Large-Scale Analysis Of The Parameters Used During Phacoemulsification: First Results From The Rophacs (Registry Of Phacoemulsification Cataract Surgery) Study

In contrast to the large number of cataract surgeries performed yearly, most studies assessing the parameters used during phacoemulsification are small-scale. Our aim was to provide an analysis of the processes of cataract surgery using the data stored in the phacoemulsifiers’ records. The ROPHACS (Registry of PHAcoemulsification Cataract Surgery) study’s objective is to collect the information recorded in a large number of Centurion phacoemulsifiers to provide a database of 100 000 procedures. Our current aim is to report an interim analysis of these records, while the collection of data remains ongoing. The study’s main outcome measure was the assessment of the duration of the phacoemulsifications.

The study was based on a nationwide collection (ClinicalTrials.gov Identifier: NCT06659419) of the data from French centers using Active Sentry (AS) (pressure sensor embedded in the handpiece) and non-AS Centurion phacoemulsifiers. The records from the last 1000 procedures performed with each phacoemulsifier were transferred to a central database. The current interim data were collected in 15 centers (5 public hospitals and 10 private clinics) and extracted from 46 phacoemulsifiers.

Consents from surgeons and administrators in each participating center were obtained. The procedures captured in the database were performed between December 2021 and January 2025. The following parameters were analyzed: duration of ultrasound usage (US), total case duration, Cumulated Dissipated Energy (CDE), BSS volume, torsional and longitudinal energy amplitude and duration, maximum infusion pressure. In AS enabled Centurions (ASC) the number of activations were recorded. The data captured from ASC were compared to that from Non-AS Centurions (N-ASC). The number of cases during which the vitrectomy mode was used was recorded. The study was supported by Alcon IIT grant #76861727.

The data from 45 909 procedures were analyzed. The mean US duration was 61.5 ± 39.2s (torsional 57.8 ± 37.1s and longitudinal 3.7 ± 7.0s). The mean total duration of the steps using the phacoemulsifier was 10’52” ± 7’13”. The mean CDE was 9.53 ± 7.57. The mean maximum infusion pressure setting was 65.8 ± 11.0mmHg. The mean volume of BSS used during the surgical steps was 90.5 ± 43.8cc. The procedures were performed with 22 921 ASC and 22 988 N-ASC. The median duration of US was 53.6s with ASC and 54.7s with N-ASC (p=0.001). The median CDE was 7.8 with ASC and 8.2 with N-ASC (p<0.001). In the ASC group, on average 3.1 ± 5.42 activations of the surge protection process were recorded. Overall, the vitrectomy mode was used in 239 (0.53%) cases.

To our knowledge, this is the first large-scale analysis of the parameters used during phacoemulsification. The number of cases included in the study allows to draw a robust global picture of modern phacoemulsification. Although there are variations from one case to another, the results show that on average modern cataract surgery is performed using the phacoemulsifier for less than 11 minutes. Assuming the use of the vitrectomy mode is an indirect indicator of posterior capsule rupture with vitreous loss, we can estimate that this complication occurs in about 1 in 189 cases. The study results can be used as a benchmark to assess the current and future generations of phacoemulsifiers.