Effect of adaptive-fluidics on intraoperative lens-iris diaphragm retropulsion syndrome in cataract surgery: randomized clinical trial

To assess the impact of an adaptive fluidics system (AFS) compared to a gravity fluidics system (GFS) on lens-iris diaphragm retropulsion syndrome during cataract surgery in myopic eyes using continuous intraoperative swept source optical coherence tomography (SS-OCT) measurements. In this explorative, randomized, patient-masked, study with intra-individual comparison, myopic cataract patients had the first operated eye allocated to the AFS or GFS groups using the same phacoemulsification platform (Stellaris/Stellaris Elite, Bausch & Lomb, Rochester, NY, USA). Fifty-four eyes of 27 patients were analyzed. Intraoperative anterior and posterior capsular bag distances were measured and compared at various timepoints during cataract surgery via an intraoperative SS-OCT prototype. Additionally, patients’ subjective discomfort was analyzed. Although intraoperative measurement failure rates were high (39.5%), we found that at the onset of phacoemulsification with irrigation in place, the mean anterior capsule deepening relative to baseline measurements was significantly less pronounced using the AFS (0.63 mm) compared to the GFS (1.19 mm, P = 0.02). While patient discomfort during surgery was also less pronounced after entering the phaco-probe with irrigation on in the AFS group, overall subjective patient discomfort during surgery revealed no statistically significant difference (P = 0.70). Our study suggests that adaptive fluidics during lens surgery appears to measurably reduce lens-iris diaphragm retropulsion syndrome compared to gravity-based fluidics at the initiation of phacoemulsification in myopic cataract patients.