Tips on getting the most from OZil

TORSIONAL phacoemulsification represents a clear advance on traditional lens extraction modalities due to its enhanced efficiency, ease of use and robust safety profile, according to a number of investigators. Speaking at the XXIV Congress of the ESCRS, several surgeons highlighted the benefits of using the OZil torsional handpiece (Alcon) in their cataract procedures and suggested it will eventually come to supplant traditional longitudinal phaco. “Torsional phaco significantly reduces undesirable aspects of traditional phaco such as cavitation, turbulence and repulsion. Our research findings help to explain the clinical observation of improved followability, reduced BSS consumption and overall improved surgical outcomes of torsional phacoemulsification,” Jaime Zacharias of the Clinica Oftalmologica Pasteur, Santiago, Chile. As a new cataract removal modality on the Infiniti Vision System (Alcon), OZil incorporates a combination of handpiece, hardware and software enhancements. By using ultrasonic oscillations of an angulated or curved needle, torsional phacoemulsification alters both the energy profile of the tip and the reaction of the lens material contacted by the vibrating needle. Unlike traditional ultrasound, there is no forward and backward movement of the tip with torsional ultrasound. In the torsional mode, the handpiece oscillates from side to side at approximately 32,000 times per second.These oscillations are much faster and because they happen at a lower frequency than longitudinal phaco, there provide approximately 20 per cent energy savings and less risk of thermal burn, according to surgeons who are familiar with the technology. Dr Zacharias’ study used in vitro recording of turbulence, repulsion and cavitation characteristics for both torsional and standard phacoemulsification systems using mixed experimental set-ups with real human cataract fragments. Defining cavitation “as expanding and imploding bubbles during cycles of ultrasonic oscillation”, Dr Zacharias noted its potentially undesirable effects in phacoemulsification surgery. “Cavitation may lead to free radical formation, loss of efficiency and turbulence induction. It can also cause random displacement of lens fragments and the possibility of direct and indirect damage to the endothelium, which is obviously something we would prefer to avoid,” he said. Using OZil, turbulence patterns using a density gradient detection method showed significant turbulence reduction, said Dr Zacharias.Also, any kind of repulsion phenomenon cannot be perceived using torsional phaco, he said.