Results of endocapsular phacofracture debulking of hard cataracts

Figures & data

Table 1 Ultrasonic energy and fluidic parameters for longitudinal and torsional (IP) quadrant removal

	Longitudinal	IP
Scultp
Bottle	78	78
Phaco	70	70
Vacuum	50	50
AFR	14	14
Rise	0	0
Quadrant removal
Bottle	85	85
Phaco	70a	100b
Vacuum	400	400
AFR	35	35
Rise	−1	−1

Notes:

a Continuous longitudinal;

b continuous IP with IP 90% vacuum trigger and 1:1 ratio and 0.7 seconds on time, with a minimum of 2 seconds continuous torsional prior to next activation.

Abbreviations: IP, Intelligent Phaco; AFR, aspiration flow rate.

Figure 1 Aspiration of first quadrant.

Notes: (A) In foot position 3 (FP 3), the obliquely oriented tip is shaving the firm corner off the fourth quadrant in the final step of debulking the nucleus and creating a thin nuclear bowl. Low vacuum at 50 mmHg and low flow at 14 cc/min prevent occlusion and inadvertent aspiration. (B) In FP 2, the obliquely oriented phaco tip aperture is poised in an access orientation to apply suction to the side of the first nuclear plate. Vacuum is starting to build and has reached 105 mmHg. (C) A tiny burst of low-power ultrasound has allowed the tip aperture to become occluded. Power has then been discontinued and vacuum has built to 368 mmHg and is providing good suction adherence. This allows the first nuclear plate to be rolled into the bowl, which is now partial as it is comprised of three remaining plates. The longer –1 rise time allows about 1 second to acquire and roll in the fragment before reaching maximum vacuum. (D) The nuclear fragment is held within the anterior central bowl by the nuclear plates, the phaco tip, and the cyclodialysis the custom 0.35 mm cyclodialysis spatula (SP765852, Baush + Lomb Stortz, Bridgewater, NJ, USA). Intermediate levels of vacuum, ultrasonic energy and flow simultaneously and in concert deform and emulsify the progressively smaller fragment while aspirating the emulsate.
Abbreviations: IP, Intelligent Phaco; CDE, cumulative dissipated energy; Irr, irrigation; Asp, aspiration; Vac, vacuum.

Figure 2 Emulsification and removal of subsequent nuclear plates.

Notes: (A) After the first quadrant has been aspirated, the cyclodialysis spatula is pushing on the peripheral edge of the fourth quadrant which easily rotates the second quadrant clockwise into its access position. (B) Flow of fluid has brought the fragment close to the tip aperture, and vacuum has reached 88 mmHg as the obliquely oriented aperture is acquiring the edge of the second plate. (C) Roll in centralization is assisted by the cyclodialysis spatula. It also then contains the plate’s position as it is being emulsified. The remaining two plates continue to form a partial bowl which creates a floor to insulate the posterior capsule from inadvertent aspiration. (D) The physical buffer of the nuclear bowl is gone as the fourth plate is being rolled into the iris plane for emulsification and removal. The cyclodialysis spatula helps manipulate and contain, but is mostly positioned under the phaco tip to protect the posterior capsule. Viscoelastic reinjection prior to this step pushes the posterior capsule back and insulates the corneal endothelium.
Abbreviations: IP, Intelligent Phaco; CDE, cumulative dissipated energy; Irr, irrigation; Asp, aspiration; Vac, vacuum.

Table 2 Preoperative and intraoperative case characteristics

	n	Mean age	NC range	NC mean
Longitudinal	24	77.4	3.8–5.1	4.2
IP	32	74.4	3.8–5.0	4.3
Overall	56	75.7	3.8–5.1	4.26

Abbreviations: NC, LOCS III nuclear color; IP, Intelligent Phaco.

Table 3 Postoperative results for ECD loss and SIA

	CDE*	Preoperative ECD	Postoperative ECD	Difference	% loss*	SIA (D)*
Longitudinal	55.7±15.5	2,765	2,603	162	5.9±13.4	0.30±0.2
IP	48.6±15.1	2,680	2,607	73	2.7±7.8	0.40±0.2
Overall	51.6±15.6	2,716	2,606	110	4.1±10.8	0.36±0.2

Note:

* P>0.05.

Abbreviations: ECD, endothelial cell density; SIA, surgically induced astigmatism; CDE, cumulative dissipated energy; D, diopter; IP, Intelligent Phaco.