Preliminary bench review suggests 4D ultrasound improves emulsification in dense cataract nucleiCould a new ultrasound mode break down the hardest cataract nuclei faster than current tools?

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.