{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T13:52:25Z","timestamp":1793109145171,"version":"4.5.0"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Ophthalmol."],"abstract":"<jats:p>Cataracta nigra, an extremely dense nuclear cataract, often requires prolonged ultrasound use during phacoemulsification, increasing the risk of corneal endothelial injury and incision-site thermal damage. We compared the Alcon UNITY Cataract System using 4-dimensional (4D) ultrasound with the Alcon CENTURION Vision System with torsional ultrasound in an ex vivo cataracta nigra bench model. A single human cataracta nigra nucleus was divided into four fragments; two fragments were emulsified with UNITY and two with CENTURION under identical user-selected console settings (35% power; IOP 36 mmHg; vacuum 450 mmHg; aspiration flow 30 mL\/min). Endpoints included emulsification time, effective phaco time (EPT), cumulative dissipated energy (CDE), and qualitative video assessment of fragments behavior. In this single-specimen model, compared with CENTURION, UNITY showed shorter emulsification time (mean 12.0 s vs 43.5 s) and lower console-reported energy indices (mean EPT 4.2 s vs 15.2 s; mean CDE 1.12 percent-seconds vs 15.01 percent-seconds). Video review suggested more continuous fragment engagement with minimal chatter using UNITY, whereas CENTURION more often showed initial fragment repulsion and turbulence. Because EPT and CDE are console-derived, these findings should be interpreted as relative performance under matched user-selected settings rather than equivalent physical energy delivery. These preliminary findings suggest that the 4D ultrasound mode might be associated with improved emulsification efficiency compared to torsional mode in ultra-dense nuclear material. Further studies using additional specimens and clinical cohorts are needed to determine whether these bench findings translate into meaningful surgical benefit.<\/jats:p>","DOI":"10.3389\/fopht.2026.1795898","type":"journal-article","created":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T05:25:10Z","timestamp":1776317110000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Four-dimensional ultrasound versus torsional ultrasound phacoemulsification in cataracta nigra: a single-nucleus ex vivo bench pilot"],"prefix":"10.3389","volume":"6","author":[{"given":"Rosa","family":"Giglio","sequence":"first","affiliation":[{"name":"Department of Medicine, Surgery and Health Sciences, University of Trieste","place":["Trieste, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Tognetto","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Health Sciences, University of Trieste","place":["Trieste, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,16]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/S0886-3350(01)00839-2","article-title":"Phacoemulsification of brunescent and black cataracts","volume":"27","author":"Singh","year":"2001","journal-title":"J Cataract Refract Surg"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/S0886-3350(96)80121-0","article-title":"Risk factors for corneal endothelial injury during phacoemulsification","volume":"22","author":"Hayashi","year":"1996","journal-title":"J Cataract Refract Surg"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1038\/eye.2008.190","article-title":"Safety and efficacy of manual small incision cataract surgery for brunescent and black cataracts","volume":"23","author":"Venkatesh","year":"2009","journal-title":"Eye (Lond)"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2009.04.047","article-title":"Comparison of torsional and longitudinal modes using phacoemulsification parameters","volume":"35","author":"Rekas","year":"2009","journal-title":"J Cataract Refract Surg"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2006.10.044","article-title":"Torsional mode versus conventional ultrasound mode phacoemulsification: randomized comparative clinical study","volume":"33","author":"Liu","year":"2007","journal-title":"J Cataract Refract Surg"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2009.04.046","article-title":"Heat production: longitudinal versus torsional phacoemulsification","volume":"35","author":"Han","year":"2009","journal-title":"J Cataract Refract Surg"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1097\/j.jcrs.0000000000001920","article-title":"Evolution of ultrasound in phacoemulsification: introduction of a novel ultrasound modality","author":"Braga-Mele","year":"2026","journal-title":"J Cataract Refract Surg"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2013.01.049","article-title":"Porcine lens nuclei as a model for comparison of 3 ultrasound modalities regarding efficiency and chatter","volume":"39","author":"Oakey","year":"2013","journal-title":"J Cataract Refract Surg"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2009.11.015","article-title":"Thermal study of longitudinal and torsional ultrasound phacoemulsification: tracking the temperature of the corneal surface, incision, and handpiece","volume":"36","author":"Jun","year":"2010","journal-title":"J Cataract Refract Surg"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.2147\/MDER.S484843","article-title":"Discrepancies in CDE and measured phaco tip energy: comparison of energy produced in longitudinal and torsional ultrasound using calorimetry","volume":"17","author":"Ricks","year":"2024","journal-title":"Med Devices (Auckl)"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2016.01.037","article-title":"Clinical study using a new phacoemulsification system with surgical intraocular pressure control","volume":"42","author":"Solomon","year":"2016","journal-title":"J Cataract Refract Surg"},{"key":"B12","unstructured":"UNITY\u00ae VCS | CS \u2013 vitreoretinal cataract & Cataract systems\n          \n          2025"},{"key":"B13","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1016\/s0886-3350(96)80272-0","article-title":"Long-term endothelial cell loss following phacoemulsification through a temporal clear corneal incision","volume":"22","author":"Dick","year":"1996","journal-title":"J Cataract Refract Surg"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2011.07.041","article-title":"Stroke dynamics and frequency of 3 phacoemulsification machines","volume":"38","author":"Tognetto","year":"2012","journal-title":"J Cataract Refract Surg"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2012.11.045","article-title":"Toward zero effective phacoemulsification time using femtosecond laser pretreatment","volume":"120","author":"Abell","year":"2013","journal-title":"Ophthalmology"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1007\/s10792-017-0674-4","article-title":"Comparison of cumulative dissipated energy delivered by active-fluidic pressure control phacoemulsification system versus gravity-fluidics","volume":"38","author":"Gonzalez-Salinas","year":"2018","journal-title":"Int Ophthalmol"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2009.11.009","article-title":"Impact of high and low aspiration parameters on postoperative outcomes of phacoemulsification: randomized clinical trial","volume":"36","author":"Vasavada","year":"2010","journal-title":"J Cataract Refract Surg"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.3928\/1081597X-20140711-06","article-title":"Real-time dynamic intraocular pressure fluctuations during microcoaxial phacoemulsification using different aspiration flow rates and their impact on early postoperative outcomes: a randomized clinical trial","volume":"30","author":"Vasavada","year":"2014","journal-title":"J Refract Surg"}],"container-title":["Frontiers in 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