Effect of incisional friction and ophthalmic viscosurgical devices on the heat generation of ultrasound during cataract surgery.
OBJECTIVE
To determine the thermal features of the Legacy (Alcon) and Sovereign (Advanced Medical Optics) phacoemulsification machines in a cadaver eye and with 7 ophthalmic viscosurgical devices (OVDs).


METHODS
In situ and in vitro study.


METHODS
Temperature without occlusion was recorded at the sleeve placed in the wound of a cadaver eye, and temperature over baseline was determined after 60 seconds. The result was then compared with the results in a previous study that used balanced salt solution (BSS) in artificial chambers. In the second portion of the experiment, with irrigation and aspiration lines occluded, temperature was recorded at the sleeve placed in an artificial chamber filled with sodium hyaluronate 2.3% (Healon5), sodium hyaluronate 1.4% (Healon GV), sodium hyaluronate 1.0% (Healon), sodium hyaluronate 1.6% (Amvisc Plus), sodium hyaluronate 1.0% (Provisc), sodium hyaluronate 3.0%-chondroitin sulfate 4.0% (Viscoat), or hyaluronate 3.0% (Vitrax). Temperature over baseline was also determined after 60 seconds. These results were compared with each set of OVD data and with the results in the prior BSS study.


RESULTS
In the eye-bank model, the Legacy machine had a 62% temperature increase from incisional friction and the Sovereign machine had a decrease of 8.6% over results in an artificial anterior chamber. The OVD temperature increases were greater for the Sovereign (P<.001) and followed the same general trend for the Legacy. The least temperature increase was with Amvisc Plus, Healon, and Healon GV; the intermediate increases were with Provisc and Vitrax; and the greatest increases were with Viscoat and Healon5. The OVD findings did not correlate with viscosity or pseudoplasticity.


CONCLUSIONS
Incisional friction alone increased heat generation in the Legacy, a stroke-length driven instrument, more than in the Sovereign, a power-driven instrument. Ophthalmic viscosurgical devices are not only a concern due to outflow occlusion but can also add up to 6 times the heat in comparison with BSS. The need to aspirate the OVD before using ultrasound is thus verified.
Floyd
Michael
M
Department of Ophthalmology and Visual Sciences, University of Utah Health Sciences Center, Salt Lake City, Utah 84132, USA.
Valentine
Jeremy
J
Coombs
Jamie
J
Olson
Randall J
RJ
D000368:Aged; D000867:Anterior Chamber / Q000502:physiology; D001831:Body Temperature; D002807:Chondroitin / Q000627:therapeutic use*; D002809:Chondroitin Sulfates; D004338:Drug Combinations; D017276:Friction; D006358:Hot Temperature; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D009883:Ophthalmic Solutions / Q000627:therapeutic use*; D018918:Phacoemulsification / Q000295:instrumentation / Q000379:methods*; D014019:Tissue Donors; D014464:Ultrasonic Therapy / Q000295:instrumentation
D004338:Drug Combinations; D009883:Ophthalmic Solutions; C501944:chondroitin sulfate, sodium hyaluronate drug combination; D006820:Hyaluronic Acid; D002807:Chondroitin; D002809:Chondroitin Sulfates