Torsional Phacoemulsification and Tip Selection

One of the recent advances in cataract surgery is torsional phacoemulsification. It was developed to increase the efficacy of ultrasonic emulsification. In torsional phacoemulsification, the torsional movement of the tip is translated to side-to-side cutting action with the aid of bent phaco tips. Lens material is cut in both directions, rather than only during a forward stroke. The efficiency of this technique is further enhanced by an improvement in followability provided by the inherent non-repulsive nature of the side-to-side motion. Tip selection is very important for the efficiency of torsional phacoemulsification. Theoretically, there are 2 ways to enhance the cutting efficiency of the tip. First is the stroke length; the 22-degree bent 30-degree Kelman mini-flared tip cuts longer than the 12-degree bent 30-degree mini-flared Kelman tip. Second is the angulation or bevel; the higher the degree (45 degrees), the better cutting efficiency. Retrospective analyses of the previously published clinical studies clearly demonstrated that the efficacy of the torsional phacoemulsification has positive correlation with both the aperture angles and neck angles of the tips. (Turk J Ophthalmol 2014; 44: 392-5