Objective:

To evaluate the emulsification efficiency of 4D ultrasound compared to torsional ultrasound in dense nuclear cataracts using an ex vivo model, highlighting its potential significance in improving surgical outcomes.

Key Findings:

• UNITY showed shorter emulsification time (mean 12.0 s) compared to CENTURION (mean 43.5 s), suggesting improved efficiency.
• Effective phaco time (EPT) was lower for UNITY (mean 4.2 s) than for CENTURION (mean 15.2 s), indicating less energy use.
• Cumulative dissipated energy (CDE) was significantly lower for UNITY (mean 1.12 percent-seconds) compared to CENTURION (mean 15.01 percent-seconds), which may reduce risk of complications.
• Video assessment indicated more continuous fragment engagement with UNITY and less turbulence compared to CENTURION, suggesting better operational stability.

Interpretation:

The findings suggest that 4D ultrasound may improve emulsification efficiency in ultra-dense cataracts compared to torsional ultrasound, although results are based on a single-specimen model, necessitating cautious interpretation.

Limitations:

• The study used a single human cataract specimen, limiting generalizability and applicability to broader patient populations.
• Results are based on console-derived metrics, which may not reflect actual physical energy delivery, potentially affecting the reliability of the findings.

Conclusion:

Preliminary results indicate that 4D ultrasound may offer advantages in emulsification efficiency for dense nuclear cataracts, warranting further studies with larger sample sizes to validate these findings.