Efficient Use of Ultrasound in Cataract Surgery

Abstract and Introduction

Abstract

Purpose of Review: Modern phacoemulsification machines apply ultrasound through a variety of settings and parameters to remove a cataract. Using these new technologies efficiently is critical for both reducing surgical times and improving postoperative outcomes. The present article reviews recent findings in phacodynamics to explore the optimum use of ultrasound in cataract surgery.

Recent Findings: In studies seeking to determine the optimum parameters in both fluidics and power, increased power and aspiration does not necessarily equate to more efficiency. New developments, such as torsional ultrasound, micropulse, and burst mode have shown increased efficiency in randomized control trials and in-vitro compared with conventional ultrasound. Regarding vacuums, the venturi pump has demonstrated greater efficiency compared with the peristaltic pump. We also explore other parameters, such as chamber pressure and tip selection. Meta-analyses on femtosecond-laser assisted cataract surgery (FLACS) have shown similar long-term visual outcomes compared to conventional cataract surgery.

Summary: Though conventional cataract surgery remains highly effective, surgeons have increasing options for customizing their ultrasound settings and phacoemulsification techniques.

Introduction

Phacoemulsification, first introduced to cataract surgery by Charles Kelman in 1967, combines high frequency ultrasound energy with vacuum and aspiration to emulsify and remove a cataract lens. The use of ultrasound continues to be a standard of care in cataract surgery throughout the developed world today. Though the principles remain the same, technology continues to advance and strive towards enhanced patient safety, improved clinical outcomes, and decreased surgical times. Contemporary phacoemulsification machines provide custom power modulation and fluidics control, thereby allowing surgeons to optimize settings and parameters to their preferences. Significant research effort has been dedicated toward the optimization of these parameters and the efficient use of ultrasound in cataract surgery, which is a complex interplay between power control and fluid dynamics.