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Comparison of torsional vs combined torsional and longitudinal phacoemulsification for hard catracts

Poster Details

First Author: V.Gupta INDIA

Co Author(s):    D. Singh   D. Aggarwal   D. Aditya   D. Madhu   D. Javed   D. Aparna     

Abstract Details


To compare the efficacy and outcome of phacoemulsification by torsional mode versus the combined torsional and longitudinal ultrasound mode in hard cataract (Nuclear Grade III/IV) and to study and compare operative and post operative effects of the two ultrasound modes on ocular tissues.


Study carried out at Dr Baba Saheb Ambedkar Hospital, New Delhi,India, a tertiary care hospital located in urban area which caters to both Urban and Rural Population.


Randomized Prospective Interventional Comparative Study. 100 eyes with grade III and IV were randomized either to combined torsional and longitudinal Phacoemulsification or pure torsional phacoemulsification. Surgeries were performed using Infiniti Vision System (Alcon Laboratories), same settings were used by a single surgeon. Pre- and post-operative (day 1, 7, 14 and 28) assessments included CDVA, IOP, CCT, Endothelial cell count (ECC). Intra-op Ultra Sound Time (UST), Cumulative Dissipated Energy (CDE), BSS (fluid) used were noted. Variables are compared using Unpaired t-test/Mann-Whitney/Chi-Square test /Fisher’s exact test between the groups. p value <0.05 was considered significant.Analysis was done using SPSS version 21.0


No significant differences in demographic or ocular characteristics of the study groups at baseline. CDE and UST analysis revealed significant results favoring pure torsional group in both the grades. BSS used was significantly lower in grade III cataract undergone pure torsional phacoemulsification. CDVA on day one of pure torsional group had significantly better vision than combined group. Transient increase in IOP on day one in both the groups but significantly lesser in combined group in grade III cataracts, day 28 no significant difference. CCT was significantly higher in combined group in grade III on day one, day seven onwards no significant difference. Significant decrease in ECC in combined group on day 1 and 7 which later became non significant


Torsional mode should be preferred choice for phacoemulsification in grade III cataracts. For grade IV cataracts both combined and torsional modality can be used equivocally. No need to change your settings for different grades of cataracts and pure torsional mode alone suffice our need and is better in terms that there are fewer restrictions on patient physical activities in early post operative period in torsional mode compare with other combined procedure i.e. early and better visual rehabilitation following torsional phacoemulsification.

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