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Ultrachopper: phaco metrics and endothelial cell loss with three different techniques

Poster Details

First Author: L.Melo COLOMBIA

Co Author(s):    L. Escaf   J. Londoño           

Abstract Details



Purpose:

To evaluate the different Ultrachopper techniques, comparing phaco metrics (Cumulative Dissipated Energy (CDE), Balanced Saline Solution (BSS), Surgical Time) with endothelial cell loss.

Setting:

Since phacoemulsification invention in 1967, cataract pre-fracture techniques are becoming popular among cataract surgeons since they aim to decrease the ultrasound energy and reduce ocular tissue impact, specially endothelial count. Phaco chop and prechop techniques are of great help in rather soft cataracts, allowing a proper nucleus fracture for its later phacoemulsification. However, because of their relatively long learning curve and their lower efficiency in hard voluminous cataracts, the dissemination of this techniques has not been the expected with just 24% of cataract surgeons using them. With the arrival of the Ultrachopper this disadvantages have been solved allowing surgeons to successfully address in an easier way the different cases they deal with. Currently, in our institution, Clínica Oftalmológica del Caribe, located in Barranquilla Colombia, 100% of our cataract cases are performed with the Ultrachopper technology using three different techniques called: Horizontal Ultrachopper, Vertical Ultrachopper and Central pit. This study wants to evaluate the different Ultrachopper tecnhiques comparing phaco metrics (Cumulative Dissipated Energy (CDE), Balanced Saline Solution (BSS), Surgical Time) and endothelial cell loss between them.

Methods:

A prospective observational study was made of 256 cases of cataract surgeries performed at the Clínica Oftalmológica del Caribe in Barranquilla Colombia, from May thru August 2013. All cases were performed by experienced cataract surgeons, using the Ultrachopper device and the Infiniti® phaco system (Alcon-Novartis Fort Worth Texas). Cataract classification (LOCS III), Ultrachopper technique, CDE (fracture, fragments emulsification, total), BSS and surgical time were assessed. In 55 cases, a specular microscopy was made before and 4 months after surgery for endothelial cell loss evaluation. The information was processed with Epi Info Software using Kruskal Wallis test.

Results:

The total time of the CDE technique ultrachopper vertically (vertical Ultrachopper 12.71 ± 7.80 , 13.72 ± 7.66 Ultrachopper horizontally ; 26.15 ± 4.93 Central pit) and volumes of SSB (vertical ultrachopper 90.04 ± 19.47 , 98.50 ± 21.90 horizontal ultrachopper ; 116.6 ± 10.81 Central pit ) and surgical time employees (vertical ultrachopper 8.41 ± 2.30 , 10.19 ± 3.51 horizontal ultrachopper ; central pit 13.30 ± 3.57) . The mean pre-operative and post-operative cell density was 2480 ± 394 and 2228 ± 453 cells/mm2 endothelial demonstrating 10.2 % loss . No statistically significant difference ( P = 0.994 ) was found in endothelial loss of the three techniques compared (vertical ultrachopper 10.1 %, 9.7 % horizontal ultrachopper ; central pit 10.9 % )

Conclusions:

The Ultrachopper device allows an effective and efficient nuclear fracture in any degree of cataract hardness or opalescence. The final phaco metrics including (Cumulative Dissipated Energy (CDE), Balanced Saline Solution (BSS), Surgical Time) using Ultrachopper are very low compared to other phaco techniques currently used, especially in hard cataract cases. It is also a very safe instrument for the corneal endothelium with a cell loss count in the order of the lowest accepted ranges for ultrasound using techniques. The Vertical Ultrachopper shows to be the more efficient of all techniques, resulting in the lowest metrics used during surgery, especially for nuclear fracture. The later can explain the surgeons obvious preference for this technique. FINANCIAL INTEREST: One of more of the authors... gains financially from product or procedure presented, One of more of the authors... travel has been funded, fully or partially, by a competing company, One of more of the authors... receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented

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