The effect of forced infusion in phacoemulsification training: a comparative study

Purpose: Forced infusion (FI) has improved the safety and the stability of anterior chamber dynamics during cataract surgery, but its role in the learning of the surgery remains underexplored. This comparative study investigates the impact of FI on cataract surgery performed by trainees. Methods: We analyzed the first 100 phacoemulsification surgeries performed by 7 trainees using 2 peristaltic pump phaco machines, one with gravity infusion (Group GI), and one with forced infusion (Group FI). The evaluated outcome included surgical time, cumulative dissipated ultrasound energy (CDE), fluid consumption, number of chamber collapses, number of posterior capsule rupture, grade of postoperative corneal edema, and endothelial cell loss. Results: Mean surgical time was 24.6 ± 11.4 min in the GI group and 19.2 ± 8.4 min in the FI group (P < 0.001). Mean CDE was 12.42 ± 2.4%/sec in the GI group, and was 10.1 ± 2.3%/sec in the FI group (P < 0.001). Mean fluid usage was 310 ± 105 mL in the GI group and was 282 ± 125 mL in the FI group (P = 0.013). Chamber collapses occurred in 6 (GI) and 4 (FI) cases (P = N.S.); posterior capsule rupture was observed in 9 (GI) and 2 (FI) eyes (P = 0.03). Corneal edema and endothelial loss were similar in the two groups. Conclusion: FI allowed shorter surgical times, lower CDE and lower fluid consumption in phacoemulsification surgery performed by our trainees, minimizing intraoperative complications. These findings support the advantages of FI in cataract surgery training and its contribution to improved surgical safety.