| Compared with the extracapsular cataract extraction, Phacoemulsification has advantages such as small surgical incision, self-closing incision, less surgical complications, quick recovery, good postoperative visual acuity, small astigmatism, and so on. In addition, patients can resume to their normal life and work quickly after the surgery since sutures are not needed in most cases. Therefore, this surgery has been widely practiced in clinics, and become the main method in modern cataract treatments. However, the high frequency vibration energy and emulsion particles associated with Phacoemulsification will inevitably leave mechanical damage to the intraocular tissues such as corneal, iris, posterior capsular, and so on. Among these damages, changes to structure, physiological function and number of corneal endothelial cell are most common, which can lead to corneal edema, increase of corneal thickness, decrease of endothelial cells, transparency drop, and other postoperative complications that will affect the surgical results. Therefore, how to improve safety of the operation and reduce damages to the corneal endothelium and other intraocular tissues during phacoemulsification, and how to more effectively remove the pacification of the lens have been the focus in the development of ultrasonic emulsification technology. A new ultrasound mode-torsional mode phacoemulsification was invented, which changed the traditional energy-based model of phacoemulsification needle, and the movement pattern of the needle in contact with the lens nucleus block, so that energy will be delivered to the lens nucleus more directly through the ultrasonic emulsification needle. Torsional mode phacoemulsification reduces the cumulative dissipated energy and ultrasound time, improves the efficiency of phacoemulsification, and consequently reduces the damages to the eye tissues.This report compares clinical results under the conventional ultrasound mode and the torsional mode phacoemulsification.,It will provide a reference for clinical practice of the torsional mode phacoemulsification.ObjectiveCompare the efficiency and safety of age-related cataract surgeries performed with torsional mode and conventional ultrasound mode phacoemulsification in the following aspects:the Ultrasound Time(UST),the Cumulative Dissipated Energy(CDE), the corneal clarity,the mean central thickness of cornea, the mean endothelial corneal cell counts (ETC), and the average best corrected visual acuity.MethodsIn this comparative case of study,252 patients (286 cases) diagnosed with cataract received surgery treatment from the same experienced doctor using Alcon infinity in our hospital from November 2007 to November 2008. The patients were divided randomly into two groups:144 cases were in the Torsional group and 142 cases were in the conventional ultrasound group. All patients were assigned to phacoemulsification by an experienced surgeon. The intraoperative data of Ultrasound Time (UST) and Cumulative Dissipated Energy (CDE) were recorded and compared, and patients were seen 1,7,and 30 days after surgery. Postoperative outcomes as the change of the best corrected visual acuity (BCVA), corneal clarity, corneal thickness, and endothelial cell count, were also measured and compared. Results(1) For gradeⅡ,Ⅲand IV nuclear density, mean CDEs were significantly lower in the Torsional group mean CDEs were(3.08±1.62)%, (7.48±2.97)%,and (14.78±7.11)% respectively for the three grades in the Torsional group;(4.24±1.05)%,(8.76±3.80)%, and(17.36±7.54)%respectively in the Ultrasound group. There are statistical differences between these two groups (P<0.05).(2) For gradeⅡ,Ⅲand IV nuclear density, mean USTs were significantly shorter in the Torsional group:mean USTs were 14.52±5.67 seconds,26.49±10.85 seconds,and 47.99±19.19 seconds for the three grades respectively in the Torsional group; 19.18±4.79,31.25±7.73,56.1614.59 seconds respectively in the Ultrasound groups (P<0.05).There are statistically differences between these two groups.(3)Comparing the corneal clarity, the Torsional group shows results:grade 0 is 94.4%,grade 1 is 4.2%,grade 2 is 1.4%,and there is no grade 3 and 41 day after operation. The Ultrasound group's results are:grade 0 is 84.5%, grade 1 is 9.9%, grade 2 is 4.2%, grade 3 is,1.4%, and there is no grade 41 day after operation. The Torsional group showed significantly less Corneal edema than the Ultrasound group in 1days and 7days postoperatively (P<0.05).But at 30days postoperative.There is no statistical difference between these two groups.(4) The mean central thickness of cornea in the Torsional group was significantly smaller than the mean thickness in the Ultrasound group in 1 day and 7 days postoperatively (P＜0.05). No statistical difference between these two groups was observed 30 days after operation.(5)7 days and 30 days after operation, the Mean endothelial corneal cell counts (ETC) in Ultrasound groups were significantly higher than the Torsional group, and the loss of ETC in Ultrasound groups were significantly lower than the Torsional group. There are statistical differences between these two groups. (6) The average best corrected visual acuity in the Torsional group is significantly better than that in the Ultrasound group 1 day and 7 days after operation(P<0.05). No statistical difference between these two groups was observed 30 days after operation.ConclusionCompared to the conventional mode, the Torsional mode can reduce the intraocular trauma during cataract extraction. It also shows a better postoperative recovery. Patients can get a good visual effect in a shorter period of time after operation. Therefore, the torsional mode is an effective and safe phacoemulsification mode, which has the value to promote in clinic.
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