Phacoemulsification Using A Handpiece With A Built-In Pressure Sensor Reduces The Ultrasound Time And The Overall Duration Of Cataract Surgery: Final Results From The Sasca (Study Of Active Sentry In Cataract Surgery) Multicenter Study

he 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 total procedure duration, the total ultrasound time (US time), the BSS volume used 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.

The median US time was 55.7 (range 0.0-530.0) and 63.6 (3.0-363.0) with and without AS, respectively (p<0.0001). The median total surgical time in minutes was significantly reduced with 9.8 ± 4.47 (N= 800) and 11.0 ± 9.22 (N= 632) in the AS and non-AS groups, respectively, p= 0.0002. The median ultrasound time in seconds was also significantly reduced in the AS group versus the non-AS group with 55.7 ± 38.66 (N= 800) and 63.6 ± 37.83 (N= 632) in the AS and non-AS groups, respectively, p< 0.0001. The median BSS volume in cc was 58.6 ± 25.38 and 63.3 ± 28.59 in the AS and non-AS groups, respectively, p= 0.0018. No adverse events recorded in either group.

The results present here showed that phacoemulsification with Active Sentry significantly reduced the ultrasound time as well as the total time of the surgical procedure . 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. 

This work was supported by an investigator-initiated study grant funded by Alcon (IIT#57203277). APB, DM, FL and PR are consultants for Alcon