PURPOSE 
To compare clinical and intraoperative parameters of 3 phaco tip designs

in torsional phacoemulsification using the bevel-down technique.

 

METHODS 
Consecutive cases were randomly assigned to have coaxial microincision cataract surgery using the mini-flared 30-degree Kelman tip, 
mini-flared 45-degree Kelman tip, or reverse mini-flared 30-degree Kelman tip. 
Clinical measurements included preoperative and 2-month postoperative uncorrected distance visual acuity, 
endothelial cell counts, and anterior segment optical coherence tomography and preoperative and 
1-day postoperative central corneal thickness. Intraoperative measurements included cumulative dissipated energy (CDE) 
and balanced salt solution use. Intraoperative video recording was used to visualize tip movements in the anterior chamber.

 

RESULTS 
The study enrolled 302 eyes of 297 patients. Intraoperatively, there was less CDE use with the 45-degree Kelman tip 
and reverse 30-degree Kelman tip than with the 30-degree Kelman tip (P<.05). 
There were no statistically significant differences in any clinical parameter between the 3 tips. 
Intraoperative films showed that the opening of the reverse 30-degree Kelman tip approached 
the nucleus more easily than the opening of the other 2 tips.

 

CONCLUSIONS 
In torsional phacoemulsification through microincisions with the bevel-down technique, 
the reverse mini-flared 0.9 mm 30-degree Kelman tip was as effective as the mini-flared 0.9 mm 45-degree Kelman tip 
with regard to intraoperative characteristics, such as total energy use.