Comparison of Endothelial Cell Changes between Torsional and Conventional mode Phacoemulsification

Main Article Content

Pornchai Simaroj
Nattaya Sinprasertkool
Walee Chochaichamnankit
Nutsuchar Wangtiraumnuay
Kaevalin Lekhanont

Abstract

Objective:To compare corneal endothelial cell loss in cataract surgery performed with conventional phacoemulsification and torsional phacoemulsification at Ramathibodi hospital.


Methods: Prospective randomized double-blind controlled trial study at Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University. Fifty eyes of 50 patients with grade 2 to 4 senile cataract (according to the Oxford classification) were randomized to have either conventional mode or torsional (OZil) mode phacoemulsification using the Infiniti Vision System. All surgeries were performed by a single experienced surgeon. A complete ophthalmologic examination was performed preoperatively and postoperatively at 1 and 7 days, and 1, 3, 6, and 12 months. Central corneal thickness (CCT) and endothelium cell parameters were measured preoperatively and postoperatively at 3, 6 and 12 months. Primary outcomes were best-corrected visual acuity (BCVA), endothelial cell density (ECD) and CCT.


Results: Preoperatively, there was no significant difference in cataract grading between 2 groups. The mean preoperative ECD was 2,521.62 ± 331.32 (1,784-3,206) cell/mm2 in the conventional group (28 patients) and 2,631.52 ± 290.75 (1,742-3,127) cell/mm2 in the torsional group (22 patients). The mean postoperative ECD at 12 months was 2,315.21 ± 385.45 (1,245-3,183) and 2,261.82 ± 292.64 (1,672-2,872) cell/mm2 in the conventional and torsional groups respectively. The mean endothelial cell loss was 9.70% in the conventional group and 12.68% in the torsional group, with no statistically significant difference between the two groups (P = 0.54). No significant differences in postoperative BCVA and CCT were found between the 2 groups.


Conclusions: Torsional mode phacoemulsification appears to be safe for corneal endothelial cells as well as conventional mode. 

Article Details

How to Cite
1.
Simaroj P, Sinprasertkool N, Chochaichamnankit W, Wangtiraumnuay N, Lekhanont K. Comparison of Endothelial Cell Changes between Torsional and Conventional mode Phacoemulsification. Rama Med J [Internet]. 2016 Jun. 30 [cited 2024 Mar. 29];39(2):110-6. Available from: https://he02.tci-thaijo.org/index.php/ramajournal/article/view/57627
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Original Articles

References

Reuschel A, Bogatsch H, Barth T, Wiedemann R. Comparison of endothelial changes and power settings between torsional and longitudinal phacoemulsification. J Cataract Refract Surg. 2010;36(11):1855-1861. doi:10.1016/j.jcrs.2010.06.060.

Zacharias J. Role of cavitation in the phacoemulsification process. J Cataract Refract Surg. 2008;34(5):846-852. doi:10.1016/j.jcrs.2008.01.013.

Davison JA. Cumulative tip travel and implied followability of longitudinal and torsional phacoemulsification. J Cataract Refract Surg. 2008;34(6):986-990. doi:10.1016/j.jcrs.2008.02.029.

Liu Y, Zeng M, Liu X, et al. Torsional mode versus conventional ultrasound mode phacoemulsification: randomized comparative clinical study. J Cataract Refract Surg. 2007;33(2):287-292.

Zeng M, Liu X, Liu Y, et al. Torsional ultrasound modality for hard nucleus phacoemulsification cataract extraction. Br J Ophthalmol. 2008;92(8):1092-1096. doi:10.1136/bjo.2007.128504.

Werblin TP. Long-term endothelial cell loss following phacoemulsification: model for evaluating endothelial damage after intraocular surgery. Refract Corneal Surg. 1993;9(1):29-35.

Sugar J, Mitchelson J, Kraff M. The effect of phacoemulsification on corneal endothelial cell density. Arch Ophthalmol. 1978;96(3):446-448.

Walkow T, Anders N, Klebe S. Endothelial cell loss after phacoemulsification: relation to preoperative and intraoperative parameters. J Cataract Refract Surg. 2000;26(5):727-732.

Bourne WM, Nelson LR, Hodge DO. Continued endothelial cell loss ten years after lens implantation. Ophthalmology. 1994;101(6):1014-1022.

Bozkurt E, Bayraktar S, Yazgan S, et al. Comparison of conventional and torsional mode (OZil) phacoemulsification: randomized prospective clinical study. Eur J Ophthalmol. 2009;19(6):984-989.

Storr-Paulsen A, Norregaard JC, Ahmed S, Storr-Paulsen T, Pedersen TH. Endothelial cell damage after cataract surgery: divide-and-conquer versus phaco-chop technique. J Cataract Refract Surg. 2008;34(6):996-1000. doi:10.1016/j.jcrs.2008.02.013.

Lesiewska-Junk H, Kaluzny J, Malukiewicz-Wisniewska G. Long-term evolution endothelial cell loss after phacoemulsification. Eur J Ophthalmol. 2002;12:30-33.