"Ultrasound-Assisted High-Fluidics Phacoaspiration": An Efficient and Safe Technique for Nucleus Quadrant Workup Through 2.2 mm Mini- and 1.6 mm Micro-Incisions Following Manual or Femtosecond Laser Sectorial Lens Fragmentation.

Purpose: To evaluate the efficiency and safety of high-fluidics ultrasound emulsification using slim-shaft-strong-bevel (SSSB) tip technology for nucleus workup through mini- and micro-incisions. Materials and

Methods

77 patients underwent immediate sequential bilateral cataract surgery using high-flow-high-vacuum easyTip®2.2 ("eT2.2") or infusion-assisted ("Hybrid") easyTip®COMICS ("eT1.6 iaCOMICS") coaxial phacoemulsification. Surgical time (ST), Effective Phacoemulsification Time (EPT), and fluid consumption (FC), central corneal thickness (CCT), and endothelial cell count (ECC) were recorded.

Results

50 patients completed the 6 months follow-up. Preoperatively, groups did not differ in nuclear hardness, CCT, or ECC. The median ST for Conquer with eT2.2 phaco was 49 s, with eT1.6 iaCOMICS phaco 57 s (p = 0.021). The median total EPT was 8.3 and 8.0 (p = 0.882), and the median EPT for Conquer was 4.0 and 4.1, respectively (p = 0.812). The median FC for Conquer was 21 mL with the eT2.2 and 22 mL with the eT1.6 iaCOMICS phaco (p = 0.29), and the overall FC was 29 mL and 33 mL, respectively (p = 0.105). Mean CCT was 561 ± 42 µm and 563 ± 45 µm on day 1 (p = 0.835), 539 ± 33 µm and 542 ± 34 µm at 1 week (p = 0.714), and 536 ± 31 µm and 541 ± 33 µm at 6 months (p = 0.55), respectively. Mean ECL at 6 months was 2.80 ± 7.28% and 3.41 ± 8.25% (p = 0.725).

Conclusions

When compared to previously published results obtained with a standard non-waisted phaco needle and lower fluidics and with the waisted easyTip®2.2 run with intermediate fluidics, ultrasound-assisted high-fluidics phacoaspiration with the easyTip®2.2 through a 2.2 mm incision and the easyTip® COMICS through a 1.6 mm incision with infusion-assistance significantly improved efficiency of nucleus workup by reducing ultrasound energy and infusion fluid consumption, with minimal transient corneal stroma swelling and low endothelial cell loss.