|
|
 |
Vol. 27, Art. 39 (pp. 949-967) | 2026
Phacoemulsification with intraocular pressure control: a review of current approaches
Takhtaev S.Yu.1, Astakhov S.Yu.1, Takhtaev Yu.V.1
1 Pavlov First Saint Petersburg State Medical University, Ministry of Health of the Russian Federation, 6-8 Lev Tolstoy St., Saint Petersburg, 197022, Russian Federation
Brief summary
Ophthalmic surgery is among the most technologically advanced and innovation-driven fields of modern medicine. Continuous refinement of ultrasound phacoemulsification remains an important area of clinical research and engineering development in contemporary ophthalmology. Modern phacoemulsification platforms from different manufacturers incorporate various active or adaptive fluidics technologies designed to maintain anterior chamber stability and control intraoperative intraocular pressure (IOP). These systems may enable cataract surgery to be performed at lower target IOP levels while maintaining adequate aspiration efficiency and chamber stability. However, the amount and quality of independent clinical evidence specifically evaluating phacoemulsification under low-IOP conditions vary substantially between different platforms and remain limited for several currently available systems. This review summarizes current approaches to phacoemulsification with intraoperative IOP control, discusses the principles and clinical application of different infusion and fluidics management systems, and analyzes the most relevant contemporary evidence regarding their potential advantages, limitations, and clinical implications. Key words phacoemulsification; intraocular pressure; low intraocular pressure; active fluidics; infusion control; cataract surgery (The article in PDF format. For preview need Adobe Acrobat Reader)  Open article in new window
Reference list 1. Solomon K.D., Lorente R., Fanney D., Cionni R.J. Clinical study using a new phacoemulsification system with surgical intraocular pressure control. J Cataract Refract Surg.2016; 42(4): 542-549. doi:10.1016/j.jcrs.2016.01.037 2. Bird B.A., Thomson R.S., Stutz L.A., et al. Effect of increasing flow when grooving during phacoemulsification. J Cataract Refract Surg.2018; 44(5): 623-626. doi:10.1016/j.jcrs.2018.01.034 3. Suzuki H., Igarashi T., Takahashi H. Effect of a new phacoemulsification and aspiration handpiece on anterior chamber stability. J Cataract Refract Surg.2023; 49(1): 91-96. doi:10.1097/j.jcrs.0000000000001071 4. Buratto L., Brint S.F., Sorce R. Cataract Surgery with Phaco and Femtophaco Techniques. CRC Press; 2024: 202. 5. Wavikar C.M., Tanna M.N., Wavikar G.C., et al. Comparison of post-operative outcomes between IOP-20 and IOP-50 in phacoemulsification with Active Fluidics System: randomized single blinded trial. Clin Ophthalmol.2025; 19: 3573-3582. doi:10.2147/OPTH.S542284 6. Boccuzzi D., Napolitano P., Giannaccare G., Taloni A. Comparative analysis of fluidics and efficiency among different phaco-emulsifying machines employed for cataract surgery. Sci Rep.2025; 15(1): 45699. doi:10.1038/s41598-025-27683-6 7. Raimondi R., Sow K., Peto T., Wride N., et al. The effect of intraocular pressure during phacoemulsification in patients with either diabetic retinopathy or glaucoma; a randomized controlled feasibility trial. Graefes Arch Clin Exp Ophthalmol.2025; 263(8): 2277-2288. doi:10.1007/s00417-025-06839-0 8. Sharif-Kashani P., Fanney D., Injev V. Comparison of occlusion break responses and vacuum rise times of phacoemulsification systems. BMC Ophthalmol.2014; 14: 96. doi:10.1186/1471-2415-14-96 9. Shi D.S., Jensen J.D., Kramer G.D., et al. Comparison of vacuum and aspiration on phacoemulsification efficiency and chatter using a monitored forced infusion system. Am J Ophthalmol.2016; 169: 162-167. doi:10.1016/j.ajo.2016.06.030 10. Vasavada V., Agrawal D., Vasavada S.A., Vasavada A.R., Yagnik J. Intraoperative performance and early postoperative outcomes following phacoemulsification with three fluidic systems: a randomized trial. J Refract Surg.2024; 40(5): e304-e312. doi:10.3928/1081597X-20240314-02 11. Nicoli C.M., Dimalanta R., Miller K.M. Experimental anterior chamber maintenance in active versus passive phacoemulsification fluidics systems. J Cataract Refract Surg.2016; 42(1): 157-162. doi:10.1016/j.jcrs.2015.08.017 12. Su Y.C., Lee Y.Y., Su Y.C. Active-fluidics versus gravity-fluidics in lens extraction: a systematic review and meta-analysis of randomized controlled trials. Eur J Ophthalmol.2023; 33(1): 247-256. doi:10.1177/11206721221107512 13. Luo Y., Li H., Chen W., et al. A prospective randomized clinical trial of active-fluidics versus gravity-fluidics system in phacoemulsification for age-related cataract. Ann Med.2022; 54(1): 1977-1987. doi:10.1080/07853890.2022.2098375 14. Wang S., Tao J., Yu X., Diao W., Bai H., Yao L. Safety and prognosis of phacoemulsification using Active Sentry and Active Fluidics with different IOP settings - a randomized, controlled study. BMC Ophthalmol.2024; 24: 350. doi:10.1186/s12886-024-03626-z 15. Rauen M.P., Joiner H., Kohler R.A., O’Connor S. Phacoemulsification using an active fluidics system at physiologic vs high intraocular pressure: impact on anterior and posterior segment physiology. J Cataract Refract Surg.2024; 50(8): 822-827. doi:10.1097/j.jcrs.0000000000001457 16. Scampoli A., Crincoli E., Governatori L., et al. Active-fluidics versus gravity-fluidics in uncomplicated cataract surgery: using optical coherence tomography angiography to estimate early changes in macular and optic disc microcirculation. Graefes Arch Clin Exp Ophthalmol.2026; 264(1): 149-157. doi:10.1007/s00417-025-06939-x 17. Rossi T., Querzoli G., Pellizzaro Deng C., et al. Anterior chamber stability during phacoemulsification: comparing different phacoemulsification systems. Graefes Arch Clin Exp Ophthalmol.2026; 264(7): 2031-2040. doi:10.1007/s00417-026-07209-0 18. Scarfone H.A., Rodriguez E.C., Rufiner M.G., et al. Vitreous-lens interface changes after cataract surgery using active fluidics and Active Sentry with high and low infusion pressure settings. J Cataract Refract Surg.2024; 50(4): 333-338. doi:10.1097/j.jcrs.0000000000001359 19. Tahtaev S.U., Astahov S.U., Tahtaev U.V., Kiseleva T.N. Zavisimost skorosti krovotoka v centralnoi arterii setchatki ot velichini vnytriglaznogo davleniya pri fakoemylsifikacii s ispolzovaniem fynkcii prinyditelnoi irrigacii. Oftalmologicheskie vedomosti. 2025; 18(2): 51-60. doi:10.17816/OV678519 20. Liu Y., Hong J., Chen X. Comparisons of the clinical outcomes of Centurion Active Fluidics System with a low IOP setting and gravity fluidics system with a normal IOP setting for cataract patients with low corneal endothelial cell density. Front Med.2023; 10: 1294808. doi:10.3389/fmed.2023.1294808 21. Qiao Y., Ye Y., Liu F., Luo L., et al. Active fluidics at lower intraocular pressure reduces intraoperative discomfort during phacoemulsification: a propensity score-matched cohort study. Front Med.2026; 13: 1783229. doi:10.3389/fmed.2026.1783229 22. Sato T. Does further lowering intraoperative intraocular pressure reduce surgical invasiveness in active-fluidics Eight-Chop phacoemulsification? A fellow-eye comparative study. J Clin Med.2026; 15(1): 366. doi:10.3390/jcm15010366 23. Berdahl J., Terveen D., Aboughaida A., et al. Bench evaluation of intraocular pressure control with clinical assessment of anterior chamber stability of a dual peristaltic phacoemulsification device. Clin Ophthalmol.2026; 20: 570189. doi:10.2147/OPTH.S570189 |
|||||||||
Articles
| Размещение рекламы | |
|
| |
 |