title: Mini-flared Kelman tip, reverse tip, and sidewinder tip with torsional phaco: a prospective randomized comparative study.
abstract: OBJECTIVE
  To compare the efficiency of surgical procedures using three phaco tip designs in torsional phacoemulsification using the bevel-down technique.
  
  
  METHODS
  In this prospective, comparative, masked study, patients were randomly assigned to have torsional coaxial microincision cataract surgery using the mini-flared 45-degree Kelman tip, reversed mini-flared 30-degree Kelman tip, or Sidewinder 30-degree Kelman tip. Clinical measurements included preoperative and 3-month postoperative corrected distance visual acuity (CDVA), endothelial cell counts (ECC), and preoperative and 1-day postoperative central corneal thickness (CCT). Intraoperative measurements included phaco time, torsional time, aspiration time, case time, cumulative dissipated energy (CDE), and balanced salt solution volume (BSS).
  
  
  RESULTS
  The study evaluated 150 eyes of 150 patients. Intraoperatively, there was no statistically significant difference in cumulative dissipated energy, case time, torsional time, and aspiration time between the three tip configurations. However, less phaco time was used with the mini-flared 45-degree Kelman tip (p=0.02) than that with the Sidewinder 30-degree Kelman tip or reversed mini-flared 30-degree Kelman tip. The mini-flared 45-degree Kelman tip and the reversed mini-flared 30-degree Kelman tip required significantly less balanced salt solution volume than that required by the Sidewinder 30-degree Kelman tip (p=0.009). There was no statistically significant difference in corrected distance visual acuity and endothelial cell counts between tips 3 months postoperatively (p>0.05).
  
  
  CONCLUSIONS
  All three tips were effective with no intraoperative complications. When using torsional phacoemulsification through microincisions and the prefracture technique with the bevel-down technique, the mini-flared 45-degree Kelman tip required a lower mean phaco time than the reversed mini-flared 30-degree Kelman tip and the Sidewinder 30-degree Kelman tip.
authors.affiliation: Brasilia Ophthalmologic Hospital, Brasilia, DF, Brazil.
authors.forename: Wilson Takashi
authors.initials: WT
authors.lastname: Hida
authors.affiliation: Brasilia Ophthalmologic Hospital, Brasilia, DF, Brazil.
authors.forename: Patrick Frensel
authors.initials: PF
authors.lastname: Tzelikis
authors.affiliation: Department of Ophthalmology, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Celso Takashi
authors.initials: CT
authors.lastname: Nakano
authors.affiliation: Department of Ophthalmology, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Antonio Francisco Pimenta
authors.initials: AF
authors.lastname: Motta
authors.affiliation: Department of Ophthalmology, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Milton Ruiz
authors.initials: MR
authors.lastname: Alves
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002452:Cell Count; D003315:Cornea / Q000601:surgery*; D004728:Endothelium, Corneal / Q000166:cytology; D004867:Equipment Design; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D018918:Phacoemulsification / Q000295:instrumentation* / Q000379:methods; D011184:Postoperative Period; D011300:Preoperative Care; D011446:Prospective Studies; D016037:Single-Blind Method; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology