Role of cavitation in the phacoemulsification process.

PURPOSE To determine the role of cavitational energy as a mechanism responsible for the emulsification of the lens during phacoemulsification. SETTING Clinica Ophthalmologica Pasteur, Santiago, Chile. METHODS Cavitation and its relationship to phacoemulsification power were documented using a combination of light sources, high-speed video recording techniques, and computerized control and by monitoring environmental pressure. The suppression of cavitation from the phaco process was achieved by building an environmental hyperbaric system capable of retaining the phacoemulsification system's ability to provide irrigation, aspiration, and vacuum necessary at standard and elevated pressures. The pressure level was controlled and monitored through a computer interface alongside the simultaneous video monitoring of cavitation bubble creation changes during pressure rise or fall. Last, evaluation and measurement of phacoemulsification was performed on real cataract fragments in the presence and absence of cavitation. RESULTS Cavitation around the phaco tip mainly occurred at longitudinal ultrasonic power levels of 30% or more. Cavitation bubble formation was observed during the backstroke or as the tip moved away from the lens material and collapsed during the forward displacement of the phaco tip. Cavitation at any power level was successfully suppressed when the pressure in the hyperbaric chamber increased beyond 2.0 bar (29.1 psi) above atmospheric pressure. Phacoemulsification performance in the presence or absence of cavitation was comparable. CONCLUSION This study found strong evidence that cavitation plays no role in phacoemulsification, leaving the jackhammer effect as the only important mechanism responsible for the lens-disrupting power of phacoemulsification.