Balanced And Hybrid Phaco Tips In Cataract Surgery: Evaluation Of Safety And Efficacy In Resident Training

Phacoemulsification is one of the most frequently performed procedures during the surgical training of ophthalmology residents and continues to be optimized with advancements in surgical instrumentation. The design of phaco tips is a critical factor directly influencing surgical efficiency and safety. While balanced tips have traditionally been preferred, hybrid tips have been proposed as a novel alternative, offering more efficient lens fragmentation with lower energy consumption, potentially improving surgical outcomes. This study aims to compare the efficacy and safety of hybrid and balanced phaco tips in cataract surgeries performed using the phacoemulsification technique.

This prospective study was conducted on patients who presented with cataracts. The procedures were carried out by ophthalmology residents under the supervision of experienced cataract surgeons.

The study was conducted on cataract patients. Included patients were diagnosed with cataracts and met the criteria for phacoemulsification surgery. Patients with systemic diseases, corneal opacities, or other ocular conditions that could contraindicate surgery were excluded. All surgeries were performed by two ophthalmology residents (second and fourth year) under the supervision of experienced cataract surgeons. A modern phacoemulsification system was used, with both hybrid and balanced phaco tips for lens emulsification and aspiration. Surgical parameters, complication rates, and postoperative outcomes were recorded through standard preoperative and postoperative tests. The data were analyzed using SPSS software.

Sixty patients were divided into four subgroups: 15 cases performed by a second-year resident and 15 by a fourth-year resident using hybrid and balanced tips. The second-year resident required significantly more fluid and had longer aspiration times than the fourth-year resident (p<0.05). With the hybrid tip, fluid usage avarage was 83cc vs. 52cc, and aspiration time was 314s vs. 197s. For balanced tip surgeries, the second-year resident used more fluid (89cc vs. 60cc)and had longer ultrasound (98s vs. 62s) and aspiration time (316s vs. 226s). No significant difference was found between tip types for aspiration fluid volume or ultrasound time. Two posterior capsule ruptures occurred in the second-year resident’s balanced tip cases (p<0.05).

The level of surgical experience significantly impacts fluid usage, aspiration time, and ultrasound duration in phacoemulsification. Second-year residents required more fluid, had longer aspiration and ultrasound times, and exhibited greater variability in surgical parameters compared to fourth-year residents. While there was no significant difference between hybrid and balanced tip usage in terms of aspiration fluid volume or ultrasound time, the higher incidence of posterior capsule rupture in the second-year resident’s balanced tip cases suggests that surgical proficiency plays a crucial role in intraoperative safety.