OBJECTIVES : Phacoemulsification is the standard of care in cataract surgery. Advances in phacoemulsification technology aim to minimize iatrogenic effects, improve patient outcomes, and optimize procedural efficiencies. A systematic literature review (SLR) was conducted to evaluate recent clinical evidence comparing safety, efficacy, and efficiency of different phacoemulsification systems.

METHODS : PubMed and EMBASE/MEDLINE databases were searched in March 2019. Observational and randomized controlled trials comparing at minimum two phacoemulsification systems were included. Searches were not limited by language and articles published between 2009-2019 were included. Article screening was performed in duplicate. Exclusion criteria encompassed phacoemulsification studies involving femtosecond laser-assisted cataract surgery (FLACS), animal or laboratory studies, and non-comparative clinical studies. From all relevant comparative clinical studies, the study and patient characteristics, clinical efficacy, procedural efficiency, and safety outcomes (intraoperative and long-term) were extracted.

RESULTS : A total of 5,895 articles were screened. Data was extracted from 27 relevant articles that included the following phacoemulsification systems: Whitestar Signature^® PRO, Legacy^®, Accurus^®, Stellaris^®, CENTURION^®, and INFINITI^®. A total of 6,099 eyes were studied in the 27 articles, the majority of which underwent phacoemulsification using CENTURION® (n=2,022 eyes) and INFINITI^® (n=3,114 eyes). In the eight studies comparing CENTURION^® and INFINITI^®, safety outcomes were similar between the two systems; however, CENTURION^® outperformed INFINITI^® in the following procedural outcomes: cumulative dissipated energy (CDE, 8/8 studies), estimated fluid usage (EFU, 3/4 studies), and total aspiration time (TAT, 3/3 studies).

CONCLUSIONS : The CENTURION^® and INFINITI^® Vision Systems encompassed the majority of comparative clinical data identified in this SLR. The CENTURION^® Vision System outperforms the INFINITI^® Vision System in CDE, EFU, and TAT. Superiority in these efficiency measures may result in reduced ocular trauma, quicker patient recovery, and superior visual outcomes.