Safety Profile of Venturi Versus Peristaltic

Phacoemulsification Pumps in Cataract Surgery

Using a Capsular Surrogate for the Human Lens
MICHAEL GILBERT, BRIAN ZAUGG, BRIAN STAGG, AND RANDALL J. OLSON
To compare the risk of capsular rupture of
the human lens during cataract surgery from contact by
phacoemulsification needles using different vacuum
pumps, ultrasound modalities, and contact angles.
! DESIGN: Experimental laboratory investigation.
! METHODS: The John A. Moran Eye Center, University
of Utah, Salt Lake City, Utah, was the setting for this
study. A Signature (Abbott Medical Optics, Inc) phacoemulsification machine was used in peristaltic and
Venturi vacuum modes with transversal and micropulsed
ultrasound. Contact was made with a capsular surrogate
to achieve tip occlusion or tip contact only. Breakage
rates were calculated by analyzing the capsular surrogate
under a surgical microscope.
! RESULTS: Venturi and peristaltic pump modes had
similar risk of capsular rupture, regardless of whether
the data were analyzed with tip occlusion data included
(44.2% peristaltic vs 40.2% Venturi, P [ .047) or
excluded from the analysis (66.3% peristaltic vs 60.3%
Venturi, P [ .013). Transversal ultrasound was significantly more likely to cause capsular rupture than micropulsed ultrasound (69.8% vs 56.8%, P < .0001). Tip
contact was significantly more likely than tip occlusion
to cause capsular rupture (63.3% vs 0%, P < .0001).
! CONCLUSIONS: There is no significant difference in
risk of capsular rupture using Venturi rather than peristaltic vacuum pumps, while transversal seemed to increase the risk when compared to micropulsed
ultrasound. Tip occlusion is not a risk factor for capsular
rupture, as all breaks in the capsular surrogate occurred
with tip contact. (Am J Ophthalmol 2015;160(1):
179184. ! 2015 by Elsevier Inc. All rights reserved.)
! PURPOSE:

ANY ADVANCES HAVE BEEN MADE IN CATARACT

surgery since its advent, especially since the addition of phacoemulsification by Dr Charles
Kelman.1 However, with the addition of this powerful

Accepted for publication Apr 10, 2015.

From the Department of Ophthalmology and Visual Sciences, John A.
Moran Eye Center, University of Utah, Salt Lake City, Utah.
Mr. Gilbert is now at Creighton University School of Medicine,
Omaha, Nebraska.
Inquiries to Randall J. Olson, John A. Moran Eye Center, University of
Utah, 65 Mario Capecchi Drive, Salt Lake City, UT 84132; e-mail:
randallj.olson@hsc.utah.edu
0002-9394/$36.00
http://dx.doi.org/10.1016/j.ajo.2015.04.017

2015 BY

technology came additional opportunities for complications.

Posterior capsular rupture is a relatively common complication of cataract extraction via phacoemulsification, with a reported incidence of between 1.7% and 5.2%.26 Capsular
rupture can occur during many different steps of cataract
surgery but most frequently occurs during nucleus removal,5
with approximately 40%60% of capsular ruptures occurring
during this stage.5,7,8 Most likely, this complication is owing
to the combination of ultrasound energy and the sharp needle
tip. While outcomes after capsular rupture are typically
good,24,68 there is a definite increase in the incidence
of temporarily raised intraocular pressure, persistent uveitis,
endophthalmitis, cystoid macular edema, retinal
detachment, and retained nuclear material, complications
that in some cases necessitate additional surgery.2,3,7,8
Thus, many advances in phacoemulsification technique
and technology have centered on reducing the risk of
capsular rupture to increase the safety of the procedure.
Given the wide array of options available to the cataract
surgeon regarding types of vacuum pumps, needle specifications, and ultrasound modalities, little data exist comparing
the safety profiles of these different options. Recent studies
have evaluated optimization of phacoemulsification variables for maximum efficiency of nuclear emulsification
and decreased chatter912; however, all of those optimized
configurations were found with the machines in
peristaltic mode. A recent study by our group showed
that Venturi vacuum significantly improved the efficiency
of lens fragment removal when compared to peristaltic
vacuum.13 Owing to the inherent differences in vacuum
generation and fluid dynamics between peristaltic and
Venturi pumps, their safety profiles cannot be assumed to
be identical. This study assesses the risk of rupture if the
phacoemulsification needle were to inadvertently contact
the capsule during cataract surgery, and compares optimized phacoemulsification settings in peristaltic and
Venturi mode.

METHODS
This study was designed as an experimental laboratory investigation. No human or animal studies were
done as part of this investigation.

! DESIGN:

ELSEVIER INC. ALL

RIGHTS RESERVED.

179

Our methods and experimental design

are a continuation and expansion of work by Meyer and associates.14 This previous study used peristaltic modes on
the Infiniti (Alcon, Inc, Fort Worth, Texas, USA) and
Signature (Abbot Medical Optics [AMO], Inc, Santa
Ana, California, USA) phacoemulsification machines
with a bottle height of 75 cm, machine-indicated flow
rate of 60 mL/min, and 550 mm Hg vacuum setting. Their
micropulsed ultrasound trials used a WhiteStar handpiece
(AMO, Inc) at 2 longitudinal power settings, 10% and
100%, both with a 6 ms on-duty cycle and 12 ms off-duty
cycle. Their transversal ultrasound trials used an Ellips
handpiece (AMO, Inc) at 100% power and torsional ultrasound trials used an OZil handpiece (Alcon, Inc) at 100%
power. For each of these 4 ultrasound modalities, they
tested 4 needles: (1) 19 gauge sharp, (2) 19 gauge Dewey
Radius (MST, Redmond, Washington, USA), (3) 20 gauge
sharp, and (4) 20 gauge Dewey Radius. For each condition,
the tip was tapped against the capsule surrogate 200 times.
Additionally, they tested 20 fresh human cadaver lenses
with exactly the same phacoemulsification parameters.
However, owing to the limited number of cadaver lenses,
they were limited to the following conditions: (1) micropulsed ultrasound at 100% power with a 6 ms on-duty cycle
and 12 ms off-duty cycle with a 20 gauge Dewey Radius
needle, (2) transversal ultrasound at 100% power with a
20 gauge sharp needle, (3) transversal ultrasound at
100% power with a 20 gauge Dewey Radius needle, and
(4) torsional ultrasound at 100% power with a 20 gauge
Dewey Radius needle. The lenses were tapped gently in
different places until capsule rupture occurred, rendering
the lenses unusable for further trials.14 They found the
rounded edge tip to be very protective of the capsule with
all modalities tested.

! PREVIOUS WORK:

Plastic wrap (Great Value Clear

Plastic Wrap; Wal-Mart Stores, Inc, Bentonville, Arkansas, USA) was stretched tightly over one end of a closed
4-inch-diameter polyvinylchloride tube as a surrogate for
the capsule in the manner previously described by Meyer
and associates.14 The Meyer study used fresh whole human
cadaver lenses to further validate this approach. All trials
were performed on plastic wrap from the same roll, and
pieces of plastic wrap were cut to be large enough to extend
beyond the edge of the tube by at least 1 inch in all directions. Tension on the capsule surrogate was established by
placing it over the pipe underwater to ensure no air bubbles
were trapped underneath, then placing a rubber band
around the diameter of the tube to secure it. Once secured
in this fashion, to ensure a reasonably uniform tension in all
directions, the capsule surrogate was examined for wrinkling, as this would indicate uneven tension. Any wrinkling was resolved by adjusting tension in the appropriate
axis of the plastic wrap. This adjustment process was
repeated until the entire surface of the capsule surrogate
was smoothly uniform. This formed a chamber that was
! CAPSULE SURROGATE:

180

completely filled with water and then submerged in a water

bath in order to have a fluid interface on both sides of the
capsule surrogate.
Signature
SETTINGS: The
(AMO, Inc) phacoemulsification machine was used with
the Fusion cassette (AMO, Inc), with all trials using a
550 mm Hg vacuum setting in both peristaltic and Venturi
modes, a bottle height of 50 cm, and balanced salt solution.
All trials in peristaltic mode used a flow rate of 40 mL/min.
While we do not know the exact fluid flow for Venturi vacuum at 550 mm Hg, in a previous study at 500 mm Hg fluid
flow was 102.2 6 2.3 mL/min for micropulsed longitudinal
and 96.6 6 0.7 mL/min for transversal ultrasound.13 Micropulsed ultrasound trials used a WhiteStar handpiece
(AMO, Inc), while transversal ultrasound trials used an
Ellips FX handpiece (AMO, Inc). Micropulsed ultrasound
was set at 50% power with a 6 ms on-duty cycle and 6 ms
off-cycle.15,16 Transversal ultrasound was set at
continuous 50% power. Ultrasound and vacuum were
both used at only their maximum setting, with all
settings on panel control to ensure uniformity. While
previous work9 has shown that micropulsed ultrasound is
most efficient at 100% power and transversal at 50% power,
we decided the fairest test would be to use the same power
setting for both in order to minimize power settings as a
confounding factor if there were differing breakage rates.

! PHACOEMULSIFICATION

All trials used phacoemulsification tips with a 30 degree bevel and 0.9 mm
(20 gauge) tip diameter. Transversal ultrasound trials
were done with a 30 degree bent (Kelman) tip, while
micropulsed trials used a straight tip. All tips were made
by MicroSurgical Technology (Redmond, Washington,
USA). A new tip was used at the beginning of each condition to control for the effect of repeated contact with the
capsule surrogate on tip sharpness.

! PHACOEMULSIFICATION TIPS:

In order to
distinguish possible differences in safety between peristaltic
and Venturi pump modes, 2 techniques for contacting the
capsule surrogate simulated different clinical situations.
The first technique consisted of tapping the edge of the
tip against the plastic wrap by approaching the membrane
with the needle bevel up at an angle approximately 30 degrees above parallel to the testing membrane, with no tip
occlusion, as indicated in the Figure, Left (tip contact). Ultrasound was engaged during the approach to the surrogate
capsule, needle contact, and retraction away from the
membrane.
The second technique involved tapping the needle
opening at an appropriate angle against the plastic wrap
to achieve tip occlusion. To achieve proper and even occlusion, the handle was held such that the bevel of the
needle was facing downward with the needle opening parallel to the capsule surrogate as indicated in the Figure,

! CONTACT WITH CAPSULE SURROGATE:

AMERICAN JOURNAL OF OPHTHALMOLOGY

JULY 2015

FIGURE. Two approaches were used to contact a surrogate of the human lens capsule with a phacoemulsification needle, in order to
assess the risk of capsule rupture using peristaltic and Venturi vacuum pumps with micropulsed and transversal ultrasound. The line
represents the capsule surrogate. (Left) Tip contact: The needle is held bevel up, at an angle approach approximately 30 degrees from
the capsule surrogate. (Right) Tip occlusion: The needle is held bevel down, with the needle bevel opening parallel to the capsule
surrogate.

Right (tip occlusion). Ultrasound was engaged during

approach to the surrogate and contact and establishment
of occlusion; once tip occlusion was indicated by the
increasing pitch of audio tones, which signaled increasing
vacuum, the pedal was released fully and the tip was simultaneously retracted away from the plastic wrap. The total
time of occlusion from initial contact of the needle to
release and retraction away from the membrane was
approximately 1 second.
In both techniques, contact between the needle and
capsule surrogate was monitored under direct visualization,
which was aided by placement of a light that would reflect
off the membrane, allowing observation of the time and
point of contact. Eight conditions were tested: (1) micropulsed ultrasound in peristaltic mode with tip contact;
(2) micropulsed ultrasound in peristaltic mode with tip occlusion; (3) transversal ultrasound in peristaltic mode with
tip contact; (4) transversal ultrasound in peristaltic mode
with tip occlusion; (5) micropulsed ultrasound in Venturi
mode with tip contact; (6) micropulsed ultrasound in
Venturi mode with tip occlusion; (7) transversal ultrasound
in Venturi mode with tip contact; and (8) transversal ultrasound in Venturi mode with tip occlusion. For each occlusion condition, contact was made with the plastic wrap in
different places for a total of 200 taps. For each tip contact,
contact was made with the plastic wrap in different places
for a total of 400 taps. This differential in the number of
taps was owing to the considerable difference in breakage
rates between tip occlusion and tip contact conditions
that we observed in preliminary experiments.
After each run of
200 or 400 taps, the plastic wrap was examined under a
microsurgical microscope (Leica Microsystems Inc, Buffalo
Grove, Illinois, USA) using a Sinskey hook (Bausch &
Lomb Inc, Rochester, New York, USA) to gently probe

! ANALYSIS OF CAPSULE SURROGATE:

VOL. 160, NO. 1

for breakage. Additionally, in tip occlusion trials we further

verified that occlusion had been achieved by observing a
full 360 degree outline of the needle in the plastic wrap
for each trial.
A x2 analysis was used to
compare breakage rates between conditions, looking at differences between peristaltic and Venturi modes; between
micropulsed and transversal ultrasound; and between tip
edge contact and tip occlusion conditions. Results were
considered statistically significant at P < .007 after a
Bonferroni correction for multiple comparisons.

! STATISTICAL ANALYSIS:

RESULTS
SEVEN COMPARISONS WERE PERFORMED ON THE DATA SET:

(1) peristaltic vs Venturi pump modes with occlusion data

included, (2) peristaltic vs Venturi pump modes without
occlusion data, (3) micropulsed vs transversal ultrasound
with occlusion data included, (4) micropulsed vs transversal ultrasound without occlusion data, (5) tip contact
vs tip occlusion techniques, (6) tip contact using micropulsed ultrasound in peristaltic vs Venturi pump modes,
and (7) tip contact using transversal ultrasound in peristaltic vs Venturi pump modes.
We analyzed the peristaltic vs Venturi pump data and
the micropulsed vs transversal ultrasound data twice,
including the occlusion data in one comparison and
excluding it in another. This is because with the occlusion
techniques, in all 800 trials and regardless of ultrasound
modality or vacuum pump type, not a single break occurred.
Hence, in comparisons where the tip occlusion data were
included, the large number of included trials that did not
cause any breaks resulted in a smaller percentage difference

SAFETY OF VENTURI VERSUS PERISTALTIC PHACOEMULSIFICATION PUMPS

181

TABLE. Breaks in a Capsular Surrogate for the Human Lens for Peristaltic and Venturi Phacoemulsification Pumps, Using Micropulsed
and Transversal Ultrasound Modalities, and Tip Contact or Tip Occlusion Techniques, With Machine Set at 550 mm Hg, 50 cm Bottle
Height (Actual), and When in Peristaltic Mode a 40 mL/min Flow Rate (Machine Indicated)
Conditions

Vacuum Pump Type

Ultrasound Modality

Tip Contact or Occlusion

1
2
3
4
5
6
7
8

Peristaltic
Peristaltic
Peristaltic
Peristaltic
Venturi
Venturi
Venturi
Venturi

Micropulsed
Micropulsed
Transversal
Transversal
Micropulsed
Micropulsed
Transversal
Transversal

Contact
Occlusion
Contact
Occlusion
Contact
Occlusion
Contact
Occlusion

No. of Trials Performed

No. (%) of Breaks

400
200
400
200
400
200
400
200

246 (61.5%)
0
284 (71%)
0
208 (52%)
0
274 (68.5%)
0

P < .0001 for all tip contact vs occlusion (rows 1, 3, 5, & 7 vs 2, 4, 6, & 8).
P .013 peristaltic vs Venturi for all comparisons with contact (rows 1 & 3 vs 5 & 7).
P < .0001 for all micropulsed vs transversal with contact (rows 1 & 5 vs 3 & 7).
P .0067 for micropulsed contact only peristaltic vs Venturi (row 1 vs 5).
P .44 for transversal contact only peristaltic vs Venturi (row 3 vs 7).

in breakage rates. Thus, in an effort to unmask possible

smaller differences between variables, we analyzed the
data both ways.
We found that there was no significant difference in
breakage rates between peristaltic and Venturi pump
modes. When tip occlusion data were included in this comparison, breakage rates were 44.2% for peristaltic pump
mode and 40.2% for Venturi pump mode (P .047).
When tip occlusion data were excluded from this comparison, breakage rates were 66.3% for peristaltic pump mode
and 60.3% for Venturi pump mode (P .013). Neither of
these comparisons exceeded our corrected level of statistical significance.
We further found that transversal ultrasound was significantly more likely to cause a breakage than micropulsed
ultrasound. When tip occlusion data were included in
this comparison, breakage rates were 46.5% for transversal
ultrasound and 37.8% for micropulsed ultrasound (P <
.0001). When tip occlusion data were excluded from this
comparison, breakage rates were 69.8% for transversal ultrasound and 56.8% for micropulsed ultrasound (P <
.0001). Both these comparisons exceeded our corrected
level of statistical significance.
As stated above, not a single break occurred in any of our
tip occlusion trials, regardless of ultrasound modality or
vacuum pump type. Thus, contacting the capsular surrogate with the tip was significantly more likely to cause a
breakage than tip occlusion, with a breakage rate of
63.3% for tip contact and 0% for tip occlusion (P <
.0001) (Table).
In an attempt to isolate the effect of switching between
peristaltic and Venturi vacuum pump modes, an additional
2 comparisons were identified and analyzed. First, breakage
rates with tip contact using micropulsed ultrasound were
61.5% for peristaltic pump mode and 52% using Venturi
182

pump mode, which reached statistical significance (P

.0067). Second, breakage rates with tip contact using transversal ultrasound were 71% for peristaltic pump mode and
68.5% for Venturi pump mode, which was not significant
(P .4415).

DISCUSSION
CAPSULE RUPTURE MOST COMMONLY OCCURS DURING THE

phacoemulsification stage of cataract surgery. Although

surgeons make every attempt to avoid contacting the
capsule with the phacoemulsification needle, occasional
inadvertent contact is inevitable. Meyer and associates14
observed that 6 variables have an effect on likelihood of
capsule breakage: (1) the amount of pressure of the tip
against the capsule; (2) the amount of active vacuum at
the tip; (3) the speed of flow of the machine; (4) the gauge
of the needle; (5) the needle sharpness and degree of angulation; and (6) the energy modulation active at the time of
contact. Our study examined the second of these variables,
which results from the inherent differences between peristaltic and Venturi pumps in fluidics at the phacoemulsification tip. The results of this study suggest 2 additional
variables: (7) the ultrasound modality in use; and (8) the
angle at which the tip contacts the capsule.
Many surgeons have observed both anecdotally and
experimentally that use of Venturi pumps can decrease
surgical time, but at the cost of higher postocclusion surge
and shorter time to react to events that occur during
phacoemulsification and aspiration of cataractous nuclear
material.1720 Contrary to expectations and paradoxically,
our results show that the Venturi pump may have a
marginally lower risk of capsular breakage than the

AMERICAN JOURNAL OF OPHTHALMOLOGY

JULY 2015

peristaltic pump, although this difference did not quite

reach statistical significance (P .0128). Once we
included tip occlusion data in the comparison, the
difference between breakage rates for peristaltic and
Venturi systems clearly was not significant. One possible
explanation is that unoccluded flow vacuum in
peristaltic systems is greater than some might
assume.14,18,21,22 This would decrease the anticipated
difference between the 2 systems in vacuum produced at
the phacoemulsification tip, even without occlusion. It
is difficult to explain why peristaltic vacuum might be
worse. However, we believe our results support the
conclusion that at the very least, there is no significant
difference between Venturi and peristaltic pumps in risk
of capsular breakage.
Our analysis revealed 2 other notable findings, both of
which achieved statistical significance. The first was the
difference in breakage rates between transversal and micropulsed ultrasound modalities, with significantly higher
breakage rates in the transversal ultrasound trials. This
finding persisted regardless of whether the tip occlusion
data were included or excluded. In this case, it may be
that the transversal motion produces more of a sideways
slicing effect on the membrane, while the traditional
micropulsed jackhammer motion simply impacts and
stretches the membrane with less likelihood of rupturing it.
Secondly, we found that contact of the tip edge with the
membrane was significantly more likely to cause breakage
than with full occlusion of the tip by the membrane.
Indeed, during a total of 800 trials with both ultrasound
modalities and both vacuum pump types in which we produced occlusion, not a single break occurred. Given the
relatively high vacuum settings used in this experiment,
this result is surprising, particularly because of the theoretically higher unoccluded flow vacuum that the Venturi
pump creates. This finding, in conjunction with our initial
observation that the Venturi and peristaltic modes likely
had fairly similar breakage rates, suggests that the main potential for phacoemulsification-associated capsular rupture
may be a consequence of the inherent sharpness of the
needle. The Meyer study, which documented that a radiused edge on the phacoemulsification needle, where all
sharpness was removed, dramatically reduced the risk of
capsular breakage, provides further support of this possibility. Thus, it is also possible that the magnitude of this effect
may differ based on the variability in tip finishes from
different needle manufacturers or differences in the edge
over time, especially small barbs. More investigation, especially of torsional motion, is needed to further explore these
findings.
Our isolated peristaltic pump vs Venturi pump comparison revealed an interesting contrast between micropulsed
and transversal ultrasound. Namely, when tip occlusion
data were excluded and only tip contact data were considered, with micropulsed ultrasound there was a statistically
significant difference in breakage rates, while with transVOL. 160, NO. 1

versal ultrasound the difference in breakage rates was not

significant. One possible explanation for this difference
rests with the different movements present at the needle
tip in each ultrasound modality. As we conjectured above,
the higher breakage rates seen in transversal ultrasound
may be attributed to a sideways slicing effect not present
in the micropulsed ultrasound modality. It may be that in
the presence of a larger risk factor for capsule rupture, in
this case transversal ultrasound, the difference made in
breakage rates by the vacuum pump type becomes less of
a factor. Contrast this with micropulsed ultrasound, in
which the jackhammer motion lowers the risk of capsule
rupture but unmasks the more subtle risk of differing vacuum pumps. As with our prior discussion above, it is difficult to explain why the peristaltic pump might be worse;
however, we should note that this finding only exceeded
our significance cutoff by a very small margin and thus
should not be given the same weight as our other findings.
Additionally, these comparisons were done excluding tip
occlusion data, magnifying differences between other variables. We again emphasize that at the very least our results
clearly support the conclusion that there is no significant
difference in the risk of capsular breakage between Venturi
and peristaltic pumps.
From a clinical perspective, several important conclusions can be drawn from our results and put into practice.
Most clearly demonstrated is the difference in breakage
rates between tip contact and tip occlusion. In surgical
practice, this most closely mirrors the bevel-up and
bevel-down approaches. Contrary to common belief,
our data support a bevel-down approach to phacoemulsification from the standpoint of reducing the risk of capsule
rupture. This is because with a bevel-down approach, in
the event of inadvertent contact with the capsule the surgeon would increase the likelihood of a tip occlusiontype
event and decrease the likelihood of a tip contacttype
event.
Furthermore, we demonstrated that using a Venturi vacuum pump in cataract surgery does not increase the risk of
capsule rupture. While our data do not address some of the
common comparisons of Venturi systems having higher
postocclusion surge and shorter reaction time intraoperatively compared to peristaltic systems, they do support
the conclusion that Venturi and peristaltic vacuum pumps
can be considered equivalent in their risk of capsule
rupture. Thus, surgeons should consider other variables,
such as efficiency, effective phacoemulsification time, and
personal preference, when evaluating vacuum pump types.
The principal limitation of this study is that our methods
are simulations of situations that can occur during cataract
surgery. It would not be possible to conduct such an experiment using human subjects. Additionally, a study with
methods similar to ours14 used a relatively small sample
of human cadaver capsules in addition to the capsular surrogate; their results from the cadaver capsules were consistent with what they observed using plastic wrap as a

SAFETY OF VENTURI VERSUS PERISTALTIC PHACOEMULSIFICATION PUMPS

183

capsular surrogate. Our results would be prohibitively

expensive to investigate and replicate using human cadaver
capsules, and we believe that our methods and procedures
provide a feasible and effective way to accomplish our objectives. At the very least the risk ratio is likely to be
similar, even if the absolute risk is likely to be somewhat
different.
In conclusion, it is important to note that the risk of
capsule rupture is directly related to direct contact with

the capsule by the sharp point of the tip and is not secondary to occlusion even with ultrasound on. Because of this
finding, we did not see a significant difference in capsular
contact risk between Venturi and peristaltic vacuum
even when we used very aggressive parameters. The use
of transversal ultrasound appears to increase capsular
rupture risk, and our previous work has shown that edge
sharpness of the tip is an additional risk factor. Other tip
motions need to be assessed in an equally rigorous fashion.

ALL AUTHORS HAVE COMPLETED AND SUBMITTED THE ICMJE FORM FOR DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST.
Mr Gilbert, Dr Zaugg, Dr Stagg, and Dr Olson do not have any proprietary or financial interest, or any other conflicts of interest, to report. This study was
supported in part by an unrestricted grant from Research to Prevent Blindness, Inc, New York, New York, USA, to the Department of Ophthalmology and
Visual Sciences, University of Utah, Salt Lake City, Utah, USA. Dr Stagg and Dr Zaugg are recipients of Achievement Rewards for College Scientists
Foundation, Inc (ARCS), Utah Chapter, Salt Lake City, Utah, USA, Scholar Awards. MicroSurgical Technology (Redmond, Washington, USA)
donated the tips that were used for the study. All authors attest that they meet the current ICMJE requirements to qualify as authors.
Susan Schulman, University of Utah School of Medicine, Salt Lake City, Utah, served as a consulting medical writer.

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AMERICAN JOURNAL OF OPHTHALMOLOGY

JULY 2015

Biosketch
Michael Gilbert, MD, graduated from the Creighton University School of Medicine. He is currently an intern at the
University of Kansas Medical Center and will be continuing there as a resident in the Department of Ophthalmology in
2016.

VOL. 160, NO. 1

SAFETY OF VENTURI VERSUS PERISTALTIC PHACOEMULSIFICATION PUMPS

184.e1

Reproduced with permission of the copyright owner. Further reproduction prohibited without
permission.