Phacoemulsification Using A Handpiece With A Built-In Pressure Sensor Reduces The Energy Required For Cataract Surgery: Final Results From The Sasca (Study Of Active Sentry In Cataract Surgery) Multicenter Study

The prevention of pressure fluctuations in the anterior chamber is an important factor for the safety of cataract surgery. Modern phacoemulsifiers are designed to prevent occlusion break surges to stabilize the anterior chamber. We compared phacoemulsifications performed with a pressure sensor built in the handpiece (Active Sentry®) with procedures using a traditional sensor placed in the phacoemulsifier. Our primary objective was to assess whether the effect of the immediate pressure adjustments provided by the Active Sentry system could result in a reduction of the energy used during phacoemulsification.

The SASCA study (Study of Active Sentry in CAtaract surgery) was a multicenter prospective clinical trial (ClinicalTrials.gov Identifier: NCT04732351). The study involved 6 surgeons in 5 French centers (2 private practices and 3 university hospitals). All participants used the Centurion® phacoemulsification system in real life condition alternatively with the handpiece-based sensors (Active Sentry system) or with the traditional phacoemulsifier-based sensors.

The following preoperative data were recorded: age, best-corrected visual acuity, axial length, anterior chamber depth and cataract nuclear opacities based on the WHO grading scale. Consecutive procedures were performed alternatively with Centurion phacoemulsifiers using Active Sentry (AS) or non-Active Sentry (non-AS) and handpieces. The study’s primary outcome measure was the Cumulated Dissipated Energy (CDE) recorded during the procedures. Secondary outcome measures were the torsional and longitudinal energy and the frequency of adverse events which occurred during the procedures. These parameters were also analyzed according to the grades of the cataracts.

We present here the final analysis on 1432 (800 AS and 632 non-AS) procedures. There were no differences between the AS and non-AS groups at baseline. The primary outcome: median CDE was respectively 8.0 (range 0.0-70.4) and 9.3 (0.0-77.6) with AS and without AS (p=0.0001). This significant lower CDE was consistent within each cataract grades. Both torsional (median 661.4 vs 725.0 for AS and non-AS, respectively, p=0.0074) and longitudinal (median 49.3 vs 74.4 for AS and non-AS, respectively, p<0.0001) US time were significantly reduced with AS. No adverse events were recorded in either group.

The analyses confirmed that phacoemulsification with Active Sentry significantly reduced the amount of energy used during the procedures and shortened their duration. Although in our study no complications were recorded in either group, on a larger scale we anticipate that the significant energy reduction linked to using the AS system will increase the overall safety of cataract surgery. The benefits of the AS-based low energy strategy for phacoemulsification will be further investigated.

This work was supported by an investigator-initiated study grant funded by Alcon (IIT#57203277)