Comparing the Efficacy Between Entry-Level Torsional and High-End Transverse Phacoemulsification Technologies

Clinical relevance: With the growing cost of equipment, uncompromised clinical care is paramount. The best possible scenario is an affordable device that delivers optimal results. Clinical studies demonstrating comparability between low-cost and high-end devices can help clinicians make informed decisions. Background: To compare the intra-operative efficacy of two phacoemulsification technologies - torsional and transverse. Methods: This was a prospective comparative study with systematic (quasi-random) allocation conducted at a tertiary eye care center. The study included 120 eyes from 112 patients with immature cataracts. Phacoemulsification was performed using either an entry-level torsional (Legion; Alcon Laboratories, Inc., Fort Worth, TX) or a high-end transverse (WhiteStar Signature Pro; Johnson & Johnson Vision, Inc., New Brunswick, NJ) machine by the same surgeon in patients assigned into two groups of 60 eyes each. Routine biometry, preoperative and postoperative day (POD 1, 30, and 90) examination on specular microscopy, pachymetry, and best-corrected visual acuity assessment were done. Intraoperatively, the mean surgical time and ultrasound time were noted. An independent, masked evaluator assessed the surgical videos. Results: The torsional system required 47.12% less ultrasound time (p < 0.001) and 5.15% less surgical time (p = 0.056) than the transverse system, with less chatter, better followability, and easier quadrant removal. There was no significant difference in postoperative visual outcomes or pachymetry measurements between preoperative and POD 1 or POD 30 in either group. Similarly, endothelial cell density changes from pre-op to POD 1, 30, and 90 were not statistically significant in both groups. Conclusion: The torsional phacoemulsification system required less ultrasound energy and a marginally shorter mean surgical time than the transverse system. The ease and efficiency of phacoemulsification, as measured by reduced chatter and better quadrant removal, were also better with the more affordable entry-level torsional system.