Comparison of Cumulative Dissipated Energy Between Two Phacoemulsification Systems Using a Modified Flip-and-Chop Technique With Multidirectional Jerking Movement From a Phacoemulsification Handpiece

IntroductionThe four-dimensional Unity phacoemulsification tip is designed to optimize tip motion and reduce time and energy consumption in cataract surgery.This study highlights a modified flip-and-chop technique with an added multidirectional jerking motion to the phacoemulsification handpiece intraocularly (referred to as the "five-dimensional flip-and-chop") and compares the cumulative dissipated energy (CDE) between the fourdimensional Unity system (Alcon Inc., Geneva, Switzerland) and the torsional Centurion system (Alcon Inc., Geneva, Switzerland) under this technique. MethodsThis is a retrospective, sequential, non-randomized comparison of 40 consecutive cases of Centurion to 40 consecutive cases of Unity performed by a single surgeon at a single ambulatory surgical suite.The initial cataract density between the groups was compared using optical coherence tomography (OCT) image quality (IQ) values from a single Maestro 2 device (Topcon, Tokyo, Japan). ResultsThe two groups had comparable mean ages, sex distributions, and IQs.The mean CDE was significantly lower in the Unity group (5.39; SD=2.8) than in the Centurion group (8.23; SD=5.9), with p=0.0075. ConclusionUtilizing the modified "five-dimensional flip-and-chop" technique, the four-dimensional Unity system produced significantly lower CDE than the torsional Centurion system.The addition of this technique to the phacoemulsification handpiece may further improve the efficiency of phacoemulsification.