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Comparison of combined torsional and conventional ultrasound mode versus torsional ultrasound mode phacoemulsification in different machines
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Jiyoung Emily Lee, Eun Chul Kim
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Received December 28, 2025 Accepted April 7, 2026 Published online April 30, 2026
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DOI: https://doi.org/10.63375/icrs.25.018
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 Abstract
 ePub
- Purpose
This study aimed to compare the clinical outcomes of phacoemulsification performed using a combined torsional and conventional ultrasound mode versus torsional ultrasound mode alone in cataract surgery.
Methods
Sixty-five patients who underwent phacoemulsification using combined torsional and conventional ultrasound mode with the Cube alpha system (Nidek Co.) were compared with 300 patients who underwent phacoemulsification using torsional ultrasound mode alone with the Centurion system (Alcon Research Ltd.). The two groups were classified as N3, N4, N5, or N6 according to the Lens Opacities Classification System III. In each subgroup, phacoemulsification time (seconds), cumulative dissipated energy (CDE), balanced salt solution (BSS) use, and postoperative best-corrected visual acuity were analyzed and compared between the combined-mode group and the torsional-only group.
Results
In the N4–N6 subgroups, the torsional-only group had significantly longer phacoemulsification times and higher CDE values than the combined-mode group (P<0.05 for all comparisons). In the N3–N6 subgroups, the total volume of BSS used in the torsional-only group (N3, 30.97±11.05; N4, 48.56±20.06; N5, 68.27±23.06; N6, 125.64±45.67) was significantly greater than that used in the combined-mode group (N3, 23.01±10.27; N4, 39.03±24.16; N5, 42.86±18.24; N6, 54.75±0.75) (P<0.05). There were no statistically significant differences between the groups in postoperative manifest refraction spherical equivalent, corneal endothelial cell loss, or best-corrected visual acuity.
Conclusion
Compared with torsional ultrasound mode alone, the combined torsional and conventional ultrasound mode was more efficient in terms of ultrasound time, CDE, and BSS use. This advantage was more evident with increasing nuclear sclerosis grade.
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