Comparison of Mini-Flared 45� Kelman and Mini-Flared OZil 12 Tips

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					Comparison of Mini-Flared 45° Kelman and
 Mini-Flared OZil 12 Tips in Resident and
    Attending Torsional Phaco Cases

   Sherleen Chen, M.D. and Roberto Pineda II, M.D.


           Massachusetts Eye and Ear Infirmary
                Harvard Medical School
                Boston, Massachusetts
                                                       Purpose
 Both have 45° bevel at tip
                                                                  • Background
                                    Mini-Flared OZil 12             • Torsional phaco more effective
                                           12° shaft angulation
                                                                      with angulation of Kelman tip than
                                                                      with straight phaco tip
                                                                    • New OZil 12 developed for
                      QuickTime™ an d a
                         decompressor
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                                                                      surgeons less comfortable with
                                                                      the standard 20° angulation of
                                                                      the Kelman tip
Mini-Flared 45° Kelman
      20° shaft angulation                                        • Goal
                                                                    • Compare safety and efficiency of
  Straight phaco tip = 0° shaft angulation                            the Mini-flared OZil 12 tip to the
                                                                      Mini-flared 45º Kelman in resident
                                                                      and attending torsional phaco
                                                                      cases
                      Methods
• 48 consecutive cases in 42 patients using torsional phaco
  performed by residents and attendings
• Cases randomly assigned to use of Mini-flared 45° Kelman
  tip or Mini-flared OZil 12 tip
• Data recorded
    • Complications
    • Nuclear Density determined pre-operatively
       • Calculated as LOCS III NC grade + LOCS III NO grade
       • Ex. NC2NO2C2 = Nuclear Density of 4
   • Metrics
      • Cumulative dispersed energy (CDE)
      • Total ultrasound time (sec)
      • Aspiration time (sec)
            Results-Safety

• No phaco complications encountered

• Posterior capsular rent occurred during
  cortical removal with I/A on one resident case
                Results-Efficacy
                                    OVERALL Data Comparison Between Tips

         Average Nuclear Density                                                  Average Nuclear Density
        when using OZil 12 = 7.74     Ozil 12 Average    Miniflare 45 Average     when using 45MFK = 6.66
              sample size: n = 17                                                 sample size: n = 30
80.0



70.0
                                                                           No statistically significant differences

60.0
         60.5
       n=14

50.0
                    48.8
                   n=28                                                                          45.5
40.0                                                                                            n=14

                                                                                                             36.8
                                                                                                            n=24
30.0



20.0



10.0                                                 11.71
                                                    n=17
                                                                    7.51
                                                                   n=31
 0.0
       U/S Total Time (sec)                                  CDE                                 Asp Time (sec/10)
                Results-Efficacy
                                    RESIDENT Data Comparison Between Tips
         Average Nuclear Density                                                    Average Nuclear Density
        when using OZil 12 = 7.67      Ozil 12 Average       Miniflare 45 Average   when using 45MFK = 6.98
               sample size: n = 9                                                   sample size: n = 10
80.0

        77.5
       n=8
70.0                 71.5                                                    No statistically significant differences
                   n=10

60.0



50.0


                                                                                                    44.5       43.9
40.0                                                                                                n=8        n=7


30.0



20.0



10.0                                                                 13.00
                                                                    n=10
                                                      8.16
                                                     n=9
 0.0
       U/S Total Time (sec)                                   CDE                                  Asp Time (sec/10)
                Results-Efficacy
                               ATTENDING Data Comparison Between Tips

           Average Nuclear Density                                               Average Nuclear Density
          when using OZil 12 = 7.81   Ozil 12 Average     Miniflare 45 Average   when using 45MFK = 6.45
                 sample size: n = 8                                              sample size: n = 20
80.0



70.0
                                                                        No statistically significant differences

60.0



50.0



40.0
                                                                                                38.9
        37.7                                                                                                 36.6
        n=6          36.1                                                                       n=7
                     n=18                                                                                   n=16
30.0



20.0



10.0
                                                   8.60         7.61
                                                   n=8          n=21
 0.0
       U/S Total Time (sec)                               CDE                                   Asp Time (sec/10)
                  Conclusions
• No statistically significant difference between tips in
  safety or efficacy
   • Sample size may be too small to achieve statistical
     signficance


• Both tips worked well

• For teaching or early learning curve in torsional
  phaco, we would suggest starting with the OZil 12 for
  easier visualization of the port, since efficiency of
  both tips appears to be similar

				
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posted:1/18/2009
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