Torsional Mode Phacoemulsification: Effective, Safe Cataract Surgery Technique of the Future

PURPOSE: To compare various outcome measures using torsional mode and longitudinal mode in the phacoemulsification of cataract with different nuclear densities. SETTING: Magrabi Eye Hospitals, Kingdom of Saudi Arabia. DESIGN: A randomized comparative clinical study. MATERIALS AND METHODS: This study includes 200 eyes of 156 patients (100 in the ultrasound longitudinal “US” group and 100 in the torsional group). All eyes received AcrySof(®) single piece intraocular lens (Alcon Surgical, Fort Worth, TX). The primary outcome measures were ultrasound time (UST), cumulative dissipated energy (CDE), and surgical complications. Postoperative outcome measures were the degree of corneal edema on the first postoperative day and final best corrected visual acuity (BCVA) and CCT (central corneal thickness). RESULTS: The differences in UST and CDE between subgroups of nucleus hardness were statistically significant (P < 0.01). The UST and CDE consistently increased in eyes with higher grades of nucleus density. On day one, the mean BCVA was 0.61 ± 0.13 decimals in the ultrasound (US) group and 0.67 ± 0.11 decimals in the torsional group (significant P < 0.05). Corneal edema was significantly less in the torsional group (P < 0.05). At 30 days, the mean BCVA was 0.94 ± 0.22 decimals in the US group and 1.0 ± 0.12 decimals in the torsional group but this difference was not statistically different (P > 0.05). CONCLUSIONS: The torsional mode provides an effective and safe method for cataract removal with lower energy usage as compared to longitudinal traditional phacoemulsification. However, the final visual outcome was similar for both study groups.