Anterior chamber stability during phacoemulsification: comparing different phacoemulsification systems

Purpose: To compare in vitro performance of phacoemulsification platforms during critical surgical phases including aspiration, occlusion and occlusion break. Methods: Five phacoemulsification platforms (Alcon Centurion, Bausch & Lomb PC Stellaris, BVI Virtuoso, DORC Eva Nexus and Zeiss Quatera) underwent standardized testing including controlled occlusion within a collapsible test chamber. Tests were conducted with 21G tips, infusion pressure presets 30 and 55 mmHg, flow-rate 30 ml/min and vacuum range 200–600 mmHg. Outcome measures included Intraocular Pressure (IOP) at rest, during aspiration, occlusion and standardized occlusion break as well as chamber volume loss and time to regain 90% of IOP after/during occlusion break. Results: All devices kept target IOP at rest. During aspiration, IOP changed significantly (p < 0.01): Stellaris showed the greatest IOP reduction, Quatera had small decrease, Virtuoso maintained preset, Centurion and Eva Nexus slightly overcompensated. During occlusion, Eva Nexus and Stellaris PC exceeded the preset 55 mmHg (p < 0.05) whereas other machines remained on target. Upon occlusion break, volume loss ranged 35-200μL (p < 0.001) and recovery time to 90% of preset IOP varied between 0.30–2 s (p < 0.001) with Centurion and Virtuoso outperforming others at 30 mmHg IOP and Centurion, Quatera and Virtuoso at 55 mmHg IOP. Conclusion: Phacoemulsifiers exhibited distinct behaviour under standardized conditions and fluidic settings significantly influenced performance. Surgeon must understand machines’ fluidic to master different platforms.