Effect of high-vacuum setting on phacoemulsification efficiency

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  2. David Steel
Author(s)Ting D, Rees J, Ng J, Allen D, Steel DH
Publication type Article
JournalJournal of Cataract and Refractive Surgery
ISSN (print)0886-3350
ISSN (electronic)1873-4502
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Purpose: To investigate the effect of high vacuum versus low vacuum settings on the efficiency of phacoemulsification.Setting: Sunderland Eye Infirmary, UK. Design: Prospective, interventional, non-randomized controlled trial. Methods: Patient population: 160 eyes of 160 patients who underwent cataract surgery in 2014 were sequentially recruited. Intervention: Cataract surgery was performed by two experienced surgeons using a phacoemulsification machine with monitored forced infusion. Dichotomous vacuum settings (350mmHg vs. 600mmHg) were employed during the nucleus removal stages of surgery with standardization of other fluidics settings. Cataractous lens was split into two hemi-nuclei using stop-and-chop technique, with one hemi-nucleus being phacoemulsified and aspirated using high vacuum setting (treatment group) and the other hemi-nucleus with low vacuum setting (control group). The order in which the high and low vacuum settings were used in each case was alternated by operating list to reduce surgeon bias. Main outcome measure: Cumulative dissipated energy (CDE) and active hemi-nucleus removal time. Results: The CDE per hemi-nucleus was significantly lower with high vacuum setting than with low vacuum setting (mean 2.81 percent-seconds, 95% confidence interval (CI), 2.44-3.21 vs. 3.81 percent-seconds, 95% CI, 3.38-4.20; p<0.001). The active hemi-nucleus removal time was significantly shorter in high vacuum group than low vacuum group (mean 27.77 seconds, 95% CI, 25.26-30.19 vs. 33.59 seconds, 95% CI, 31.07-35.92; p<0.001). These differences in CDE and active hemi-nucleus removal time between the two vacuum settings were independent of the surgeon, patient’s age and sex, incision size, or nucleus density. No intraoperative complications were observed in either group. Conclusions: High vacuum setting improves phacoemulsification efficiency using an active fluidics system and torsional phacoemulsification.
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