Does low infusion pressure microincision cataract surgery (LIPMICS) reduce frequency of post-occlusion breaks?

To compare the number of surge events and efficacy of phacoemulsification using a near-physiological intraocular pressure (IOP) setting and a standard IOP setting. The surgical data of patients who underwent phacoemulsification with IOL implantation using the CENTURION Vision System's Active Fluidics setting and Active Sentry Handpiece (Alcon Laboratories, USA) were analyzed. The study included 181 patients (204 eyes). In Group 1, the IOP was set at 20 mmHg (n=102, 50%), and in Group 2, the IOP was set at 60 mmHg (n=102, 50%). Total case time was significantly lower (p=.036) in Group 1 (0:03:17.20 ± 0:00:34.55 vs. 0:03:28.71 ± 0:00:43.03). There was no statistically significant difference between the mean cumulative dissipated energy (CDE) (7.06 ± 3.20 vs. 7.59 ± 3.26) and mean ultrasound (UJS) time (0:00:36 ± 0:00:12 vs. 0:00:38 ± 0:00:13) between the two groups (p=0.24 and p=0.31, respectively). Active sentry (AS) engaged less often (p<0.001) in Group 1. There was no statistically significant correlation between the CDE and AS activation in Group 1 (p=0.96). A strong statistically significant correlation between the CDE and AS activation (p<0.0001, r=0.61, CI (0.47 to 0.72)) was observed in group 2. During phacoemulsification, surge events are more likely to occur when operating at high IOP settings. LIPMICS = low infusion pressure microincision cataract surgery, IOP = intraocular pressure, CDE = cumulative dissipated energy, UJS = mean ultrasound time, AS = Active sentry, LOCS = Lens Opacities Classification System, NO = nuclear opalescence, AFR = aspiration flow rate.