Effect of IOP based infusion system with and without balanced phaco tip on cumulative dissipated energy and estimated fluid usage in comparison to gravity fed infusion in torsional phacoemulsification

BACKGROUND: To evaluate the effect of three different combinations of tip designs and infusion systems in torsional phacoemulsification (INFINITI and CENTURION) in patients with cataract. According to the manufacturer, two unique improvements in the Centurion are: active fluid dynamic management system and use of an intrepid balanced tip. The study specifically aimed to evaluate the beneficial effects, if any, of change in tip design and infusion system individually and in combination on both per-operative parameters as well as endothelial health over 6 months. METHODS: One hundred and twenty six consenting patients of grade 4.0–6.9 senile cataract were randomized into three groups for phacoemulsification: Group A (n = 42): Gravity fed infusion system and 45(0) Kelman miniflared ABS phaco tip; Group B (n = 42): intraocular pressure (IOP) based infusion system and 45(0) Kelman miniflared ABS phaco tip; Group C (n = 42): IOP based infusion system and 45(0) Intrepid balanced phaco tip. The cumulative dissipated energy (CDE), estimated fluid usage (EFU) and total aspiration time (TAT) were compared peroperatively. The endothelial parameters were followed up postoperatively for six months. RESULTS: The three arms were matched for age (p = 0.525), gender (p = 0.96) and grade of cataract (p = 0.177). Group C was associated with significant reductions in CDE (p = 0.001), EFU (p < 0.0005) as well as TAT (p = 0.001) in comparison to the other groups. All three groups had comparable baseline endothelial cell density (p = 0.876) and central corneal thickness (p = 0.561). On post-operative evaluation, although all groups were comparable till 3 months, by 6 months, the percentage losses in endothelial cell density were significantly lower in group C as compared to the other groups. CONCLUSIONS: Use of an IOP based phacoemulsification system in association with use of the Intrepid balanced tip reduces the CDE, EFU and TAT in comparison to a gravity fed system with a mini flared tip or IOP based system with a mini flared tip while also providing better endothelial preservation thus favouring the use of an IOP fed system with a balanced tip. TRIAL REGISTRATION: Trial registration No.: CTRI/2016/06/007022.