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TESTUPLOAD

TESTUPLOAD. TORS I ONAL PHACOEMULS I F I CAT I ON. I n January 2006 Alcon Surgical incorporated Ozil torsional into the Infiniti Vision System.

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TESTUPLOAD

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  1. TESTUPLOAD

  2. TORSIONAL PHACOEMULSIFICATION • In January 2006 Alcon Surgical incorporated Oziltorsional into the Infiniti Vision System. • Unlike the conventional longitudinalphacoemulsification which emulsifies the lens with forward and backward movement of the phaco tip, Oziltorsional technology produces a side-to-side motion of the phaco tip. • Efficiency is increased with this technology since it does not produce repulsion and breaks up the nucleus by shearing and not by the conventional jackhammer effect.

  3. TORSIONAL PHACOEMULSIFICATION Straight Phaco Tip 45 º Bent Phaco Tip Shearingeffectincreaseswiththeuse of bent tips.

  4. OZil® IP (Intelligent Phaco) • Total occlusion decreases the efficiency of torsional US by causing the lost of the optical shearing plane, generally combined torsional/longitudinal US mode was chosen for emulsification. • Recently Intelligent Phaco (IP) upgrade which delivers a very small amount (short pulse) of longitudinal US just before the occlusion is complete, added to Oziltorsional technology to further increase its efficiency.

  5. OZil® IP (Intelligent Phaco) OZil® IP does is avoid a complete occlusion of the tip and maintain the right shearing plane and keep the emulsification on going. Static, occluded or blocked tip impacts followability, allowing fragments to fall away from tip

  6. TheStudy • PURPOSE:To compare the safety and efficacy of microcoaxial phacoemulsification surgeries performed with Ozil Intelligent Phaco (IP) torsional mode and combined torsional/longitudinal ultrasound (US) mode using Infiniti Vision System.

  7. METHODS • Between January and May 2010microcoaxial phacoemulsification with Ozil IP torsional mode (G1) was performed in 30 eyes of 30 patients and microcoaxial phacoemulsification withcombined torsional/longitudinal US mode(G2) was performed in 30 eyes of 30 patients by using theInfiniti Vision System (Alcon Laboratories). • O.9 mm 30-degree mini-flare 12-degree bent tip was used in all of the operations.. • The intrepid ClearCut 2.2 mm dual-bevel metal keratome (Alcon) was used for 2.2 mm incisions.

  8. METHODS • Patientswereexaminedfor; • Intraoperativecomplications, • Mean US times, • Longitudinal US amplitudes • Torsionel US amplitudes, • CummulativeDissipatedEnergy (CDE) • Postoperative outcome measures were anterior chamber reactions, change in the corneal clarity, central corneal thickness (CCT), early uncorrected visual acuity (UCVA) and final best corrected visual acuity (BCVA).

  9. METHODS • AnteriorchamberreactionsandCornealedemaweregraded as • AnteriorChamberReactions: • None, • Mild (1-3 cells in 16X field), • Moderate (3-10 cells in 16X field), • Severe • Cornealedema • None, • Mild, • Moderate, • Severe

  10. NUCLEUS GRADES 2,23 2,13 P=0,629 (P>0,05) Meannucleusgrades of thegroupsweresimilar.

  11. PARAMETERS Ozil IP Phaco 1 - Grooving AspirationVacuum Ozil IP 28 cc/min. 50 mmHg %80 Linear PanelLinear Phaco 2 - Chopping Aspiration Vacuum Ozil IP 32 cc/min. 330 %80 LinearLinearLinear IP pulse: 10% longitudinal torsional ratio. IP vacuum threshold:95% of the maximum Pulse length:10 ms. Torsionel/Longitudinal Phaco 1 - Grooving AspirationVacuum Ozil/Long. 28 cc/min. 50 mmHg %40-%60 Linear PanelLinear Phaco 2 - Chopping AspirationVacuum Ozil/Long. 32 cc/min. 350 %40-%60 LinearLinearLinear

  12. ENERGY PARAMETERS GROUP 1 (OZiL IP) • Mean US Time: • 1 min 21 sec (SD 35.56 sec) • Meanlongitudinal US amp: • 0.55 (SD 0.49) • Meantorsionel US amp: • 26.96 (SD 9.33) • CDE: • 10.18 (SD 6.22) GROUP 2 (OZiL/LONGITUDINAL) • Mean US Time: • 1 min 58 sec (SD 55.86 sec) • Meanlongitudinal US amp: • 3.86 (SD 1.75) • Meantorsionel US amp: • 3.92 (SD 1.41) • CDE: • 9.89 (SD 7.00) US time and phaco amplitudeswerefoundlower in group 1 where as torsionalamplitudewasfoundhigher in thisgroup. CDE valuesweresimilar. (p1=0,014, p2=0,001, p3= 0,001, p4= 0,874)

  13. OPERATION TIMES AND VOLUME OF BSS USED GROUP 1 (OZiL IP) • Meanoperation time: • 15 min 56 sec (SD 4 min14sec) • Meanvolume of BSS used: • 65.25 cc (SD 17.54) GROUP 2 (OZiL/LONGITUDINAL) • Meanoperation time: • 15 min 29 sec (SD 3 min 43sec) • Meanvolume of BSS used: • 84.55 cc (SD 28.35) • Meanoperationtimesweresimilar: • p=0,779 • StatisticallySignificantlylessamount of BSS used in group 1 • p=0,017

  14. POSTOPERATIVE CORNEAL EDEMA 0,53 0,50 P=0,823 (P>0,05) Postoperativemean Cornealedema of thegroupsweresimilar

  15. CCT CHANGES 96,70 µ 92,60 µ Preopmean pachymeter readings: G 1= 536,65 µG 2= 515,65 µ P=0,874 (P>0,05) post-op CCT changes of thegroupsweresimilar

  16. ANTERIOR CHAMBER REACTIONS 0,56 0,50 P=0,625 (P>0,05) mean anterior chamber reactions of the groups were similar

  17. Early UCVA and 3rd week BCVA of thegroups (Snellen): G1: 0,56 / 0,83 G2: 0,57 / 0,67 P=0,881 (P>0,05) Mean post-op UCVA of thegroupsweresimilar Mean BCVA of G1 wasfoundstatisticallyinsignificantlyhigher than G2 P=0,081 (P>0,05) There was not any complication affecting the visual outcome in both groups. POSTOPERATIVE VISUAL ACUITY

  18. DISCUSSION • Oziltorsional phaco is one of theimportantinnovations in phacoemulsification technologies. Unliketheconventionallongitudinal phaco, it produces a side-to-side motion of the phaco tip (1). • Shearingeffect is producedbytheconvertion of torsionalmovementtohorizontalsidetosidemotionbytheaid of bent tips (2). 1. Liu Y, Zeng M, Liu X, Luo L, Yuan Z, Xia Y, Zeng Y. Torsionalmodeversusconventionalultrasoundmodephacoemulsification; randomizedcomparativeclinicalstudy. J CataractRefractSurg 2007;33:287–292 2. Davison JA. Cumulative tip travelandimpliedfollowability of longitudinalandtorsionalphacoemulsification. J CataractRefractSurg 2008;34:986–990

  19. DISCUSSION • Theclinnicaladvantages of torsionaltechnologyare (3,4); • Efficientshearingeffectresults in lessrepulsion, • Decreasedturbulance, • Lessamount of heatproduction, • Morestableanteriorchamber. • Increasedfollowability. 3. Zeng M, Liu X, Liu Y, Xia Y, Luo L, Yuan Z, Zeng Y, Liu Y. Torsionalultrasoundmodalityfor hard nucleusphacoemulsificationcataractextraction. Br J Ophthalmol 2008; 92:1092–1096 4. Hoffman RS, Fine IH, Packer M. New phacoemulsificationtechnology. CurrOpinOphthalmol 2005; 16:38–43

  20. DISCUSSION • Total occlusion of the tip should be avoidedtohavethethemaximumefficiency of torsional phaco. • IP (Intelligent Phaco) delivers a very small amount (short pulse) of longitudinal US just before the occlusion is complete, • Withthe IP upgrade; • Occlusionsdecrease, • Diminished risk of clogging • Morestableanteriorchamber, • Shifts in th IOP decrease, • Theeye is kept in a morenaturalstatethroughoutthesurgery

  21. DISCUSSION • Withtheaid of IP upgradethesurgerieswereperformedsafelyandefficientlybyusingtorsional phaco only. • FollowingsafetyandefficacymeasureswerefoundsimilarbetweentheOzil IP andcombinedtorsional/longitudinalgroups: • CDE, • CCT changes • Visualacuities • UST andvolume of BSS usedweresignificantlylower in IP group. • No complicationswereobserved in bothgroups

  22. CONCLUSION • Ozil IP torsional mode may provide more effective lens removal than combined torsional/longitudinal US mode with a lower UST and volume of BSS used.

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