Blended tip affords easy transition to torsional ultrasound

Key Points

San Diego-A new phacoemulsification tip with a less angled tip configuration has been designed for use during microcoaxial techniques with torsional ultrasound.

"The majority of cataract surgeons worldwide prefer a straight tip when performing phacoemulsification. This preference theoretically requires conversion to a Kelman tip to optimize performance of torsional ultrasound," he said. Dr. Osher is professor of ophthalmology at the University of Cincinnati and medical director emeritus of the Cincinnati Eye Institute.

"I have always enjoyed using a straight flared tip for the emulsification; it is very easy to maneuver and occlude inside the eye. Yet with the introduction of torsional ultrasound, it is impossible to gain the benefits of more efficient cutting and less repulsion unless the tip has some curvature. I have tried using a Kelman tip but found it difficult to occlude fully and to maneuver as easily as my traditional approach. Moreover, because the opening on the Kelman tip has always seemed to be on the wrong side, I requested that it be moved with the curve rather than opposite the curve. I know that Takayuki Akahoshi, MD, who is the director of ophthalmology, Mitsui Memorial Hospital, Tokyo, also arrived at the same conclusion independently," Dr. Osher explained.

The tip was manufactured and has been used in clinical evaluations for 1 year. The results have been excellent, according to Dr. Osher, who reported that the new design combined the maneuverability and ease of occlusion of a straight tip with the followability and thermal advantages of torsional ultrasound.

"There is noticeably more efficiency and less chatter with the quadrants, and the tip could be easily occluded with minimal rotation inside the chamber. Moreover, it was easy to enter the nucleus initially bevel down, retaining the overlying viscoelastic material, and then rotating the tip 180° bevel up for effective sculpting at very low and safe parameters, as I have always advocated for slow motion phacoemulsification," Dr. Osher said.

"In a recent study presented at ASCRS by my fellow, Fabio Vaz, MD, he found that 96% of patients obtained an uncorrected visual acuity of 20/40 or better on the first postoperative day; 62% of patients had either 20/20 or 20/25 unaided visual acuity. These results confirmed the lack of turbulence and chatter inside of the eye," he added.

"Because 70% of the surgeons worldwide prefer a straight tip, this new tip design should offer an easy transition to torsional ultrasound," Dr. Osher concluded.