Fluid dynamics, cavitation, and tip-to-tissue interaction of longitudinal and torsional ultrasound modes during phacoemulsification.

PURPOSE To describe the fluidic events that occur in a test chamber during phacoemulsification with longitudinal and torsional ultrasound (US) modalities. SETTING Pasteur Ophthalmic Clinic Phacodynamics Laboratory, Santiago, Chile, and Nanyang Technological University, Singapore. DESIGN Experimental study. METHODS Ultra-high-speed videos of a phacoemulsifying tip were recorded while the tip operated in longitudinal and torsional US modalities using variable US power. Two high-speed video cameras were used to record videos up to 625,000 frames per second. A high-intensity spotlight source was used for illumination to engage shadowgraphy techniques. Particle image velocimetry was used to evaluate fluidic patterns while a hyperbaric environmental system allowed the evaluation of cavitation effects. Tip-to-tissue interaction at high speed was evaluated using human cataract fragments. RESULTS Particle imaging velocimetry showed the following flow patterns for longitudinal and torsional modes at high US powers: forward-directed streaming with longitudinal mode and backward-directed streaming with torsional mode. The ultrasound power threshold for the appearance of cavitation was 60% for longitudinal mode and 80% for torsional mode. Cavitation was suppressed with pressure of 1.0 bar for longitudinal mode and 0.3 bar for torsional mode. Generation of previously unseen stable gaseous microbubbles was noted. Tip-to-tissue interaction analysis showed the presence of cavitation bubbles close to the site of fragmentation with no apparent effect on cutting. CONCLUSIONS High-speed imaging and particle image velocimetry yielded a better understanding and differentiated the fluidic pattern behavior between longitudinal and torsional US during phacoemulsification. These recordings also showed more detailed aspects of cavitation that clarified its role in lens material cutting for both modalities.