Can Torsional Phacoemulsification Decrease the Risk for Corneal Decompensation in Fuchs

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Can Torsional Phaco Decrease the Risk for Corneal
Decompensation in Fuchs Endothelial Dystrophy
RCT
M. Doors, MD Tos T.J.M. Berendschot, PhD
Carroll A.B. Webers, MD, PhD Rudy M.M.A. Nuijts
MD, PhD
The authors have received research funding from
Alcon
University Eye Clinic azMaastricht
April 7-9 2010 Boston
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Torsional vs Longitudinal

• Goal phaco technology
• Reducing US power and improving its efficiency
• Longitudinal ? repulsion
• Torsional ? rotary oscillations ? no repulsion
• 2 studies comparing torsional vs longitudinal
  mode in healthy eyes1,2
• Torsional mode
• Lower US time and CDE
• CCT significantly thinner at 1 day and 1 week
  postoperatively
• Faster visual recovery
• Less endothelial cell loss

1Liu, JCRS 2007287 2 Zeng, BJO 20081092
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Purpose and Methods

• To compare the effect of torsional and
  longitudinal phaco on CT and corneal volume in
  patients with Fuchs endothelial dystrophy
• RCT torsional (n26) vs longitudinal (n26)
• Inclusion
• Patient with FED needing cataract surgery gt 40
  years old
• Exclusion
• Previous corneal/intraocular surgery and other
  visually significant ocular diseases (AMD)

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Methods

• Randomisation
• Nucleus density grade (LOCS II)
• Stage of Fuchs disease
• Age
• Phacoemulsification with soft shell technique
• Investigator and patient blinded for treatment
• Visante OCT
• Pachymetry map
• Pentacam
• Corneal volume

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Results

• Follow-up visits 1 day, 1 week, 1 month, 3
  months, 6 months
• Preliminary results mean follow-up 5.5 1.2
  months (range 1-6 months)
• Mean age 72.4 7.8 years
• 20 Men, 32 Female

1 day Postoperatively CCT 733 µm
PreoperativelyCCT 655 µm
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Longitudinal vs. TorsionalPreoperative
Longitudinal (n26) Mean SD Torsional (n26) Mean SD P-value
Stadium Fuchs 1.77 0.77 1.73 0.78 0.858
Nucleus Density (0-3) 1.81 0.90 1.62 0.90 0.443
OCT CCT (µm) 593 50 591 52 0.917
OCT 12 oclock CT (µm) 695 49 685 65 0.513
OCT 6 oclock CT (µm) 642 43 639 53 0.821
PC mean volume (mm3) 60.6 4.3 60.8 5.2 0.843
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Longitudinal vs TorsionalIntraoperative
Longitudinal (n22) Mean SD Torsional (n23) Mean SD P-value
Total US time (mmss) 0129 0044 0057 0025 0.003
CDE 24.37 16.65 11.45 6.14 0.001
BSSuse quad removal (ml) 85.8 38.0 62.6 22.1 0.010
US equivalent position 3 17.6 4.9 19.3 2.6 0.123
Aspiration time (mmss) 0607 0219 0518 0138 0.151
Operating time (minutes) 1157 409 1026 308 0.140
No intraoperative complications
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Nucleus Density and CDE
Harder nucleus was associated with higher CDE
(r .587 Plt0.001)
P0.004
P0.002
Blue longitudinal Green torsional
CDE lower in torsional group, especially for hard
nucleus!
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Longitudinal vs TorsionalPostoperative
Blue longitudinal Green torsional
No significant differences P gt 0.05
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Longitudinal vs TorsionalPostoperative

Blue longitudinal Green torsional
Significant difference P 0.010
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Correlations CCT and CDE
r 0.440 P 0.001
r 0.460 P 0.001
Higher preoperative CCT and higher CDE were
associated with larger postoperative increase in
CCT
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Conclusions

• Higher preoperative CCT and higher CDE were
  associated with a larger postoperative increase
  in CCT
• Torsional mode may provide more effective lens
  removal with a shorter total US time and lower
  CDE, especially in patient with a hard nucleus