Application of active-fluidic pressure control phacoemulsification system in dense nuclear cataract

Objective To compare the surgical efficiency and postoperative evaluation indicators between active-fluidic pressure control phacoemulsification system and gravity-fluidics in dense nuclear cataract surgery. Methods A total of 60 patients (60 eyes) with age-related cataract admitted in the First Affiliated Hospital of Army Medical University from January 2020 to December 2020 were enrolled in this prospective study, and all of them were classified as NⅣ grade according to the Lens Opacities Classification System Ⅱ (LOCS Ⅱ). They were randomized into the active-fluidics group (n=30, phacoemulsification by active-fluidic pressure control system) or the gravity-fluidics group (n=30, phacoemulsification by gravity-fluidic system). Intraoperative parameters, such as cumulative dissipated energy (CDE), ultrasound total time (UTT), torsional amplitude (TA), torsion usage time (TUT), aspiration time (AT), and fluid used (FU) were recorded and compared between the 2 groups. Postoperative evaluation indicators, like central corneal thickness (CCT), central corneal edema and thickness (CCT) at 1 d after surgery were also collected and compared. Results There were no significant differences in preoperative best corrected distance visual acuity, CCT, and corneal endothelial cell count between the 2 groups. Intraoperatively, the active-fluidics group had significantly lower CDE, UTT, TUT, AT and FU than the gravity-fluidics group (P < 0.05), though TA did not differ. Moreover, the active-fluidics group also presented better UDVA (P=0.005), less increase of CCT (P=0.006), slighter central corneal edema (P < 0.001), and smaller proportion of patients with moderate to severe central corneal edema (P < 0.001) than the gravity-fluidics group in 1 d after surgery. Conclusion The active-fluidics configuration achieves a higher surgical efficiency than the traditional gravity-fluidics system in phacoemulsification of dense nuclear cataract, with slighter postoperative corneal edema, less change of CCT and faster recovery of UDVA.