Can we improve the efficacy of modern cataract surgery by using different tip designs? A comparison of balanced and tapered tip in femtosecond laser-assisted cataract surgery and manual phacoemulsification

Abstract

Importance: Different tip designs in modern cataract surgery have not been studied between the reported systems.

Background: Aim of this study is to assess the efficacy of two tip designs, Intrepid® balanced tip (BT) and Kelman tapered tip (TT), in femtosecond laser assisted cataract surgery (FLACS) and the microcoaxial torsional phacoemulsification.

Design: Prospective randomized unmasked cohort outcome study (hospital setting).

Participants: Threehundert-forty-three eyes of 343 patientes underwent cataract surgery.

Methods: Data of n = 196 FLACS and n = 147 manual phacoemulsification were analysed. Intrepid® balanced tip and Kelman tapered tip, Alcon, USA, were tested in FLACS (LenSx Alcon, USA) und manual phaco (Alcon Centurion System, USA). Four study cohorts were formed; FLACS BT (n = 90, 70.2 years), FLACS TT (n = 106, 68.1years), Manual BT (n = 70, 71.3 years), Manual TT (n = 77, 71.8 years). The nuclei were graded in Lens Opacities Classification System (LOCS) II,III and IV.

Main outcome measures: Cumulative dissipated energy (CDE%s), balanced salt solution volume (BSSml), total longitudinal energy (%s) and torsional amplitude (%s).

Results: Lower CDE values were seen in FLACS compared to manual phacoemulsification (CDE %s median FLACS BT 3.28, FLACS TT 4.07, Manual BT 5.57, Manual TT 6.27). There was a significant difference between CDE FLACS BT and FLACS TT (p = 0.038), and between FLACS BT and Manual TT (p = 0.001).

Conclusions and relevance: The right choice of tip designs in advanced phacoemulsification systems is a key factor in increasing efficacy in cataract surgery. The balanced tip showed a considerable energy-saving advantage in FLACS and manual phacoemulsification compared to the tapered tip.

Keywords: Intrepid balanced tip; Kelman tapered tip; femtosecond laser-assisted cataract surgery; phacoemulsification.