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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 az Maastricht. - PowerPoint PPT Presentation
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Can Torsional Phaco Decrease the Risk for Corneal Decompensation in Fuchs
Endothelial Dystrophy: RCT
University Eye ClinicazMaastricht
April 7-9 2010 Boston
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
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 2007;2872 Zeng, BJO 2008;1092
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 (n=26) vs longitudinal (n=26) • Inclusion:
– Patient with FED needing cataract surgery > 40 years old
• Exclusion:– Previous corneal/intraocular surgery and other
visually significant ocular diseases (AMD)
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
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
PreoperativelyCCT 655 μm
1 day Postoperatively
CCT 733 μm
Longitudinal vs. TorsionalPreoperative
Longitudinal (n=26)
Mean ± SD
Torsional (n=26)
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 o’clock CT (μm) 695 ± 49 685 ± 65 0.513
OCT 6 o’clock CT (μm) 642 ± 43 639 ± 53 0.821
PC mean volume (mm3) 60.6 ± 4.3 60.8 ± 5.2 0.843
Longitudinal (n=22)Mean ± SD
Torsional (n=23)Mean ± SD P-value
Total US time (mm:ss) 01:29 ± 00:44 00:57 ± 00:25 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 (mm:ss) 06:07 ± 02:19 05:18 ± 01:38 0.151
Operating time (minutes) 11:57 ± 4:09 10:26 ± 3:08 0.140
No intraoperative complications
Longitudinal vs TorsionalIntraoperative
Harder nucleus was associated
with higher CDE (r = .587; P<0.001)
CDE lower in torsional group, especially for hard nucleus!
Nucleus Density and CDE
Blue = longitudinal Green = torsional
P=0.002
P=0.004
Longitudinal vs TorsionalPostoperative
No significant differences P > 0.05Blue = longitudinal; Green = torsional
Longitudinal vs TorsionalPostoperative
*Significant difference P = 0.010
*
Blue = longitudinal; Green = torsional
Correlations CCT and CDE
Higher preoperative CCT and higher CDE were associated with larger postoperative increase in CCT
r = 0.440
P = 0.001
r = 0.460
P = 0.001
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