Optimum use of a higher end phacoemulsification machine (Stellaris) operating on hard brown cataracts – comparing dual linear versus trilinear phacoemulsification

Jacob Samuel Mathew

Vasan Eye Care Hospital, Cochin, India

Purpose : to prove the advantages of Stellaris phacoemulsification machine on hard brown cataracts, comparing Tri linear phacoemulsification over the standard dual linear settings.

Methods: topical clear corneal phacoemulsification conducted by a single surgeon on hard brown cataracts - 2.8 mm incision with the stellaris machine, on 56 eyes using dual linear settings (group I) on 23 eyes and trilinear phacoemulsification (group II) on the rest. Eyes with well dialating pupil and healthy corneas were chosen. exclusion criteria : rigid pupil, pseudoexfoliation, high myopes, glaucoma. Soft shell technique was resorted to with use of Viscoat. Introperatively the Average phaco time (APT), the Effective phaco time (EPT) and the health of the wound were noted. Post operatively follow up done on day of surgery, 1 week and 1 month – checking for corneal clarity, wound health, AC reaction, Vision and refraction, noting any signs of corneal endothelial damage at any stage.

Results : Group I had an APT of around 46 seconds and EPT of 21 seconds on an average with 8 eyes showing wound burn and 3 requiring suturing for wound closure. Group II APT was 32 seconds and EPT was 12 seconds, with no eye showing wound burn. 40% in groupI had mild striate keratopathy (SK) on day one with all clearing up on follow up and group II had SK in just 10% eyes on day one.

Conclusions : Trilinear phacoemulsification with its energy modulation option is the best answer for eyes with Gr IV nuclear sclerosis.