Cataract removal using transversal phaco (Whitestar Signature with Ellips Transversal Ultrasound, Abbott Medical Optics) with a Venturi pump improved the followability of nuclear fragments and reduced chatter at the phaco tip compared with conventional longitudinal phaco with a peristaltic pump. Six months postoperatively, the endothelial cell count (ECC) was only slightly decreased with transversal phaco compared with longitudinal phaco.

Developments in phacoemulsification continue to evolve, according to Dr Matteo Piovella. He described the latest generation of torsional and transversal phacoemulsification and compared their effects during the annual meeting of the American Society of Cataract and Refractive Surgery.

Transversal phaco can be performed with a bent or a straight tip, while torsional phaco requires use of a bent tip. He demonstrated on a video how different ultrasound settings work in the eye.

"Ellips transversal technology provides better efficiency when extracting hard nuclei. The nucleus is very stable at the phaco tip," said Dr Piovella, scientific director, CMA Outpatient Microsurgery Center, Monza, Italy. "Conversely, there is a ping-pong effect with the Whitestar system with a peristaltic pump."

As the technology advances, he added, the ultimate goals of phaco are shorter surgeries, fewer problems, and greater effectiveness.