PURPOSE: Cataract surgery is the most performed surgical procedure worldwide, exceeding 10 million cases annually. Despite its prevalence, phacoemulsification technology lacks standardization, making direct comparisons of clinical outcomes and machine settings challenging. This study aims to evaluate the fragmentation efficiency of two phacoemulsification systems under controlled conditions. We sought to provide surgeons with data-driven insights into surgical settings and advancing the standardization of phacoemulsification systems.

METHODS: Pig lenses were excised and hardened by immersion in 80°C water for 2 minutes. Fragmentation tests compared the Stellaris Elite (Bausch & Lomb) using a 1.8 MICS needle (28.5 kHz, up to 150 µm stroke) and the Centurion (Alcon) with the Ozil handpiece and Balanced Tip (44.5 kHz, up to 90 µm stroke, longitudinal; 32 kHz, torsional). Each machine operated on a single lens location with an 80 ms pulse under a constant 450 mmHg vacuum, submerged in water. Tests were conducted at 10%, 20%, 40%, and 80% power, with three repetitions per condition. Fragmentation depth was measured via OCT, calculated per cycle, and normalized. Cumulative Dissipated Energy (CDE) was recorded for the Centurion and calculated for the Stellaris Elite based on ultrasonic energy principles.

RESULTS: The Stellaris Elite system demonstrated significantly higher fragmentation efficiency compared to the Centurion across all tested power levels in longitudinal mode. At 10%, 20%, 40%, and 80% power, the Stellaris Elite achieved fragmentation efficiency improvements of 5x, 1.85x, 2.2x, and 1.54x, respectively, with an average increase of 2.65x. Additionally, the calculated CDE was lower with reductions of 1.09x, 1.7x, 2.4x, and 3.3x at 10%, 20%, 40%, and 80% power, averaging a 2.1x reduction overall. When compared to the Centurion torsional mode, the Stellaris Elite longitudinal mode achieved an average of 5.26x greater efficiency, along with a 1.4x average reduction in CDE (all with p<0.05).>

CONCLUSIONS: Prioritizing lower ultrasonic frequencies and longer stroke lengths significantly enhanced fragmentation efficiency and reduced CDE in hardened pig lens tests. These findings highlight the importance of frequency and stroke as critical variables for advancing and standardizing phacoemulsification technology.