Effectiveness of High Vacuum Versus Lower Vacuum With New Phacoemulsification Console With Active Fluidics
Narrative Responses:
Purpose
A new phacoemulsification machine with Active Fluidics has been introduced (Centurion). Initial evaluation showed very stable anterior chamber even with high fluidics settings. This prospective observational study is designed to test how efficiently and how safely it works with high (600mmHg) vacuum compared to moderate (350mmHg) vacuum.
Methods
Surgery was performed by 2 experienced surgeons, using the Centurion Vision System with torsional ultrasound, using incisions of 2.2, 2.0 and 1.8 mm. A stop and chop technique was used and one heminucleus was removed with peak vacuum of 600mmHg and the other with 350mmHg vacuum – all other fluidic parameters were the same, including a target IOP of 40 mmHg (equivalent to bottle height 54 cm). Surgical video was analyzed for AC stability and time to remove each heminucleus, and the console’s metrics data screen used to record phaco energy (CDE) and fluid use.
Results
80 eyes were operated on with each incision size. Analysis of surgical video showed very stable anterior chambers, and no surgical complications. Phaco energy used, and time to remove the heminucleus were significantly less (p<0.001) with the higher vacuum settings. As expected IP was active more with the low vacuum settings (as measured by ‘longitudinal on time’ which was also highly significant p<0.001)). BSS fluid use was also significantly less in the high vacuum group (p<0.05).
Conclusion
Surgery was safely and efficiently performed with high vacuum settings despite using a relatively low IOP during the procedure (equivalent bottle height 54cm). The use of smaller bore phaco needles with smaller incisions will be facilitated by this new system due to the ability to use high vacuums safely.