Abstract:

Objective To determine the influence of round blunt phaco tips on efficiency and safety in conventional phacoemulsification. Design Prospective cohort study. Participants This study enrolled 406 eyes of 342 senile cataract patients who had undergone phacoemulsification between October 2014 and December 2015 in the Second Affiliated Hospital of Zhengzhou University. Methods The eyes were divided into 2 groups according to its nuclear hardness, and phacoemulsification in each group was performed with round blunt phaco tips or standard phaco tips randomly. Main Outcome Measures Surgical time (ST), average ultrasound energy (AVE), accumulative phaco time (APT), effective phaco time (EPT), the rate of posterior capsule rupture and the central corneal thickness (CCT) preoperatively and postoperatively at 1 day. Results Clinical characteristics such as age and sex were similar in both tip groups of each nuclear hardness group (all P＞0.05). There was no statistical difference in all of intraoperative parameters between the two tip groups for patients with non-hard nuclear (all P＞0.05). In hard nuclear group, AVE (42.2%±5.1%, 38.9%±6.4%, P=0.004) and EPT(15.53±3.47 s, 13.34±3.18 s, P=0.001) were significantly higher in round blunt phaco tip group than in standard phaco tip group. But the rest of intraoperative parameters showed no difference between different tip groups (all P＞0.05). The overall incidence of posterior capsule rupture was 4.18%, with 3.79% in non-hard nuclear group and 5.17% in hard nuclear group respectively. In non-hard nuclear group, the incidence of posterior capsule rupture was 1.42% and 6.52% with round blunt phaco tips and standard phaco tips respectively (P=0.035). In hard nuclear group, the incidence of posterior capsule rupture was 1.78% and 9.26% with round blunt phaco tips and standard phaco tips (P=0.225). The change in CCT was similar in both tip groups for non-hard nuclear group (78.5±50.6 μm, 71.6±53.3 μm, P=0.263). But for hard nuclear patients, the change in CCT was significantly thicker in the round blunt phaco tip group (220.8±36.3 μm）, than that of traditional tip group（98.4±53.1 μm, P=0.01). Conclusion The round blunt phaco tip is a reliable and safe option in phacoemulsification, the rate of posterior capsule rupture can be reduced, but the average ultrasound energy and effective phaco time were increased for hard nuclear. (Ophthalmol CHN, 2017, 26: 79-83）

Key words: cataract/ surgery, phacoemulsification, phaco tip