“Ultrasound-Assisted High-Fluidics Phacoaspiration”: An Efficient and Safe Technique for Nucleus Quadrant Workup Through 2.2 mm Mini- and 1.6 mm Micro-Incisions Following Manual or Femtosecond Laser Sectorial Lens Fragmentation

<b>Purpose</b>: To evaluate the efficiency and safety of high-fluidics ultrasound emulsification using slim-shaft-strong-bevel (SSSB) tip technology for nucleus workup through mini- and micro-incisions. <b>Materials and Methods</b>: 77 patients underwent immediate sequential bilateral cataract surgery using high-flow-high-vacuum easyTip^®2.2 ("eT2.2") or infusion-assisted ("Hybrid") easyTip^®COMICS ("eT1.6 iaCOMICS") coaxial phacoemulsification. Surgical time (ST), Effective Phacoemulsification Time (EPT), and fluid consumption (FC), central corneal thickness (CCT), and endothelial cell count (ECC) were recorded. <b>Results</b>: 50 patients completed the 6 months follow-up. Preoperatively, groups did not differ in nuclear hardness, CCT, or ECC. The median ST for Conquer with eT2.2 phaco was 49 s, with eT1.6 iaCOMICS phaco 57 s (<i>p</i> = 0.021). The median total EPT was 8.3 and 8.0 (<i>p</i> = 0.882), and the median EPT for Conquer was 4.0 and 4.1, respectively (<i>p</i> = 0.812). The median FC for Conquer was 21 mL with the eT2.2 and 22 mL with the eT1.6 iaCOMICS phaco (<i>p</i> = 0.29), and the overall FC was 29 mL and 33 mL, respectively (<i>p</i> = 0.105). Mean CCT was 561 ± 42 µm and 563 ± 45 µm on day 1 (<i>p</i> = 0.835), 539 ± 33 µm and 542 ± 34 µm at 1 week (<i>p</i> = 0.714), and 536 ± 31 µm and 541 ± 33 µm at 6 months (<i>p</i> = 0.55), respectively. Mean ECL at 6 months was 2.80 ± 7.28% and 3.41 ± 8.25% (<i>p</i> = 0.725). <b>Conclusions</b>: When compared to previously published results obtained with a standard non-waisted phaco needle and lower fluidics and with the waisted easyTip^®2.2 run with intermediate fluidics, ultrasound-assisted high-fluidics phacoaspiration with the easyTip^®2.2 through a 2.2 mm incision and the easyTip^® COMICS through a 1.6 mm incision with infusion-assistance significantly improved efficiency of nucleus workup by reducing ultrasound energy and infusion fluid consumption, with minimal transient corneal stroma swelling and low endothelial cell loss.