Unraveling Active Surge Mitigation (ASM) Actuation: Optimizing Phacoemulsification With Active Sentry Handpiece

The purpose of this study is to determine which demographic and biometric factors, lens hardness, complications such as PEX and IFIS, and intraoperative metrics have the greatest influence on Active Surge Mitigation (ASM) actuation during phacoemulsification using the Centurion® Vision System with the ACTIVE SENTRY® Handpiece. The preoperative analysis considered age, gender, biometric data (obtained using the Zeiss IOL Master 700 and Oculus Pentacam), and lens hardness according to the Lens Opacification Classification System (LOCS III). Intraoperative Floppy Iris Syndrome (IFIS) and Pseudoexfoliation Syndrome (PEX) were also assessed. Intraoperative metrics during phacoemulsification included total case time, cumulative dissipated energy (CDE), total ultrasound time (U/S time), and the number of active surge mitigation (ASM) actuations. Significant positive correlations were found between ASM and both LOCS (P=0.001) and age (P=0.017), albeit a significant negative correlation was observed with anterior chamber depth (ACD) (P=0.005). No significant differences in the number of ASM actuations were observed between genders or in patients with PEX or IFIS. In multivariate analysis, an ASM ≥ 1 significantly predicted higher LOCS (OR 1.79, 95% CI 1.04-2.95), whereas greater ACD reduced this likelihood (OR 0.311, 95% CI 0.100-0.960). ASM actuation is more frequent with advanced lens hardness and old age, while a deep anterior chamber reduces actuations compared to a shallow one. Lens hardness affects ASM more than anterior chamber depth, and no significant correlation was found between PEX, IFIS, and ASM.