1. No author has any financial or proprietary interest in any materials or methods mentioned Seung Hyun Kim M.D. ; Tae Hoon Oh M.D. Department of Ophthalmology and Visual Science, The Catholic University of Korea Soft shell technique in torsional mode: Clinical outcomes

2. Introduction Torsional mode phacoemulsification Forward-and-backward movement : Jackhammer effect Conventional ultrasound phacoemulsification Side to side movement, tip of shearing motion The torsional mode priovides more effective lens removal with a lower level phacotime & energy (J Cataract Refract Surg 2007;33:287-292)

3. Soft shell technique Introduction  Dispersive OVDs and Cohesive OVDs (1999, Arshinoff)  Protect conreal endothelial damage with low or moderate nucleus cataract (J Cataract Refract Surg 1999;25:167-173)  Soft shell technique protected corneal endothelial cells with nuclear opacity grade of ≥ 4 (J Cataract Refract Surg 2004;30:2366-2370)

4. Purpose To evaluate the efficacy and safety of torsional mode phacoemulsification on corneal endothelial cells in soft shell technique and conventional OVD technique

5.  Prospective study St. Mary’s hospital 2008.7~2008.10 F/U : 2.1 ± 1.3 Months  Total 70 eyes of 38 patients with moderate cataract(LOC III, grade 2,3) Soft shell technique group - 35 eyes of 20 patients - 3% sodium hyaluronate-4% chondroitin sulfate(Viscoat™) and 1.2 % sodium hyaluronate(Biolon prime™) Control group - 35 eyes of 18 patients - 1.2 % sodium hyaluronate(Biolon prime™) Method

6. - Ultrasound(US) time - Mean US amplitude - Mean cumulative dissipated energy (CDE) - Used BSS volume - Uncorrected Visual acuity (UCVA) - Best corrected visual acuity (BCVA) - Central corneal thickness (CCT) - Endothelium cell count Intra-operative Parameters Assessment Post-operative Examination F/U : Post-OP 1day, 1 week, 1 month, 2 months Method

7. Intraoperative characteristics Result Ultrasound Time UST P=0.4680 Unpaired T-test Ultrasound amplitude USI P=0.8538 (sec) (%)

8. Intraoperative characteristics Result Used Balanced solution BSS P=0.1758 Unpaired T-test Cumulative Dissipated Energy CDE P=0.6737 (cc)

9. Postoperative characteristics Result Uncorrected Visual acuity VA Pre-op2Mo Best Corrected Visual acuity VA Pre-op2Mo

10. Result Corneal Edema after Surgery CCT change(µm) Pre-opPOD 1DPOD 7DPOD 1MoPOD 2Mo CCT change(%) Soft-shell technique group 567.90 ±31.46 585.73 ±38.64 574.17 ±39.07 575.33 ±40.13 571.90 ±39.36 0.67 ±2.97 Control group 571.10 ±31.96 584.53 ±39.90 573.93 ±36.46 573.13 ±31.79 571.30 ±31.63 0.07 ±2.44 P-value0.6790.3250.4830.2060.3000.299 CCT(µm)

11. Pre-opPOD 1MoEC loss rate(%) (POD 1Mo) POD 2MoEC loss rate(%) (POD 2Mo) Soft-shell technique group 2798.9 ±249.98 2584.8 ±334.37 7.32±11.2 2442.4 ±427.01 12.04±12.9 Control group 2815.3 ±295.38 2449.1 ±457.03 12.51±16.0 2427.3 ±258.21 13.23±15.5 P-value0.8160.195P=0.1200.880P=0.745 EC= Endothelial cell Result Corneal Endothelial Cell after Surgery

12. Postoperative Complications No significant differences in the density of corneal endothelium and the thickness of cornea between the soft shell technique group and the control group Therefore, torsional mode phacoemulsification is a safe US operation which has no significant effect on corneal endothelium and additional soft shell technique has no siginificant effect on corneal endothelim in torsional mode. Conclusions