Clinical Ophthalmology (Jan 2017)
Wound and surface temperatures in vivo in torsional and longitudinal modalities of ultrasound in coaxial microincisional cataract surgery
Abstract
Swapna Nair,1 Ramachandran Unnikrishnan Nair2 1Department of Cataract and Refractive Surgery, 2Department of Vitreoretinal Services, Chaithanya Eye Hospital and Research Institute, Trivandrum, Kerala, India Background: To study phacoemulsification probe shaft/wound and corneal surface/tip temperatures in vivo during longitudinal, torsional and combined phacoemulsification modes and their relationship to machine parameters. Design: This was a prospective study at Chaithanya Eye Hospital and Research Institute, Trivandrum, India (tertiary). Participants: Twenty-two eyes of 22 patients were randomized into six groups depending on the grade of nuclear sclerosis (NS) and the type of ultrasound used: Group 1, torsional in NS2; Group 2, torsional in NS3; Group 3, torsional with intermittent longitudinal in NS2; Group 4, torsional with intermittent longitudinal in NS3; Group 5, longitudinal in NS2; Group 6, longitudinal in NS3. Methods: Patients underwent phacoemulsification by torsional, longitudinal or combined modalities. A thermal camera was used to measure phaco probe temperatures. Main outcome measures: The mean probe shaft and tip temperatures were documented for different ultrasound modalities. Results: The mean shaft and tip temperatures were: Group 1, 29.22°C±0.71°C and 28.4°C±0.88°C; Group 2, 32.12°C±0.62°C and 31.88°C±0.84°C; Group 3, 30.25°C±0.71°C and 29.35°C±0.62°C; Group 4, 31.95°C±0.65°C and 32.01°C±1.31°C; Group 5, 23°C and 27.6°C and Group 6, 23°C and 29.68°C, respectively. In all groups using longitudinal ultrasound, the phaco tip surface temperatures were higher than the shaft temperatures, except in Group 3. Shaft temperatures were higher than tip temperatures in cases using torsional phaco, except in Group 4. The mean temperature difference between groups was significant only for shaft temperatures (P=0.001). On thermal imaging, for torsional phaco, the rise in temperature of the probe from shaft to tip was dependent on the amplitude of ultrasound applied (P=0.009). Conclusion: The shaft temperatures were higher than over the phaco tip during torsional phacoemulsification. Keywords: thermal imaging, cataract, phacoemulsification, microincision, torsional ultrasound
