Why balanced tip increases phaco with less energy

Epe, Netherlands-A new surgical advance-the Intrepid Balanced phacotips designed specifically for microcoaxial torsional ultrasound-has been found to have a significantly increased emulsification effect and markedly reduced shaft action compared with the traditional Kelman flared and mini-tips, said Khiun Tjia, MD.

The new balanced tip in the Centurion Vision System (Alcon Laboratories), according to Dr. Tjia, is characterized by a noteworthy motion of the tip: the movement at the tip end is increased, but is decreased at the incision.

This movement, said Dr. Tjia-of Isala Clinics, Epe, Netherlands-seems to be more efficient, and the risk of a thermal effect in the eye is greatly decreased.

The flared tips and mini-tips were used with the Infiniti system (Alcon).

Dr. Tjia compared the performance of the balanced tips in a preliminary observational study with traditional Kelman tips evaluated in a previous comparative study. He explained that while the Kelman-style phacotips are widely used for longitudinal and torsional ultrasound, a drawback during torsional ultrasound is the substantial tip motion of the shaft, which can cause unwanted corneal stromal changes.

“The novel balanced phacotip has been designed specifically for torsional ultrasound with enhanced sideways tip displacement at the tip end and greatly reduced tip action along the shaft,” Dr. Tjia explained.

In the study, Dr. Tjia performed all surgeries with identical fluid dynamics and ultrasound settings. Sixty eyes were assigned to undergo phacoemulsification and they were evenly distributed among each of the three types of tips. With the Infiniti system, the fluidics settings were vacuum, 300 mm Hg and flow 25 ml/minute, and the respective values with the Centurion system were 550 mm Hg and 30 ml/minute.

He reported that the balanced tips had an increased emulsification effect at the end with a visible increased cavitation effect at the sides of the tip end, while no significant phacotip shaft motion was observed. In contrast, the Kelman tips had significant tip action at the incisional site. The cumulative dissipated energy levels seemed to be lower with the balanced tips.

No wound changes were observed with the balanced tips.

Specifically, the cumulative dissipated energy in eyes with grade 1+ nuclei was markedly lower with the balanced tips (4.11), compared with the tapered tips (10.77) and mini-tips (7.47). Likewise, in eyes with grade 2+ nuclei, the respective values were 7.22. 20.12, and 12.17.

Dr. Tjia noted that not enough balanced tips were available to allow a prospective comparative study to be conducted. However, one such study is needed to prove the apparent increased performance of balanced tips compared with the Kelman tips.

“The balanced tip does not impact the cataract incision,” Dr. Tjia said. “The Centurion system allows higher fluidics settings. The cumulative dissipated energy with the (system) and balanced tip is significantly reduced compared with the Infiniti system with the tapered tips and minitips.”

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