TESTUPLOAD

TORSIONAL PHACOEMULSIFICATION

In January 2006 Alcon Surgical incorporated Ozil torsional into the Infiniti Vision System. Unlike the conventional longitudinal phacoemulsification which emulsifies the lens with forward and backward movement of the phaco tip, Ozil torsional technology produces a side-to-side motion of the phaco tip.Efficiency is increased with this technology since it does not produce repulsion and breaks up the nucleus by shearing and not by the conventional jackhammer effect.

TORSIONAL PHACOEMULSIFICATION

Straight Phaco Tip 45 º Bent Phaco TipShearing effect increases with the use of bent tips.

OZil® IP (Intelligent Phaco)

Total occlusion decreases the efficiency of torsional US by causing the lost of the optical shearing plane, generally combined torsional/longitudinal US mode was chosen for emulsification.

Recently Intelligent Phaco (IP) upgrade which delivers a very small amount (short pulse) of longitudinal US just before the occlusion is complete, added to Ozil torsional technology to further increase its efficiency.

OZil® IP (Intelligent Phaco)

OZil® IP does is avoid a complete occlusion of the tip and maintain the right shearing plane and keep the

emulsification on going.

Static, occluded or blocked tip impacts followability,

allowing fragments to fall away from tip

The Study

PURPOSE: To compare the safety and efficacy of microcoaxial phacoemulsification surgeries performed with Ozil Intelligent Phaco (IP) torsional mode and combined torsional/longitudinal ultrasound (US) mode using Infiniti Vision System.

METHODS

Between January and May 2010 microcoaxial phacoemulsification with Ozil IP torsional mode (G1) was performed in 30 eyes of 30 patients and microcoaxial phacoemulsification with combined torsional/longitudinal US mode (G2) was performed in 30 eyes of 30 patients by using the Infiniti Vision System (Alcon Laboratories).O.9 mm 30-degree mini-flare 12-degree bent tip was used in all of the operations..The intrepid ClearCut 2.2 mm dual-bevel metal keratome (Alcon) was used for 2.2 mm incisions.

METHODS

Patients were examined for; Intraoperative complications, Mean US times, Longitudinal US amplitudes Torsionel US amplitudes, Cummulative Dissipated

Energy (CDE) Postoperative outcome

measures were anterior chamber reactions, change in the corneal clarity, central corneal thickness (CCT), early uncorrected visual acuity (UCVA) and final best corrected visual acuity (BCVA).

METHODS

Anterior chamber reactions and Corneal edema were graded as

Anterior Chamber Reactions:

None, Mild (1-3 cells in 16X field), Moderate (3-10 cells in 16X field), Severe

Corneal edemaNone, Mild, Moderate, Severe

0

0,5

1

1,5

2

2,5

3

3,5

4

Mean Nucleus Grades (LOCSII)

GROUP 1

GROUP 2

NUCLEUS GRADES

2,132,23

P=0,629 (P>0,05) Mean nucleus gradesof the groups were similar.

Ozil IPPhaco 1 - Grooving Aspiration Vacuum Ozil IP 28 cc/min. 50 mmHg %80 Linear Panel LinearPhaco 2 - Chopping Aspiration Vacuum Ozil IP 32 cc/min. 330 %80 Linear Linear LinearIP pulse: 10% longitudinal torsional ratio.IP vacuum threshold: 95% of the maximum Pulse length: 10 ms.

Torsionel/Longitudinal Phaco 1 - Grooving Aspiration Vacuum Ozil/Long. 28 cc/min. 50 mmHg %40-%60 Linear Panel LinearPhaco 2 - Chopping Aspiration Vacuum Ozil/Long. 32 cc/min. 350 %40-%60 Linear Linear Linear

PARAMETERS

ENERGY PARAMETERSGROUP 1 (OZiL IP)

Mean US Time: 1 min 21 sec (SD 35.56 sec)

Mean longitudinal US amp: 0.55 (SD 0.49)

Mean torsionel US amp: 26.96 (SD 9.33)

CDE: 10.18 (SD 6.22)

GROUP 2 (OZiL/LONGITUDINAL)Mean US Time:

1 min 58 sec (SD 55.86 sec)Mean longitudinal US amp:

3.86 (SD 1.75)Mean torsionel US amp:

3.92 (SD 1.41)CDE:

9.89 (SD 7.00)

US time and phaco amplitudes were found lower in group 1 where as torsional amplitude was found higher in this group. CDE values were similar. (p1=0,014, p2=0,001, p3= 0,001, p4= 0,874)

OPERATION TIMES AND VOLUME OF BSS USED

GROUP 1 (OZiL IP)Mean operation time:

15 min 56 sec (SD 4 min14sec)Mean volume of BSS used:

65.25 cc (SD 17.54)

GROUP 2 (OZiL/LONGITUDINAL)Mean operation time:

15 min 29 sec (SD 3 min 43sec)Mean volume of BSS used:

84.55 cc (SD 28.35)

Mean operation times were similar: p=0,779

Statistically Significantly less amount of BSS used in group 1

p=0,017

0

0,2

0,4

0,6

0,81

1,2

1,4

1,6

1,8

2

Postoperative Corneal Edema

GR 1GR 2

POSTOPERATIVE CORNEAL EDEMA

0,500,53

P=0,823 (P>0,05) Postoperative meanCorneal edema of the groups were similar

0

20

40

60

80

100

120

140

Postoperative CCT Changes

GR 1GR 2

CCT CHANGES

92,60 µ 96,70 µ

Preop mean pachymeter readings: G 1= 536,65 µ G 2= 515,65 µP=0,874 (P>0,05) post-op CCT changes of the groups were similar

0

0,2

0,4

0,6

0,81

1,2

1,4

1,6

1,8

2

Anterior Chamber Reactions

GR 1GR 2

ANTERIOR CHAMBER REACTIONS

0,560,50

P=0,625 (P>0,05) mean anteriorchamber reactions of the groupswere similar

Early UCVA and 3rd week BCVA of the groups (Snellen):

G 1: 0,56 / 0,83 G 2: 0,57 / 0,67

P=0,881 (P>0,05) Mean post-op UCVA of the groups were similarMean BCVA of G1 was found statistically insignificantly higher than G2 P=0,081 (P>0,05) There was not any complication affecting the visual outcome in both groups.

POSTOPERATIVE VISUAL ACUITY

DISCUSSION

Ozil torsional phaco is one of the important innovations in phacoemulsification technologies. Unlike the conventional longitudinal phaco, it produces a side-to-side motion of the phaco tip (1).

Shearing effect is produced by the convertion of torsional movement to horizontal side to side motion by the aid of bent tips (2).

1. Liu Y, Zeng M, Liu X, Luo L, Yuan Z, Xia Y, Zeng Y. Torsional mode versus conventional ultrasound mode phacoemulsification; randomized comparative clinical study. J Cataract Refract Surg 2007;33:287–292

2. Davison JA. Cumulative tip travel and implied followability of longitudinal and torsional phacoemulsification. J Cataract Refract Surg 2008;34:986–990

DISCUSSION

The clinnical advantages of torsional technology are (3,4); Efficient shearing effect results in less repulsion, Decreased turbulance, Less amount of heat production, More stable anterior chamber. Increased followability.

3. Zeng M, Liu X, Liu Y, Xia Y, Luo L, Yuan Z, Zeng Y, Liu Y. Torsional ultrasound modality for hard nucleus phacoemulsification cataract extraction. Br J Ophthalmol 2008; 92:1092–1096

4. Hoffman RS, Fine IH, Packer M. New phacoemulsification technology. Curr Opin Ophthalmol 2005; 16:38–43

DISCUSSION

Total occlusion of the tip should be avoided to have the the maximum efficiency of torsional phaco.

IP (Intelligent Phaco) delivers a very small amount (short pulse) of longitudinal US just before the occlusion is complete,

With the IP upgrade; Occlusions decrease, Diminished risk of clogging More stable anterior chamber, Shifts in th IOP decrease, The eye is kept in a more natural state throughout the surgery

DISCUSSIONWith the aid of IP upgrade the surgeries were performed safely and efficiently by using torsional phaco only.

Following safety and efficacy measures were found similar between the Ozil IP and combined torsional/longitudinal groups:

CDE, CCT changes Visual acuities

UST and volume of BSS used were significantly lower in IP group.

No complications were observed in both groups

CONCLUSION

Ozil IP torsional mode may provide more effective lens removal than combined torsional/longitudinal US mode with a lower UST and volume of BSS used.