Evaluation of Corneal Endothelium Damage with a New Handheld Fragmentation Device

Purpose: To quantify damage to corneal endothelial cells (CECs) from a new handheld lens fragmentation device and compare it with damage from a standard phacoemulsification device. Setting: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. Design: Experimental Study. Methods: Fifteen New Zealand white rabbits received bilateral surgery. Their eyes were divided into 3 groups (10 eyes/group): Intrepid Balanced Tip (Centurion Ozil handpiece; Alcon), miCOR 700 (Zeiss) half throttle (infusion/aspiration only), or full throttle (lens agitator engaged). After incision, the tip of each device was inserted into the anterior chamber and activated for 30 seconds. Following euthanasia and enucleation, the corneas were removed, stained with trypan blue/alizarin red, and photographed in a standardized manner (five X400 magnification photos from the center of each cornea). The ImageJ program was used to evaluate CEC damage and loss in the photographs. Results: The overall differences among the 3 groups regarding intact, damaged, and lost cells were statistically significant. However, by applying the Bonferroni correction, only the post-hoc pairwise comparisons between groups 1 (phaco tip) and 2 (miCOR tip, half throttle, without lens agitator engaged) were statistically significant regarding the 3 above-mentioned parameters. Conclusion: miCOR is a handheld, finger-controlled lens removal device with a blunt and rounded tip that vibrates at a low frequency, using mechanical agitation for nuclear disassembly. This acute rabbit study suggests CEC damage from the device, when the lens agitator is engaged is comparable to that of standard torsional phacoemulsification.