1. OHM Comparative quantification of ingress of trypan blue into anterior chamber following microcoaxial phacoemulsification with torsional or longitudinal ultrasound The authors have received travel expense reimbursement from Alcon Laboratories, USA Abhay Vasavada, Vaishali A Vasavada, Devarshi Gajjar, Shetal Raj Iladevi Cataract and IOL Research Center, Ahmedabad, India

2. Berdahl JP, Jun P, DeStafeno JJ, et al Comparison of a torsional handpiece through microincision versus standard clear corneal cataract wounds J Cataract Refract Surg 2008; 34 (12): 2091-2095 Phacoemulsification using the OZil™ handpiece through a microincision with an Ultrasleeve and a 45- degree miniflared tip showed favorable clinical and intraoperative characteristics such as less total energy use and less endothelial cell loss at 6 months Introduction

3. Praveen MR, Vasavada AR, Gajjar D, et al Comparative quantification of ingress of trypan blue into the anterior chamber after microcoaxial, standard coaxial, and bimanual phacoemulsification: randomized clinical trial J Cataract Refract Surg 2008 Jun; 34 (6): 1007-12 * Trypan blue ingress into the anterior chamber found in all three groups. * There was no significant difference between the standard coaxial and microcoaxial phacoemulsification following IOL implantation.

4. Aim To compare ocular surface fluid ingress into the anterior chamber during microcoaxial phacoemulsification performed with the Torsional ultrasound (Ozil™) and Longitudinal ultrasound using Trypan Blue as the quantifying tracer Study design: Prospective, Randomized, Masked study Study population: 80 consecutive patients undergoing phacoemulsification for uncomplicated age-related cataracts 80 consecutive patients undergoing phacoemulsification for uncomplicated age-related cataracts

5. 80 eyes - Random allocation into 2 groups: Group I Torsional ultrasound (n = 40) Group II Longitudinal ultrasound (n = 40) Exclusion Criteria Dense cataracts (> grade 4), uveitis, shallow anterior chamber, glaucoma, high myopia (AL > 25mm) Intraoperative complications: Wound site thermal injury (WSTI), Posterior capsule rupture, Incisional damage / suture Materials And Methods

6. Surgical Technique All surgeries performed by a single surgeon (ARV) Microcoaxial phacoemulsification performed on the Infiniti Vision System ™ 2.2mm temporal single plane clear corneal incision Standardized surgical parameters 0.9mm miniflared ABS 45 deg Kelman tip used

7. Surgical Parameters Used Group II: Longitudinal Ultrasound Torsional amplitude : Ozil continuous with linear control, upto 80 Aspiration flow rate (AFR) : 25cc/min Vacuum (mmHg) : upto 650mmHg ( depending on grade cataract ) Bottle height : 90-110cm Preset U/S power (Pulse mode) : 60% preset, 40 pps, 40% on time Aspiration flow rate (AFR) : 25cc/min Vacuum (mmHg) : upto 650mmHg ( depending on grade cataract ) Bottle height : 90-110cm Group I: Torsional Ultrasound (Ozil ™)

8. Methodology All incisions were hydrated Speculum was removed Trypan blue applied over conjunctiva Encouraged to blink for 2 min After IOL implantation 0.1ml aqeous aspirated

9. Observation Quantify the ingress of trypan blue in anterior chamber in the two groups * Trypan blue was first scanned at different wave lengths (190nm to 900nm) using a U.V visible spectrophotometer *The maximum optical density of trypan blue was found to be at 595nm *A standard graph using different dilutions of trypan blue was created Quantification of Trypan Blue

10. Standard Graph

11. Comparison of log of denominators of Trypan blue ingress into the anterior chamber between the two groups: GROUPNMEAN + SDMIN.MAX. Ozil TM 403.77 + 0.82*1.04.75 Longitudinal ultrasound40 3.40 + 0.60 1.64.75 Mann Whitney U Test P= 0.007Results * Higher Log value of Trypan blue ingress indicates lesser amount of Trypan blue in the anterior chamber

12. Conclusion Trypan blue ingress was found in both groups Trypan Blue ingress was statistically significantly greater following phacoemulsification with Longitudinal ultrasound as compared to Torsional ultrasound (Ozil TM )