123

Aspiration time (mm:ss) 06:07 ± 02:19 05:18 ± 01:38 0.151

Operating time (minutes) 11:57 ± 4:09 10:26 ± 3:08 0.140

No intraoperative complications

Longitudinal vs TorsionalIntraoperative

Page 8: Can Torsional Phaco Decrease the Risk for Corneal Decompensation in Fuchs  Endothelial Dystrophy: RCT

Harder nucleus was associated

with higher CDE (r = .587; P<0.001)

CDE lower in torsional group, especially for hard nucleus!

Nucleus Density and CDE

Blue = longitudinal Green = torsional

P=0.002

P=0.004

Page 9: Can Torsional Phaco Decrease the Risk for Corneal Decompensation in Fuchs  Endothelial Dystrophy: RCT

Longitudinal vs TorsionalPostoperative

No significant differences P > 0.05Blue = longitudinal; Green = torsional

Page 10: Can Torsional Phaco Decrease the Risk for Corneal Decompensation in Fuchs  Endothelial Dystrophy: RCT

Longitudinal vs TorsionalPostoperative

*Significant difference P = 0.010

*

Blue = longitudinal; Green = torsional

Page 11: Can Torsional Phaco Decrease the Risk for Corneal Decompensation in Fuchs  Endothelial Dystrophy: RCT

Correlations CCT and CDE

Higher preoperative CCT and higher CDE were associated with larger postoperative increase in CCT

r = 0.440

P = 0.001

r = 0.460

P = 0.001

Page 12: Can Torsional Phaco Decrease the Risk for Corneal Decompensation in Fuchs  Endothelial Dystrophy: RCT

Conclusions

• Higher preoperative CCT and higher CDE were associated with a larger postoperative increase in CCT

• Torsional mode may provide more effective lens removal with a shorter total US time and lower CDE, especially in patient with a hard nucleus