A Fluidics Comparison of Alcon Infiniti, Bausch & Lomb Stellaris, and Advanced Medical Optics Signature Phacoemulsification Machines

Purpose: To compare three phacoemulsification machines for measurement accuracy and postocclusion surge (POS) in human cadaver eyes. Design: In vitro comparisons of machine accuracy and POS. Methods: Tip vacuum and flow were compared with machine indicated vacuum and flow. All machines were placed in two human cadaver eyes and POS was determined. Results: Vacuum (% of actual) was 101.9% ± 1.7% for Infiniti (Alcon, Fort Worth, Texas, USA), 93.2% ± 3.9% for Stellaris (Bausch & Lomb, Rochester, New York, USA), and 107.8% ± 4.6% for Signature (Advanced Medical Optics, Santa, Ana, California, USA; P < .0001). At 60 ml/minute flow, actual flow and unoccluded flow vacuum (UFV) was 55.8 ± 0.4 ml/minute and 197.7 ± 0.7 mm Hg for Infiniti, 53.5 ± 0.0 ml/minute and 179.8 ± 0.9 mm Hg for Stellaris, and 58.5 ± 0.0 ml/minute and 115.1 ± 2.3 mm Hg for Signature (P < .0001). POS in an 32-year-old eye was 0.33 ± 0.05 mm for Infiniti, 0.16 ± 0.06 mm for Stellaris, and 0.13 ± 0.04 mm for Signature at 550 mm Hg, 60 cm bottle height, 45 ml/minute flow with 19-gauge tips (P < .0001 for Infiniti vs Stellaris and Signature). POS in an 81-year-old eye was 1.51 ± 0.22 mm for Infiniti, 0.83 ± 0.06 mm for Stellaris, 0.67 ± 0.01 mm for Signature at 400 mm Hg vacuum, 70 cm bottle height, 40 ml/minute flow with 19-gauge tips (P < .0001). Conclusions: Machine-indicated accuracy, POS, and UFV were statistically significantly different. Signature had the lowest POS and vacuum to maintain flow. Regarding POS, Stellaris was close to Signature; regarding vacuum to maintain flow, Infiniti and Stellaris were similar. Minimizing POS and vacuum to maintain flow potentially are important in avoiding ocular damage and surgical complications.