Torsional扭摆式超声乳化对白内障超声乳化手术学习曲线的影响(英文)

ExploringtheBenefitsofOZil™TorsionalModetotheMinimumofPhacoemulsificationLearningCurveforSurgeon-in-trainingCataractCenter

TianjinEyeHospitalClinicalCollegeofOphthalmologyTianjinMedicalUniversityMaZhongxuIntroductionPhacoSincetheintroductionofphacoemulsificationasacataractremovaltechniquein1967,thelongitudinalmovementofthephacotipintheconventionalUSmodedoesnotbechangedfornearly38years.OZilAlconIn2006,AlconSurgicalincorporatedOZil

Torsional

intotheInfinitiVisionSystem.Torsionaltechnologyisamodalityofphacothatoffersadvantagesoverothermodalities.Itappearstobeaverysafeandeffectivemethodofcataractremoval.CompanyLogoECCEtoPhaco

Withtheincreasingtrendtowardsphacoemulsificationanincreasedcomplicationrateduringthelearningcurvegivesrisetoadilemmaastothebeststageatwhichasurgeon-in-trainingcansafelylearnthetechnique.

CouldanextracapsularsurgeonmakeasupervisedtransitionfromECCEtophacoemulsificationwiththehelpofnewTorsionalmode?CompanyLogoOZilTorsionalvs

ConventionalUSTheOZil

Torsionalsystemisahardwareandsoftwareupgrade

whichincludesadedicatedhandpiecethatproduces

side-to-siderotaryoscillationsofthephaco

tip.Comparingwiththejackhammermotioninconventionalphaco,theimprovedOZil

Torsional

oscillationsheersthelens

materialwithvirtuallyno

repulsion,therebydramaticallyreducedphaco

energyrequiredforlensremovalwithoutcompromising

efficiency.CompanyLogoObjectivesAToevaluateoutcomesofphacoemulsification

performedbyasurgeon-in-trainingwith

OZil™torsional

modeduringhistrainingexperienceandtodeterminealearningcurveforthisprocedure.BToassessthebenefitsofOZil™torsional

modetothephacoemulsification

learningcurve.CompanyLogoMaterialsandmethods1Retrospectivechartreviewofsurgeon-in-trainingperformedphacoemulsificationwithtorsionalmodeatourCataractSurgeryCenter.2OutcomesmeasuredincludedpostoperativeUCVA,BCVA,intraoperativecomplications,adjustedphacotimes,andrateofcornealendothelialcellsloss.LensnucleusdensitygradingaccordingtotheLOCSIII（II~70%,III~30%）CompanyLogoResultCompanyLogoUncorrectedvisualacuityoutcomesPostoperativemeanUCVAwas0.5.CompanyLogoBestspectacle-correctedvisualacuityoutcomes[TherewerenosignificantdifferencesinaverageUCVAorBSCVAorinthepercentageofeyesachievingaUCVAorBSCVAof1.0or0.5orbetterbasedonsurgerycasenumber.]CompanyLogoPosteriorcapsuletearandvitreouslossrates[Intraining,therewasasignificantreductioninvitreouslossratesafterthefirst65cases(5.0%vs1.8%;P=.03).]CompanyLogoMeanAdjustedPhacoemulsification[Meanadjustedphacoemulsificationtimewas0.68minutes,withasignificantreductioninadjustedphacoemulsificationtimeafterthefirst68cases(0.87vs0.52minutes;P<.001).]CompanyLogoThemeanrateofcornealendothelialcellsloss[Themeanrateofcornealendothelialcellslosswas10.43±6.33％,withasignificantreductionintherateofcornealendothelialcellslossafterthefirst65cases(12.44±6.38％vs8.22±5.14％;P<.01).]CompanyLogoDiscussionATechniquecharacteristicsofOZil

TorsionalmodeBKeypointstomasterTorsional

phacoemulsificationforSurgeon-in-trainingCHowtoshortenthephacolearningcurvethroughexploringandunderstandingthebenefitofthephacomodeCompanyLogoOZil

Torsional

vs

ConventionalUS…Torsional

phacoemulsificationappearstobeaverysafeandeffectivemethodofcataractremoval,lessenergy;betterfollowability;greatersafetybecauseofalessenedriskofwoundburn;andeaseofusebecauseoflessmanipulation;patients'postoperativevisionandcellcountwereexcellent.(SoniaH.Yoo,2006)CompanyLogoCOMPARISONConventionalOZilFrequency40kHz32kHzMax.stroke90µm90µmStrokedirectionLongitudinalSidetoSidePreferredModePulse/burstContinuousCuttingActionDuringforwardstrokeonlyDuringeitherleftorrightdirectionVacuumneedsBenefitsfromhighvacuumtoreducerepulsionMediumvacuumissufficienttopullmaterialthroughRepulsionMitigatedbyvacuumandpulse/burstReducedornotpresentHeatProportionaltopowerProportionaltoamplitudebut2/3lessthaninphacoBestPhacoTip1.1Flared0.9mmABSCOMPARISONCompanyLogoOZil

Torsional

Mode

ConventionalModeFollowabilityCompanyLogoOZil

Torsional

Mode

ConventionalModeEfficiencyCompanyLogoAdvantageofTorsionalModelessenergylessenedriskofwoundburnbetterfollowabilitygreatersafetyeaseofuse

goodpostoperativevisionBenefitCompanyLogoConclusionAThisstudyindicatesthatwithcarefulcaseselectionandsupervisionphacocanbeasafeprocedure.CTheTorsionalmodeprovidesthephysicaladvantagesforsurgeon-in-trainingandthatmightreducethelearningcurveforp