Comparison of Intraoperative Parameters between Two Handpieces in One-Handed Phacoemulsification with Active Fluidics

<b>Purpose</b>: To compare anterior chamber stability and surgical efficiency in one-handed phacoemulsification, comparing Ozil and Active Sentry (AS) handpieces. <b>Methods</b>: Observational and comparative study. Selected patients were divided into two groups, AS and Ozil handpieces, and underwent one-handed phacoemulsification. Parameters like IOP per quadrant, vacuum, and aspiration flow were fixed in all surgeries. The study endpoints were intraoperative anterior chamber instability score (IACIS), cumulative dissipated energy (CDE), followability, and surgery duration. <b>Results</b>: Mean age was 71.42 years in the AS group vs. 73.97 in the Ozil Group. Mean Axial Length was 22.85 ± 1.21 mm with Active Sentry vs. 23.3 ± 1.29 mm with Ozil (<i>p</i> = 0.324). IACIS was 0.10 ± 0.30 with AS vs. 0.63 ± 0.71 with Ozil (˂0.001*). CDE was 9.95 ± 4.76 percent-seconds with AS vs. 10.89 ± 6.55 percent-seconds with Ozil (0.519). The followability score was 0.74 ± 0.855 with AS vs. 0.83 ± 0.874 with Ozil (<i>p</i> = 0.678). Surgery duration was 19.00 ± 5.44 min with AS vs. 24.57 ± 6.51 with Ozil (<i>p</i> < 0.001). <b>Conclusions</b>: The Active Sentry handpiece improves anterior chamber stability in one-handed phacoemulsification while maintaining surgical performance during nucleus removal without an auxiliary side-port. To the best of our knowledge, this is the first study demonstrating that the Active Sentry handpiece can increase anterior chamber stability not only in conventional phacoemulsification but also in one-handed phacoemulsification.