Phacoemulsification At Physiological Irrigation Pressure (20 Mmhg): One-Year Clinical Experience In 949 Eyes

To determine whether phacoemulsification can be routinely performed at a physiological irrigation pressure of 20 mmHg in the absence of ocular contraindications, while maintaining intraoperative stability and low complication rates, and to define the proportion of cases requiring intraoperative pressure escalation.

Tertiary referral university eye center, Czech Republic, performing routine and complex cataract surgery under standard operating room conditions.

Retrospective analysis of 949 consecutive phacoemulsification procedures was performed over one year using the Centurion® Vision System (Alcon) with Active Sentry® handpiece. Irrigation pressure was preset at 20 mmHg following individualized preoperative assessment of ocular anatomy. No exclusion was made based on cataract density, and complex cases including advanced cataracts and eyes with zonular compromise were included. The preset pressure strategy allowed intraoperative adjustment when clinically indicated. Primary outcomes were completion at preset pressure, need for intraoperative pressure escalation, posterior capsule rupture, operative time, and cumulative dissipated energy (CDE).

Surgery was completed at the preset irrigation pressure of 20 mmHg in 900 eyes (95%). In 47 eyes (5%), irrigation pressure was increased intraoperatively to 26–30 mmHg to maintain chamber stability, particularly in eyes with shallow anterior chamber depth. Posterior capsule rupture occurred in 2 eyes (0.2%); both were managed without vitreous prolapse or need for anterior vitrectomy. Median total case time was 537 seconds (~9.0 minutes), and median CDE was 3.8. No technical system failures or clinically relevant chamber instability were observed throughout the series.

Phacoemulsification performed at a physiological irrigation pressure of 20 mmHg using active fluidics is clinically feasible and reproducible in a large consecutive cohort. Intraoperative stability was maintained in the vast majority of eyes, with a low posterior capsule rupture rate and limited need for pressure escalation. Maintaining near-physiological intraoperative pressure may support preservation of anterior segment relationships and enable cataract surgery to be performed under more physiological intraoperative conditions. Careful preoperative assessment remains essential when adopting low-pressure fluidic strategies.