ORIGINAL RESEARCH article
Front. Med.
Sec. Ophthalmology
Active Fluidics at Lower Intraocular Pressure Reduces Intraoperative Discomfort During Phacoemulsification: A Propensity Score-Matched Cohort Study
Yuanjiao Qiao
Ye Ye
Fangyan Liu
Lishi Luo
Xiaosheng Huang
Biyun Liang
Wenqun Xi
Xinhua Liu
Kun Zeng
Shenzhen Eye Hospital, Shenzhen, China
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Abstract
Background: Phacoemulsification under topical anesthesia requires adequate intraocular pressure (IOP) maintenance, but elevated IOP may contribute to patient discomfort and corneal stress. Active fluidics technology enables surgery at lower target pressures, yet the impact on patient-centered outcomes remains underexplored. Methods: This prospective cohort study compared the Centurion Vision System with active fluidics (target IOP 30 mmHg) versus the Stellaris Elite System with gravity-based fluidics (approximately 62 mmHg) in patients undergoing phacoemulsification for age-related cataract. Propensity score matching (1:1) balanced baseline characteristics between groups. The primary outcome was intraoperative discomfort, assessed by supplemental anesthesia requirement and patient-reported pain scores (numerical rating scale, 0-10). Secondary outcomes included central corneal thickness (CCT), endothelial cell density (ECD), and visual acuity over one month of follow-up. Results: After matching, 130 patients (65 per group) were analyzed. Fewer patients in the Active Fluidics Group required supplemental anesthesia (3.1% vs. 13.8%; relative risk 0.22; 95% CI 0.05-0.98; p=0.028). Median pain scores during phacoemulsification were lower in the Active Fluidics Group (1 vs. 3; p<0.001). Day-1 CCT increase was smaller with active fluidics (28.4 vs. 46.8 micrometers; mean difference -18.4 micrometers; 95% CI -26.1 to -10.7; p<0.001), though this difference resolved by one month. ECD loss and final visual acuity were comparable between groups. No intraoperative complications occurred. Conclusion: Phacoemulsification using active fluidics at lower target IOP was associated with reduced intraoperative discomfort and attenuated early postoperative corneal edema while maintaining equivalent safety and visual outcomes.
Summary
Keywords
active fluidics, Corneal Edema, Intraocular Pressure, intraoperative discomfort, Phacoemulsification
Received
08 January 2026
Accepted
09 February 2026
Copyright
© 2026 Qiao, Ye, Liu, Luo, Huang, Liang, Xi, Liu and Zeng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Kun Zeng
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