Comparison of the effect of torsional and microburst longitudinal ultrasound on clear corneal incisions during phacoemulsification

• Published in: Journal of cataract and refractive surgery Vol. 38; no. 5; pp. 833 - 839
• Main Authors: Vasavada, Abhay R., MS, FRCS, Vasavada, Vaishali, MS, Vasavada, Viraj A., MS, Praveen, Mamidipudi R., DOMS, Johar, S.R. Kaid, PhD, Gajjar, Devarshi, PhD, Arora, Anshul I., MSc
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-05-2012; Elsevier
• Subjects: Animals; Aqueous Humor - metabolism; Biological and medical sciences; Collagen Type I - metabolism; Coloring Agents - pharmacokinetics; Cornea - diagnostic imaging; Cornea - surgery; Corneal Endothelial Cell Loss - diagnosis; Descemet Membrane - pathology; Double-Blind Method; Female; Fluorescent Antibody Technique, Indirect; Humans; Lens Implantation, Intraocular; Male; Medical sciences; Middle Aged; Ophthalmology; Phacoemulsification - methods; Prospective Studies; Rabbits; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the eye and orbit; Surgical Flaps - pathology; Trypan Blue - pharmacokinetics; Ultrasonography; Wound Healing; Incision; Cornea; Treatment; Surgery; Ophthalmology; Phacoemulsification; Ultrasound; Comparative study
• ISSN: 0886-3350; 1873-4502
• DOI: 10.1016/j.jcrs.2011.11.050

Purpose To compare incision integrity after clear corneal microcoaxial phacoemulsification using longitudinal and torsional ultrasound (US). Setting Iladevi Cataract & IOL Research Centre, Ahmedabad, India. Design Prospective randomized experimental clinical trial. Methods Part 1 comprised an experimental study of rabbit eyes. Group 1 received longitudinal US. Group 2 received torsional US. The right eye of each rabbit served as a control. Samples were processed for histomorphology and collagen I denaturation by immunofluorescence. Part 2 comprised a clinical trial of patients. Group 1 received torsional US. Group 2 received longitudinal US. At the end of surgery, trypan blue 0.0125% was instilled. After 2 minutes, 0.1 mL of aqueous was aspirated and its optical density measured. Results In part 1, incision histomorphology was comparable in both modalities. Collagen denaturation tests (immunofluorescence, dot blot analysis) showed no irregularity in collagen arrangement in either group. In Group 2, Descemet membrane was detached and endothelial cells were minimal at the roof of the incision. In part 2, trypan blue ingress into the anterior chamber was significantly greater in Group 1 than in Group 2 (mean 3.40 + 0.6 log units versus and 3.77 + 0.82 log units) ( P <.007). Conclusions Incision histomorphology in the torsional group showed minimal Descemet membrane detachment and minimal endothelial cell loss at the roof of the incision. Minimal ingress of trypan blue into the anterior chamber was observed with torsional US, indicating better wound integrity than with longitudinal US. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.