Comparison of clinical outcomes of torsional handpiece through

micro incision and standard clear corneal incision

So-Hyang Chung, MD, PhD, Choun-Ki Joo, MD, PhD

Department of Ophthalmology and Visual Science, College of Medicine,

The Catholic University of Korea, Seoul, Korea

* Authors have no financial interests.

1. Reduction of incision size2. Decreased energy and increased efficiency3. Less endothelial cell loss

Introduction

* Advancement of Cataract surgery technique

1. Reduce the amount of phacoemulsification energy 2. Increase efficiency 3. Allow cataract surgery through micro coaxial inci-

sion.

* OZiL torsional handpiece > traditional handpiece

Purpose

2.2mm micro coaxial incision

(32 eyes)0.9mm mini-flared 45- degree bevel Kelman ABS tip

2.8mm Standard clear corneal in-cision (28 eyes)0.9mm micro 45 degree bevel Kel-

man ABS tip

Versus

• Our study was designed to compare torsional ultrasound

systems with same degree tips between standard 2.8 mm

standard clear corneal incisions and 2.2 mm micro coaxial

incisions.

Methods ethod

Retrospective study

Duration : April 2008 ~ September 2008

Patients : 60 eyes patients

1. Operated by one surgeon

2. Cataracts of similar density (LOCS III classifica-

tion –grade III, IV)

Exclusion criteria

1. Underlying systemic disease or ocular disease

(DM, Corneal surface irregularity, high myopia,

RD, glaucoma)

2. Age > 80yrs

Methods

Parameters Intra-operative parameters▪ Mean cumulative dissipated energy (CDE)▪ Total balanced salt solutions (BSS)

Post-operative parameters▪ Central corneal thickness (CCT) at postoperative 1 day▪ Endothelial cell loss (ECL) at postoperative 6 months

All cases were uncomplicated.All cases were uncomplicated.

5

In the bag IOL im-

plantation

6

Suture-less tech-nique2

3

Temporal clear

corneal incision

About 6.0mm CCC di-ameter

1

patients selection

4

Pha-coemuls-ification

Results

ParameterMean + SD

2.2mm incision 2.8mm incision P-value

Intra-operative

CDE 6.18±3.54 10.38±4.61 0.038

BSS used 72.06±24.1 95.23±35.5 0.307

Paired T-test P<0.05

ParameterMean + SD

2.2mm incision 2.8mm incision P-value

Post -operative

Central corneal thickness(μm)

Pre-operative 554.17±35.8 534.86±31.7 0.091

POD #1 622.05±71.7 604.72±57.2 0.479

Change 67.88±75.06 69.86±55.87 0.985

Endothelial cell count (cells/mm2)

Pre-operative 2494±359 2683±325 0.402

POD#6mon 2185±441 2188±452 0.346

Change -309±423 -495±486 0.048

Intra-operative and post-operative characters.

2.2 mm micro coaxial incision 2.8 mm standard in-cision

• CDE showed positive correlation with BSS use

(P<0.001, R2=0.302).

2.2mm group 2.8mm group

• CDE showed positive correlation with ECL and CCT change (P=0.006, R2=0.345, P=0.22, R2=0.346).

2.2 mm micro coaxial incision 2.8 mm standard in-cision

• BSS use showed positive correlation with ECL

(P=0.012, R2=0.283).

Discussion

CDE and endothelial cell loss were lower in

the micro coaxial incision group (P<0.05).

Better cutting efficiency with a mini-flared 45-degree tip

may reflect its better holding force factor of a mini-

flared 45-degree tip in micro coaxial incision.

Postoperative endothelial cells loss

correlated with intra-operative CDE and BSS

use.

Discussion

Phacoemulsification (using the OZil torsional hand-

piece)

through 2.2 mm micro coaxial incisions showed less

total energy use and less endothelial cell loss than

2.8 mm standard incisions.

Torsional ultrasound systems through 2.2 mm micro

coaxial incisions were safe and effective in pha-

coemulsification!