The impact of new surgical techniques, devices and intraocular lenses on clinical, functional, and refractive results of cataract surgery.

Aims and scopes: the aim of this study is to investigate the impact of new surgical techniques and devices on surgical and functional results of cataract surgery. Introduction: with more than 19 millions surgeries per year cataract is the most performed surgical procedure after childbirth and is therefore a high interest topic for both clinical and industrial world. For this reason cataract surgery is a highly innovative field with new devices and instruments emerging every year. The impact of new devices and instruments on clinical and functional results is nevertheless poorly investigated. Methods: monocentric, retrospective, non randomized clinical study. In this study we investigated the impact of two different phacoemulsification platforms (Alcon Centurion Vision System vs Stellaris® Enhanced Vision System) and three different Intra-Ocular Lenses (Alcon Clareon IOL, Alcon Acrysof IQ IOL and Bausch&Lomb enVista IOL) on surgical and clinical outcomes of cataract surgery. All surgeries have been performed in our clinic during a 2 years period (1st April 2017 to 31st January 2019) by the same experienced surgeon. Patients have been subjected to four follow-up visits (1, 15 days and 3, 6 months after surgery). Intra-operative data such as surgery duration and ultra sound usage have been registered as well as postoperative outcomes regarding refraction and IOL performance. Results: 180 patients participated to the study. Mean US time was equivalent for both phaco-platforms while irrigation liquid per minute and US percentage used were significantly lower for Stellaris® platform. Glistening phenomena were found in Acrysof IOLs only while posterior capsule opacification was found in one patient implanted with the enVista IOL. No differences in visual acuity were found among the subgroups. Conclusions: Different phacoemulsification machines apply distinct mechanism of vacuum power production and fluidic control. These mechanism influence intra-operative parameters such as surgery duration, fluid consumption and ultrasound usage. In our study we found these differences don’t affect clinical outcomes of cataract surgery but studies with larger population, different surgeons and prolonged follow-up are needed to better investigate this topic. Hydrophobic Acrylic IOLs show a significant higher grade of glistening when compared with newer IOLs. The impact of this phenomenon on visual acuity is otherwise still controversial. Studies with larger population and prolonged follow-up are needed to better investigate this aspect.