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Can Torsional Phaco Decrease the Risk for Corneal Decompensation in Fuchs Endothelial Dystrophy: RCT

Can Torsional Phaco Decrease the Risk for Corneal Decompensation in Fuchs Endothelial Dystrophy: RCT. M. Doors, MD; Tos T.J.M. Berendschot, PhD; Carroll A.B. Webers, MD, PhD; Rudy M.M.A. Nuijts MD, PhD. The authors have received research funding from Alcon. University Eye Clinic az Maastricht.

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Can Torsional Phaco Decrease the Risk for Corneal Decompensation in Fuchs Endothelial Dystrophy: RCT

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  1. Can Torsional Phaco Decrease the Risk for Corneal Decompensation in Fuchs Endothelial Dystrophy: RCT M. Doors, MD; Tos T.J.M. Berendschot, PhD; Carroll A.B. Webers, MD, PhD; Rudy M.M.A. Nuijts MD, PhD The authors have received research funding from Alcon University Eye Clinic azMaastricht April 7-9 2010 Boston

  2. Torsional vs Longitudinal • Goal phaco technology: • Reducing US power and improving its efficiency • Longitudinal  repulsion • Torsional  rotary oscillations  no repulsion • 2 studies comparing torsional vs longitudinal mode in healthy eyes1,2 • Torsional mode: • Lower US time and CDE • CCT significantly thinner at 1 day and 1 week postoperatively • Faster visual recovery • Less endothelial cell loss 1Liu, JCRS 2007;287 2 Zeng, BJO 2008;1092

  3. Purpose and Methods • To compare the effect of torsional and longitudinal phaco on CT and corneal volume in patients with Fuchs’ endothelial dystrophy • RCT: torsional (n=26) vs longitudinal (n=26) • Inclusion: • Patient with FED needing cataract surgery > 40 years old • Exclusion: • Previous corneal/intraocular surgery and other visually significant ocular diseases (AMD)

  4. Methods • Randomisation: • Nucleus density grade (LOCS II) • Stage of Fuchs’ disease • Age • Phacoemulsification with soft shell technique • Investigator and patient blinded for treatment • Visante OCT • Pachymetry map • Pentacam • Corneal volume

  5. Results • Follow-up visits: 1 day, 1 week, 1 month, 3 months, 6 months • Preliminary results: mean follow-up 5.5 ± 1.2 months (range 1-6 months) • Mean age: 72.4 ± 7.8 years • 20 Men, 32 Female 1 day Postoperatively CCT 733 μm PreoperativelyCCT 655 μm

  6. Longitudinal vs. TorsionalPreoperative

  7. Longitudinal vs TorsionalIntraoperative No intraoperative complications

  8. Nucleus Density and CDE Harder nucleus was associated with higher CDE (r = .587; P<0.001) P=0.004 P=0.002 Blue= longitudinal Green= torsional CDE lower in torsional group, especially for hard nucleus!

  9. Longitudinal vs TorsionalPostoperative Blue= longitudinal; Green= torsional No significant differences P > 0.05

  10. Longitudinal vs TorsionalPostoperative * Blue= longitudinal; Green= torsional *Significant difference P = 0.010

  11. Correlations CCT and CDE r = 0.460 P = 0.001 r = 0.440 P = 0.001 Higher preoperative CCT and higher CDE were associated with larger postoperative increase in CCT

  12. Conclusions • Higher preoperative CCT and higher CDE were associated with a larger postoperative increase in CCT • Torsional mode may provide more effective lens removal with a shorter total US time and lower CDE, especially in patient with a hard nucleus

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