Purpose: To compare the outcomes of longitudinal and torsional modes of phacoemulsification with foldable intraocular lens implantation surgery using an intrepid balanced tip with gravity fluidics system.

Methods: This single-centre prospective study comprised a total of 80 eyes of 80 patients having senile cataract with nuclear opalescence (NO) grade II-IV (LOCS III). Cataracts of each grade were randomly assigned into 2 groups LPKE and TPKE mode. All the patients were operated by the same surgeon using the same machine having gravity fluidics using an intrepid balanced tip. Patients were evaluated on postoperative days (PODs) 1,7,15 and 30 for BCVA, CCT, and ECD. Intraoperative outcome measures were cumulative dissipated energy (CDE) and ultrasound time (UST). Postoperative outcome measures were best corrected visual acuity (BCVA), central corneal thickness (CCT), and endothelial cell density (ECD) on days 1,7,15, and 28.

Results: The difference of CDE and UST between the 2 modes was found to be significant (p<0.001) in favor of TPKE mode in all NO grades. TPKE mode performs better than LPKE mode regarding ECL, CCT change, and BCVA change, although the differences were insignificant (P > 0.05).

Conclusion: When using gravity fluidics along with the intrepid balanced tip, TPKE mode appeared to be a more efficient mode of PKE with reduced mean UST and CDE across all NO grades, as compared to LPKE mode. However, ECL, CCT change, and BCVA change seemed to be comparable between the two modes.