Comparison of Endothelial Cell Changes between Torsional and Conventional mode Phacoemulsification

Main Article Content

Pornchai Simaroj
Nattaya Sinprasertkool
Walee Chochaichamnankit
Nutsuchar Wangtiraumnuay
Kaevalin Lekhanont


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
Simaroj, P., Sinprasertkool, N., Chochaichamnankit, W., Wangtiraumnuay, N., & Lekhanont, K. (1). Comparison of Endothelial Cell Changes between Torsional and Conventional mode Phacoemulsification. Ramathibodi Medical Journal, 39(2), 110-116. Retrieved from
Original Articles


1. 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.

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

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

8. 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.

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

10. 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.

11. 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.

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