Schmidt Sabine, Hubich Sophie, Vetter Jan Markus, Wirbelauer Christopher
Augenklinik Berlin-Marzahn GmbH.
Klin Monbl Augenheilkd. 2018 Aug;235(8):889-893. doi: 10.1055/s-0043-124083. Epub 2018 Feb 16.
Torsional mode phacoemulsification results in more effective fragmentation of the nucleus due to a different movement of the phacotip. In this clinical study, we investigated the influence of a modified tip design and active fluidics on the efficacy of phacoemulsification and safety for the corneal endothelium.
We conducted a prospective randomized 2 : 1 study in which 40 patients were operated on with the mini-flared Kelman Tip using the Infiniti System (group 1), and 20 patients were operated on with the Intrepid Balanced Tip and the Centurion System. We analyzed the intraoperative cumulative dissipated energy and also the density of the corneal endothelium measured with an endothelial microscope (CEM 530, Nidek) pre- and postoperatively.
Both groups did not differ preoperatively in age, sex, axial length of the globe or corneal endothelium cell density nor cataract density (LOCS3). All surgeries were uneventful. The cumulative dissipated energy in group 1 (mini-flared Kelman tip, Infiniti System) was 38% higher than in group 2 (balanced tip, Centurion System; p < 0.05). The endothelial cell loss was 8% in group 1 and 10.3% in group 2 (p > 0.05). The cell size (polymegathism) increased in both groups significantly with + 37 µm in group 1 (p < 0.05) und + 54 µm in group 2 (p < 0.05). There was no statistically significant difference between both groups (p > 0.05). The number of hexagonal cells (pleomorphism) and corneal thickness did not differ in both groups either pre- nor postoperatively.
Compared to torsional phacoemulsification with a mini-flared Kelman Tip and gravity fluidics, torsional phacoemulsification with a modified tip design and active fluidics is 38% more effective regarding the cumulative dissipated energy. Endothelial cell loss occurs to a similar extend using both systems. The postoperative changes in cell size (polymegathism), number of hexagonal cells (pleomorphism) and corneal thickness (pachymetry) were similar among both systems. We conclude, that the intraoperative stress on the endothelium is equivalent with both systems used.
扭转模式超声乳化术由于超声乳化头的不同运动方式，能使晶状体核更有效地破碎。在这项临床研究中，我们调查了改良的超声乳化头设计和主动流体学对超声乳化术疗效及角膜内皮安全性的影响。
我们进行了一项前瞻性随机2∶1研究，其中40例患者使用Infiniti系统的微型喇叭口Kelman超声乳化头进行手术（第1组），20例患者使用Intrepid平衡超声乳化头和Centurion系统进行手术。我们分析了术中累积耗散能量，以及术前和术后用内皮显微镜（CEM 530，尼德克）测量的角膜内皮密度。
两组患者在年龄、性别、眼轴长度、角膜内皮细胞密度或白内障密度（LOCS3）方面术前均无差异。所有手术均顺利完成。第1组（微型喇叭口Kelman超声乳化头，Infiniti系统）的累积耗散能量比第2组（平衡超声乳化头，Centurion系统）高38%（p<0.05）。第1组内皮细胞损失率为8%，第2组为10.3%（p>0.05）。两组细胞大小（多形性）均显著增加，第1组增加了+37μm（p<0.05），第2组增加了+54μm（p<0.05）。两组之间无统计学显著差异（p>0.05）。两组术前和术后六边形细胞数量（多形性）和角膜厚度也无差异。
与使用微型喇叭口Kelman超声乳化头和重力流体学的扭转超声乳化术相比，采用改良超声乳化头设计和主动流体学的扭转超声乳化术在累积耗散能量方面效率高38%。两种系统导致的内皮细胞损失程度相似。两种系统术后细胞大小（多形性）、六边形细胞数量（多形性）和角膜厚度（测厚）的变化相似。我们得出结论，两种系统对内皮的术中压力相当。
