Mini-flared Kelman tip, reverse tip, and sidewinder tip with torsional phaco: a prospective randomized comparative study

Purpose: To compare the efficiency of surgical procedures using three phaco tip designs in torsional phacoemulsification using the bevel-down technique. Methods: In this prospective, comparative, masked study, patients were randomly assigned to have torsional coaxial microincision cataract surgery using the mini-flared 45-degree Kelman tip, reversed mini-flared 30-degree Kelman tip, or Sidewinder 30-degree Kelman tip. Clinical measurements included preoperative and 3-month postoperative corrected distance visual acuity (CDVA), endothelial cell counts (ECC), and preoperative and 1-day postoperative central corneal thickness (CCT). Intraoperative measurements included phaco time, torsional time, aspiration time, case time, cumulative dissipated energy (CDE), and balanced salt solution volume (BSS). Results: The study evaluated 150 eyes of 150 patients. Intraoperatively, there was no statistically significant difference in cumulative dissipated energy, case time, torsional time, and aspiration time between the three tip configurations. However, less phaco time was used with the mini-flared 45-degree Kelman tip (p=0.02) than that with the Sidewinder 30-degree Kelman tip or reversed mini-flared 30-degree Kelman tip. The mini-flared 45-degree Kelman tip and the reversed mini-flared 30-degree Kelman tip required significantly less balanced salt solution volume than that required by the Sidewinder 30-degree Kelman tip (p=0.009). There was no statistically significant difference in corrected distance visual acuity and endothelial cell counts between tips 3 months postoperatively (p>0.05). Conclusion: All three tips were effective with no intraoperative complications. When using torsional phacoemulsification through microincisions and the prefracture technique with the bevel-down technique, the mini-flared 45-degree Kelman tip required a lower mean phaco time than the reversed mini-flared 30-degree Kelman tip and the Sidewinder 30-degree Kelman tip.研究目的：本研究旨在对比三种超声乳化尖端设计在采用斜面向下（bevel-down）技术的扭转式超声乳化术中的手术效率。研究方法：本研究为一项前瞻性、对照盲法研究，将患者随机分配接受采用迷你喇叭口45度Kelman尖端、反向迷你喇叭口30度Kelman尖端或Sidewinder 30度Kelman尖端的扭转式同轴微切口白内障手术。临床观测指标包括术前及术后3个月的矫正远视力（corrected distance visual acuity, CDVA）、内皮细胞计数（endothelial cell counts, ECC），以及术前与术后1天的中央角膜厚度（central corneal thickness, CCT）。术中观测指标包括超声乳化时间、扭转时间、抽吸时间、手术总时长、累积分散能量（cumulative dissipated energy, CDE）及平衡盐溶液灌注量（balanced salt solution volume, BSS）。研究结果：本研究共纳入150例患者的150只眼。术中层面，三种尖端构型在累积分散能量、手术总时长、扭转时间及抽吸时间上均无统计学显著性差异。但采用迷你喇叭口45度Kelman尖端时的超声乳化时间显著短于Sidewinder 30度Kelman尖端与反向迷你喇叭口30度Kelman尖端（p=0.02）。迷你喇叭口45度Kelman尖端与反向迷你喇叭口30度Kelman尖端所需的平衡盐溶液灌注量显著低于Sidewinder 30度Kelman尖端（p=0.009）。术后3个月时，不同尖端组间的矫正远视力与内皮细胞计数均无统计学显著性差异（p>0.05）。研究结论：三种尖端均安全有效，未出现术中并发症。当通过微切口、采用预劈核技术联合斜面向下技术进行扭转式超声乳化时，迷你喇叭口45度Kelman尖端的平均超声乳化时间低于反向迷你喇叭口30度Kelman尖端与Sidewinder 30度Kelman尖端。