1. Prospective Study Comparing Outcomes of Torsional versus Traditional Phacoemulsification Systems on Dense Cataracts
Bonnie An Henderson MD, Kelly J Grimes MS
Ophthalmic Consultants of Boston
Harvard Medical School
Financial Disclosure
Henderson: Alcon labs- grant support, speaker’s bureau
ISTA pharmaceuticals- grant support
Grimes: None

2. Purpose
To compare the post-operative surgical outcomes of torsional (Alcon Infiniti™ Ozil) and traditional (Bausch and Lomb Millennium™) phacoemulsification systems on different grades of cataracts

3. Methods Preoperatively:
Patients’ standard preoperative examination and measurements were recorded.
Additionally, preoperative central corneal pachymetry was recorded.
All cataracts were graded by the LOCS classification by one examiner (BAH)
Only cataracts that were NO4NC4 or higher were considered “dense” and included in the subgroup

4. Methods
Patients were randomized to receive cataract surgery using either the Alcon Infiniti™ OZil machine or the B&L Millennium™ machine.
Surgical technique, instruments, type of viscoelastic, and type of IOL were held constant for all surgeries in the study

5. Methods Intraoperatively:
total surgical time, phaco time, ultrasound time and energy, total BSS, phaco BSS were recorded
Patients with previous corneal disease were excluded from the study
Patients with an IOP > 26 on postoperative day 1 were excluded from analysis (due to effect of high IOP and causal relationship to corneal edema)

6. Methods
Patients were followed up at one day, one week, and one month post-operatively.
Recorded at each visit:
vision, intraocular pressure
corneal thickness
anterior chamber inflammation
corneal edema
All patients received the same type and quantity of postoperative drops
Data was analyzed in two groups: 1) all lens densities 2) a sub-group of dense lens cataract patients (NO4, NC4 or denser).

7. Results 127 patients (69 B & L, 58 Alcon)
36 dense lens patients (21 B & L, 15 Alcon)
6 patients excluded due to IOP > 26 on postoperative day 1

8. Results – All Cases Alcon (58) B&L (69) P-value
Pachymetry (post-op Δ in µ)
POD 1
20.62
55.59
0.0014
POW 1
8.14
14.37
0.301
POM 1
-7.57
-1.13
0.182
K Edema*
1.71
2.74
0.0021
0.09
0.46
0.017
0.00
0.04
N/A
AC Cells*
4.95
4.90
0.69
1.21
2.13
0.0009
0.13
0.68
* numerical values represent physician's quantitative estimation of corneal edema/anterior chamber inflammation respectively as follows:
NL = 0, rare/trace = 1, occasional = 2, 0.5 = 3, 1+ = 4, 2+ = 5, 3+ = 6, 4+ =7

9. Results – Dense Lens Cases
Alcon (15)
B&L (21)
P-value
Pachymetry (post-op Δ in µ)
POD 1
25.56
92.76
0.016
POW 1
12.92
21.30
0.455
POM 1
-7.25
6.38
0.22
K Edema*
2.63
3.47
0.2302
0.63
0.06
0.1064
0.00
0.05
N/A
AC Cells*
5.19
5.06
1.56
2.50
0.21
0.048
0.24
* numerical values represent physician's quantitative estimation of corneal edema/anterior chamber inflammation respectively as follows:
NL = 0, rare/trace = 1, occasional = 2, 0.5 = 3, 1+ = 4, 2+ = 5, 3+ = 6, 4+ =7

10. Results – Dense Lens Cases
Alcon
B&L
P-value
All Cases
Total Time (min)
9.24
9.98
0.1
Total BSS (cc)
190.5
222.3
0.0001
Phaco BSS (cc)
103.7
102.1
0.8449
Dense Lenses
10.06
10.95
0.45
228.8
225.0
0.78
96.4
104.7
0.38
* numerical values represent physician's quantitative estimation of corneal edema/anterior chamber inflammation respectively as follows:
NL = 0, rare/trace = 1, occasional = 2, 0.5 = 3, 1+ = 4, 2+ = 5, 3+ = 6, 4+ =7

11. Conclusions
Phacoemulsification cataract extraction on all lens types by torsional energy (Alcon Infiniti™ Ozil) resulted in significantly less corneal edema and thickness on post op day one compared to surgery by traditional ultrasound energy.
There was significantly less corneal edema and anterior chamber inflammation at one week postoperatively with the torsional energy system.