ASCRS 2026: Carlton Yuen, MD, BSc, ABO, on dual-pump phaco fluidics and low endothelial cell loss

For cataract surgeons, the conversation around phacoemulsification is increasingly shifting from ultrasound power to fluidics strategy. Carlton Yuen, MD, BSc, ABO, of Aloha Vision Consultants in Honolulu, Hawaii, discussed how dual-pump phaco technology may help reduce effective ultrasound time while supporting endothelial preservation in his presentation at the American Society of Cataract and Refractive Surgery (ASCRS) 2026 annual meeting in Washington, DC, April 10–13.

Yuen began by reframing the way surgeons think about phacoemulsification. “Typically, we think about the ultrasound doing the majority of the work,” he said, but argued that contemporary cataract surgery has evolved toward “a point of fluidics,” with surgeons leveraging advanced pump systems to improve efficiency and control. Specifically, he described selective use of peristaltic and Venturi pump modes depending on the surgical step.

In his technique, the peristaltic pump is used for groove creation and removal of the first nuclear fragment, where holding power and controlled occlusion are advantageous. He then transitions to the Venturi pump for removal of the remaining lens material and cortical cleanup, citing its superior “followability” and rapid aspiration of nuclear fragments and cortex.

A central aim of this approach is minimizing ultrasound exposure. As Yuen noted, “we all want to use as little ultrasound energy as possible.” In the study he presented, this translated into an average effective phacoemulsification time of 1.7 seconds. He attributed this low phaco time to selecting “the right pump in the right situation” and switching modes during different phases of the case.

The study combined femtosecond laser cataract surgery with phacoemulsification using the Veritas dual-mode, dual-pump platform. After femtosecond lens fragmentation, surgeons used the selected pump mode according to the procedural step, allowing for efficient lens removal with minimal ultrasound.

A key outcome emphasized in the presentation was endothelial preservation. Yuen noted that the team “effectively lost almost no endothelial cells with cataract surgery,” contrasting this with other published studies reporting 13% to 17% endothelial cell loss. He suggested that replacing ultrasound-driven lens fragmentation with more fluidics-based aspiration may have contributed to this finding.

As he described it, rather than using ultrasound to break up the cataract with “severe violent vibrations,” the goal is to “use the pump to suck the cataract out in a more gentle fashion,” which he believes contributed to the low endothelial cell loss observed.

Yuen also highlighted the practical utility of Venturi mode during cortical cleanup, particularly for surgeons who struggle with irrigation and aspiration. The ability to “grab those pieces of cortex and peel them so quickly” was presented as a key advantage.

Overall, the talk encouraged surgeons to move beyond legacy pump preferences and “choose the appropriate settings for each portion of the cataract surgery.”