Comment on: Experimental study comparing 2 different phacoemulsification systems with intraocular pressure control during steady-state flow and occlusion break surge events
Bibliographic record
Abstract
I would like to commend Fanney et al. for their recent article.”1 However, in this study, the authors compare the newest Zeiss Quatera 700 (Quatera) with the older generation, 10-year-old, Alcon CENTURION Vision System without Active Sentry (Centurion). Why compare with a technology that is no longer the gold standard of phacoemulsification surgery? Below are additional notable items. The same first author who worked on this manuscript demonstrated that the CENTURION Active Sentry (CAS), newest Alcon phacoemulsification platform, has significantly less surge volume when compared with Centurion, at the same single intraocular pressure (IOP) and vacuum shown in Figure 5 of the current study using the same eye model/method.2 Why did the authors choose not to discuss this study or provide surge volume data for other IOP set points and vacuum limits? In Figure 5, it seems that the surge duration time for Centurion was measured at a point where it has stabilized, whereas it has not fully stabilized for Quatera. In addition, CAS recovers significantly faster than Centurion.3 The authors discuss that high-flow rates, up to 90 mL/min, could provide greater time efficiency. Although this may be true for Quatera, this cannot be generalized for all systems. Using Centurion, there may be no gains in efficiency past 40 mL/min flow rate during the grooving step.4 High-flow phacoemulsification cataract surgery, even for routine cases, may have potential downsides that warrants further investigation, but this was not discussed.5 IOP compensation for incision leakage is a feature that is available on Centurion but seems to not have been set up appropriately by the user before testing. In addition, IOP compensation for incision leakage is an automatic feature available with CAS. Selection of specific sizes for gauge and aspiration tubing has associated advantages and disadvantages. It is understandable that the authors used the gauge size available with each system. However, a smaller gauge size as was used with Quatera is known to help reduce surge but may also reduce efficiency. Similarly, although a larger aspiration tubing provides the benefit of a lower passive vacuum, as noted by the authors, it may also increase surge. Is there a reason that the authors did not at least note these points brought up here in the discussion of the paper for reader awareness of potential confounding factors? Overall, the addition of this body of evidence corroborates the importance of using surge to evaluate phacoemulsification equipment performance and adds valuable information regarding the newest Zeiss Quatera 700 System. The observations made above hopefully add a more complete picture that is of value to readers.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.003 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".