Intraocular Pressure Control after Trabeculectomy, Phacotrabeculectomy and Phacoemulsification in a Hispanic Population

PubMed Central

L Jung, Jennifer; Isida-Llerandi, Cristina G; Lazcano-Gomez, Gabriel; SooHoo, Jeffrey R

2014-01-01

ABSTRACT Purpose: To compare the efficacy of different surgical strategies for intraocular pressure (IOP) control in Hispanic glaucoma patients with and without visually significant cataracts. Design: Comparative retrospective consecutive case series. Methods: The charts of 153 consecutive patients with primary open angle glaucoma who underwent either trabeculectomy alone (n = 51), phacotrabeculectomy (n = 51), or phacoemulsification alone (n = 51) were reviewed to compare IOP control, the number of glaucoma medications required postoperatively, and the inci dence of surgical complications. Results: Preoperative IOP was 17.5 ± 5.2 mm Hg in the trabe-culectomy group, 15.4 ± 4.5 mm Hg in the phacotrabeculectomy group and 13.9 ± 2.9 mm Hg in the phacoemulsification group (p < 0.001 for all comparisons). Mean IOP reduction from baseline was 4.2 ± 6.9 (24.6%) for the trabeculectomy group, 2.9 ± 5.0 (20.8%) for the phacotrabeculectomy group, and 0.9 ± 3.4 (6.5%) for the phacoemulsification group (p = 0.009). The number of IOP-lowering medications required postoperatively decreased significantly in all three groups (p = 0.001). The rate of early and late postoperative complications was similar between the trabeculectomy and phacotrabeculectomy groups and less for the phacoemulsification group. Conclusion: Trabeculectomy and phacotrabeculectomy are both viable surgical options for managing open angle glau coma. Both resulted in similar rates of success, IOP reduction, decrease in use of IOP-lowering medications and post operative complication rates. Phacoemulsification alone had a lower success rate and greater need for postoperative IOP-lowering medications compared to trabeculectomy alone or phacotrabeculectomy. Phacoemulsification alone may be a reasonable option for patients with visually significant cataract and lower baseline IOP. How to cite this article: Jung JL, Isida-Llerandi CG, Lazcano-Gomez G, SooHoo JR, Kahook MY. Intraocular Pressure Control after Trabeculectomy, Phacotrabeculectomy and Phaco-emulsification in a Hispanic Population. J Curr Glaucoma Pract 2014;8(2):67-74. PMID:26997812

An unusual complication of combined gonioscopy-assisted transluminal trabeculotomy and phacoemulsification: vision loss due to intracapsular hematoma.

PubMed

Yalinbas, Duygu; Aktas, Zeynep; Hepsen, İbrahim; Dilekmen, Nilay

2017-09-23

To report two cases with an acute vision loss due to intracapsular hemorrhage (hematoma) after an uncomplicated gonioscopy-assisted transluminal trabeculotomy (GATT) combined with phacoemulsification surgery. Case report. Seventy-six-year-old male and 75-year-old female patients with cataract and pseudoexfoliative glaucoma (XFG) uncontrolled with maximum medical therapy both underwent GATT combined with phacoemulsification. Shortly after the surgery, intracapsular hematoma behind the intraocular lens (IOL) were noted in both patients. Hematoma cleared in both of them via IOL extraction-anterior vitrectomy and YAG-laser capsulotomy, respectively. Hematoma cleared in both patients without any surgical complications. Vision loss due to unclearing intracapsular hematoma might be an early complication of combined GATT and phacoemulsification surgery.

The Effect of Phacoemulsification on Intraocular Pressure in Glaucoma Patients: A Report by the American Academy of Ophthalmology.

PubMed

Chen, Philip P; Lin, Shan C; Junk, Anna K; Radhakrishnan, Sunita; Singh, Kuldev; Chen, Teresa C

2015-07-01

To examine effects of phacoemulsification on longer-term intraocular pressure (IOP) in patients with medically treated primary open-angle glaucoma (POAG; including normal-tension glaucoma), pseudoexfoliation glaucoma (PXG), or primary angle-closure glaucoma (PACG), without prior or concurrent incisional glaucoma surgery. PubMed and Cochrane database searches, last conducted in December 2014, yielded 541 unique citations. Panel members reviewed titles and abstracts and selected 86 for further review. The panel reviewed these articles and identified 32 studies meeting the inclusion criteria, for which the panel methodologist assigned a level of evidence based on standardized grading adopted by the American Academy of Ophthalmology. One, 15, and 16 studies were rated as providing level I, II, and III evidence, respectively. All follow-up, IOP, and medication data listed are weighted means. In general, the studies reported on patients using few glaucoma medications (1.5-1.9 before surgery among the different diagnoses). For POAG, 9 studies (total, 461 patients; follow-up, 17 months) showed that phacoemulsification reduced IOP by 13% and glaucoma medications by 12%. For PXG, 5 studies (total, 132 patients; follow-up, 34 months) showed phacoemulsification reduced IOP by 20% and glaucoma medications by 35%. For chronic PACG, 12 studies (total, 495 patients; follow-up, 16 months) showed phacoemulsification reduced IOP by 30% and glaucoma medications by 58%. Patients with acute PACG (4 studies; total, 119 patients; follow-up, 24 months) had a 71% reduction from presenting IOP and rarely required long-term glaucoma medications when phacoemulsification was performed soon after medical reduction of IOP. Trabeculectomy after phacoemulsification was uncommon; the median rate reported within 6 to 24 months of follow-up in patients with controlled POAG, PXG, or PACG was 0% and was 7% in patients with uncontrolled chronic PACG. Phacoemulsification typically results in small, moderate, and marked reductions of IOP and medications for patients with POAG, PXG, and PACG, respectively, and using 1 to 2 medications before surgery. Trabeculectomy within 6 to 24 months after phacoemulsification is rare in such patients. However, reports on its effects in eyes with advanced disease or poor IOP control before surgery are few, particularly for POAG and PXG. Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Endothelial protection: avoiding air bubble formation at the phacoemulsification tip.

PubMed

Kim, Eung Kweon; Cristol, Stephen M; Kang, Shin J; Edelhauser, Henry F; Yeon, Dong-Soo; Lee, Jae Bum

2002-03-01

To investigate the conditions under which bubbles form during phacoemulsification. Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea. In the first part of the study, the partial pressure of oxygen (pO(2)) was used as a surrogate measure for the partial pressure of air. Irrigation solutions packaged in glass and plastic containers were studied. A directly vented glass bottle was also tested. The pO(2) of the various irrigation solutions was measured as the containers were emptied. In the second part, phacoemulsification procedures were performed in rabbit eyes with different power settings and different irrigation solutions. Intracameral bubble formation during the procedure was recorded. Following the phacoemulsification procedures, the corneas were stained for F-actin and examined for endothelial injury. The initial pO(2) in irrigation solutions packaged in glass bottles was about half that at atmospheric levels; in solutions packaged in plastic, it was at atmospheric levels. As irrigation solutions were drained from the container, the pO(2) of the solution tended to rise toward atmospheric levels. The rate of pO(2) increase was markedly reduced by using a directly vented glass bottle. In the phacoemulsification procedures, bubble formation was most likely to occur with higher pO(2) and higher power settings. Observation of bubbles by the surgeon was highly correlated with endothelial damage. Keeping the pO(2) low reduced the risk of endothelial damage, especially at higher phacoemulsification powers. The packaging of irrigation solutions was the most important factor in controlling the initial pO(2) of the solution. The pO(2) can be minimized throughout a phacoemulsification procedure by using a directly vented glass bottle.

Quantification of hydroxyl radical produced during phacoemulsification.

PubMed

Gardner, Jonathan M; Aust, Steven D

2009-12-01

To quantitate hydroxyl radicals produced during phacoemulsification with various irrigating solutions and conditions used in cataract surgery. Chemistry and Biochemistry Department, Utah State University, Logan, Utah, USA. All experiments were performed using an Infiniti Vision System phacoemulsifier with irrigation and aspiration. Hydroxyl radicals were quantitated using electron spin resonance spectroscopy and a spectrophotometric assay for malondialdehyde, which is formed by the oxidation of deoxyribose by the hydroxyl radical. Hydroxyl radical production increased during longitudinal-stroking phacoemulsification as power levels were increased in a nonlinear, nonexponential fashion. The detection of hydroxyl radical was reduced in irrigating solutions containing organic molecules (eg, citrate, acetate, glutathione, dextrose) and further reduced in Navstel, an irrigating solution containing a viscosity-modifying agent, hydroxypropyl methylcellulose. Hydroxyl radicals produced in settings representative of those used in phacoemulsification cataract surgery were quantitated using the deoxyribose method. Hydroxyl radical production was dependent on the level of ultrasound power applied and the irrigating solution used. Oxidative stress on the eye during phacoemulsification may be minimized by using irrigating solutions that contain organic molecules, including the viscosity-modifying agent hydroxypropyl methylcellulose, that can compete for reaction with hydroxyl radicals.

Clinical Analysis of Ocular Parameters Contributing to Intraoperative Pain during Standard Phacoemulsification

PubMed Central

Kim, Myung Jun

2017-01-01

Purpose. To study the correlation between ocular parameters and subjective pain that patients perceived during phacoemulsification. Methods. Medical records of 142 patients who underwent standard phacoemulsification under topical anesthesia between March and August 2016 were retrospectively reviewed. The pain during phacoemulsification and 1 h after surgery was assessed and compared using a visual analog scale. In addition, demographic data, preoperative biometric parameters, and intraoperative surgical parameters were recorded. Results. Mean age of patients was 67.49 ± 12.50 years. The mean pain score was 2.26 ± 0.85 during phacoemulsification and 0.40 ± 0.69 postoperatively. Intraoperative pain was significantly associated with higher preoperative intraocular pressure (β = 0.220, P = 0.016), greater anterior chamber depth (β = 0.210, P = 0.028), and greater axial length (β = 0.181, P = 0.043). Conclusions. To reduce the subjective pain when patients have high preoperative intraocular pressure, large anterior chamber depth, or great axial length, supplementary procedures may be required. PMID:28491473

Vitreous humor thermodynamics during phacoemulsification.

PubMed

Salcedo-Villanueva, Guillermo; Kon-Jara, Veronica; Harasawa, Mariana; Cervantes-Coste, Guadalupe; Ochoa-Contreras, Daniel; Morales-Cantón, Virgilio; Guerrero-Naranjo, José Luis; Quiroz-Mercado, Hugo; Landers, Maurice B

2015-08-01

The purpose of this study is to determine baseline vitreous humor temperature during a combined phacoemulsification and pars plana vitrectomy (PPV) procedure; to determine what is the temperature variation during phacoemulsification; and to compare vitreous temperature to sublingual temperature. The methods used are prospective, interventional and comparative study. Patients with a diagnosis of cataract and vitreous hemorrhage, programed for a combined procedure of phacoemulsification and PPV, were included. Patients were excluded if posterior capsular rupture existed during the anterior segment procedure. A thermoprobe was inserted through a PPV trocar. Measurement of the vitreous temperature was obtained at baseline and throughout phacoemulsification, at the end of every surgical step, and every 5 min. Sublingual temperature was measured with the same probe at the end of the surgery. Room temperature was registered. Seventeen eyes of 17 patients were included. Mean sublingual temperature was 36.5 °C (standard deviation [σ] 0.26 °C). Mean total vitreous temperature was 31.47 °C (σ 2.1 °C). Mean baseline vitreous temperature was 33.04 °C (σ 0.99 °C). Comparison of sublingual temperature with baseline vitreous temperature resulted in a significant difference (t test P < 0.000. 95 % confidence interval 2.93-3.98). Temperature measured by surgical step and surgical time presented a significant decrease in temperature from baseline (Kruskal-Wallis P < 0.000, P = 0.003, respectively). Vitreous humor is significantly hypothermic when compared to sublingual temperature. Vitreous temperature decreases significantly during phacoemulsification.

Ultrasonic-generated fluid velocity with Sovereign WhiteStar micropulse and continuous phacoemulsification.

PubMed

Steinert, Roger F; Schafer, Mark E

2006-02-01

To evaluate and compare ultrasonic turbulence created by conventional and micropulse ultrasound technology. Sonora Medical Systems, Longmont, Colorado, USA. A high-resolution digital ultrasound probe imaged the zone around a phacoemulsification tip. Doppler analysis allowed determination of flow. The fluid velocity was measured at 4 levels of ultrasound power at a constant flow, comparing the ultrasonic conditions of continuous energy to WhiteStar micropulses. In addition to the normal baseline irrigation and aspiration, fluid movement was detected directly below the phaco tip, produced by a nonlinear effect known as acoustic streaming. Acoustic streaming increased with increased phacoemulsification power for both conditions. At each of the 4 levels of power, fluid velocity away from the tip was less with micropulse technology than with continuous phacoemulsification. The demonstrated decrease in acoustic streaming flow away from the phaco tip with Sovereign WhiteStar micropulse technology compared to conventional ultrasound provides an objective explanation for clinical observations of increased stability of nuclear fragments at the tip and less turbulence in the anterior chamber during phacoemulsification. This methodology can be used to examine and compare fluid flow and turbulence under a variety of clinically relevant conditions.

Corneal Optical Quality Following Sub 1.8 mm Micro-Incision Cataract Surgery vs. 2.2 mm Mini-Incision Coaxial Phacoemulsification

PubMed Central

Alió, Jorge L.; Elkady, Bassam; Ortiz, Dolores

2010-01-01

Purpose: To study and compare the effects of the micro-incision cataract surgery (MICS-sub 1.8 mm) and miniincision coaxial phacoemulsification (2.2 mm) on the optical quality of the cornea characterized in terms of corneal aberrations. Materials and Methods: Fifty eyes underwent MICS and 50 mini-incision phacoemulsification, by the same surgeon. Both types of cataract surgery were performed using low ultrasound power and through a clear corneal incision, placed on the steepest corneal meridian ranging from 1.6 to 1.8 in MICS (Group I) and from 2.12 to 2.3 mm in mini-incision coaxial phacoemulsification (Group II). Seidel and Zernike aberration coefficients and RMS values were obtained for a 6-mm pupil preoperatively and one month after surgery. Results: The corneal astigmatism did not show statistically significant changes in either of the two groups: (MICS: –0.73 ± 0.63, –0.65 ± 0.53 D, P = 0.25), (mini-incision phacoemulsification; –1.21 ± 1.52, –1.00 ± 1.19 D, P = 0.12). The total RMS remained unchanged after MICS (1.77 ± 1.7, 1.65 ± 1.3 μm, P = 0.18) and mini-incision phacoemulsification (2.00 ± 1.87, 2.09 ± 1.8 μm, P = 0.41). Statistically significant changes were found for coma (P = 0.004) and higher-order aberrations (P < 0.001), showing MICS significantly less changes in cornea. Conclusions: Both MICS and mini-incision phacoemulsification do not degrade the optical quality of the cornea. Both surgeries do not induce a modification of the corneal astigmatism, even in the axis. It seems that 2 mm is the limit around which no optical changes are induced by cataract surgery in the human cornea. PMID:20543945

Phacoemulsification in pseudoexfoliation syndrome.

PubMed

Akinci, Arsen; Batman, Cosar; Zilelioglu, Orhan

2008-01-01

To compare the incidence of intraoperative and early postoperative complications (IEPC), visual outcomes, and change in intraocular pressure (IOP) between eyes with and without pseudoexfoliation syndrome (PEX) having cataract extraction by phacoemulsification. 800 eyes with PEX and 1,600 eyes without PEX having cataract extraction by phacoemulsification were included in this retrospective study. Evaluated parameters were incidence of IEPC, visual outcomes and change in IOP. chi2 and Student's t test were used for statistical analysis. There were no significant differences in the incidence of IEPC and visual acuity gain between the two groups (p > 0.05). Rise in IOP in the early postoperative period was significantly higher in the PEX group (p < 0.02). Patients with PEX who have phacoemulsification can achieve results similar to patients without PEX. IOP control in the early postoperative period seems to be more important in patients with PEX. Copyright 2008 S. Karger AG, Basel.

Corneal higher-order aberrations after phacoemulsification: a comparison of 3 different incision sizes.

PubMed

von Sonnleithner, Christoph; Pilger, Daniel; Homburg, David; Brockmann, Tobias; Torun, Necip; Bertelmann, Eckart

2017-06-26

To analyze the impact of different incision sizes for phacoemulsification on corneal higher-order aberrations (HOA). Patients seeking cataract surgery were randomly assigned to one of the following groups: 1.4 mm with biaxial microincision phacoemulsification (25 eyes), 1.8 mm with coaxial phacoemulsification (27 eyes), and 2.2 mm with coaxial phacoemulsification (62 eyes). Inclusion criteria were a minimum age of 18 years and uncomplicated cataract. Exclusion criteria were history of ocular trauma or intraocular surgery, any sign of inflammation or infection, pseudoexfoliation syndrome, glaucoma, optic atrophy, diabetic retinopathy, lens dislocation, cataracta intumescens, cataracta matura, and corneal diseases. Patients underwent phacoemulsification with implantation of an intraocular lens. Aberrometry was performed using an iTrace aberrometer with a pupil scan size of 5.0 mm preoperatively and at postoperative follow-up visits after 1 month. The paired sample t test and analysis of covariance were used for statistical analysis. Ninety patients (114 eyes) were enrolled (mean age 73.7 ± 8.9 years). In all groups, an increase of total HOAs could be measured. The strongest increase was seen in the 2.2 mm group (mean difference 0.031 [95% confidence interval (CI) 0.006-0.056], p = 0.014) and in the 1.4 mm group (mean difference 0.035 [95% CI -0.007 to 0078], p = 0.097). No important difference was found in the 1.8 mm group. The 2.2 mm and the 1.4 mm incisions seem to have a higher impact on corneal HOAs in comparison to the 1.8 mm incision.

Phacoemulsification and implantation of an accommodating IOL after PRK.

PubMed

Aslanides, loannis M; Plainis, Sotiris; Kumar, Vinod; Ginis, Harilaos

2006-01-01

To present a case of phacoemulsification and implantation of an accommodating intraocular lens (IOL) in a patient with cataract formation after previous refractive surgery. A 50-year-old man, who initially had photorefractive keratectomy to correct moderate myopia, developed a cataract in one eye. He subsequently underwent phacoemulsification and implantation of a 1CU accommodating IOL, as he wished to remain spectacle independent. The patient's distance vision was fully restored. However, accommodative function, which was assessed using subjective and novice objective techniques, was only partially restored. Although the accommodating IOL fully restored the patient's distance vision, accommodative function was only partially restored.

Dry Eye Following Phacoemulsification Surgery and its Relation to Associated Intraoperative Risk Factors.

PubMed

Sahu, P K; Das, G K; Malik, Aman; Biakthangi, Laura

2015-01-01

The purpose was to study dry eye following phacoemulsification surgery and analyze its relation to associated intra-operative risk factors. A prospective observational study was carried out on 100 eyes of 100 patients without preoperative dry eye. Schirmer's Test I, tear meniscus height, tear break-up time, and lissamine green staining of cornea and conjunctiva were performed preoperatively and at 5 days, 10 days, 1-month, and 2 months after phacoemulsification surgery, along with the assessment of subjective symptoms, using the dry eye questionnaire. The correlations between these values and the operating microscope light exposure time along with the cumulative dissipated energy (CDE) were investigated. There was a significant deterioration of all dry eye test values following phacoemulsification surgery along with an increase in subjective symptoms. These values started improving after 1-month postoperatively, but preoperative levels were not achieved till 2 months after surgery. Correlations of dry eye test values were noted with the operating microscope light exposure time and CDE, but they were not significant. Phacoemulsification surgery is capable of inducing dry eye, and patients should be informed accordingly prior to surgery. The clinician should also be cognizant that increased CDE can induce dry eyes even in eyes that were healthy preoperatively. In addition, intraoperative exposure to the microscopic light should be minimized.

Surgical peripheral iridectomy via a clear-cornea phacoemulsification incision for pupillary block following cataract surgery in acute angle closure.

PubMed

Fang, Aiwu; Wang, Peijuan; He, Rui; Qu, Jia

2018-05-18

To describe a technique of surgical peripheral iridectomy via a clear-cornea tunnel incision to prevent or treat pupillary block following phacoemulsification. Description of technique and retrospective description results in 20 eyes of 20 patients with acute angle closure with coexisting visually significant cataract undergoing phacoemulsification considered at risk of postoperative papillary block as well as two pseudo-phakic eyes with acute postoperative pupillary-block. Following phacoemulsification and insertion of an intraocular lens, a needle with a bent tip was inserted behind the iris through the corneal tunnel incision. A blunt iris repositor was introduced through the paracentesis and placed above the iris to exert posterior pressure and create a puncture. The size of the puncture was enlarged using scissors. For postoperative pupillary block the same technique was carried out through the existing incisions created for phacoemulsification. Peripheral iridectomy was successfully created in all 22 eyes. At a mean follow-up of 18.77 ± 9.72 months, none of the iridectomies closed or required enlargement. Two eyes had mild intraoperative bleeding and one eye a small Descemet's detachment that did not require intervention. No clinically significant complications were observed. Visual acuity and IOP improved or was maintained in all patients. The incidence of pupillary block in our hospital was 0.09% overall, 0.6% in diabetics and 3.5% in those with diabetic retinopathy. This technique of peripheral iridectomy via the cornea tunnel incision can be safely used during phacoemulsification in eyes at high risk of pupillary block or in the treatment of acute postoperative pupillary-block after cataract surgery. The technique is likely to be especially useful in brown iris, or if a laser is not available.

Impact of virtual reality simulation on learning barriers of phacoemulsification perceived by residents.

PubMed

Ng, Danny Siu-Chun; Sun, Zihan; Young, Alvin Lerrmann; Ko, Simon Tak-Chuen; Lok, Jerry Ka-Hing; Lai, Timothy Yuk-Yau; Sikder, Shameema; Tham, Clement C

2018-01-01

To identify residents' perceived barriers to learning phacoemulsification surgical procedures and to evaluate whether virtual reality simulation training changed these perceptions. The ophthalmology residents undertook a simulation phacoemulsification course and proficiency assessment on the Eyesi system using the previously validated training modules of intracapsular navigation, anti-tremor, capsulorrhexis, and cracking/chopping. A cross-sectional, multicenter survey on the perceived difficulties in performing phacoemulsification tasks on patients, based on the validated International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric (ICO-OSCAR), using a 5-point Likert scale (1 = least and 5 = most difficulty), was conducted among residents with or without prior simulation training. Mann-Whitney U tests were carried out to compare the mean scores, and multivariate regression analyses were performed to evaluate the association of lower scores with the following potential predictors: 1) higher level trainee, 2) can complete phacoemulsification most of the time (>90%) without supervisor's intervention, and 3) prior simulation training. The study was conducted in ophthalmology residency training programs in five regional hospitals in Hong Kong. Of the 22 residents, 19 responded (86.3%), of which 13 (68.4%) had completed simulation training. Nucleus cracking/chopping was ranked highest in difficulty by all respondents followed by capsulorrhexis completion and nucleus rotation/manipulation. Respondents with prior simulation training had significantly lower difficulty scores on these three tasks (nucleus cracking/chopping 3.85 vs 4.75, P = 0.03; capsulorrhexis completion 3.31 vs 4.40, P = 0.02; and nucleus rotation/manipulation 3.00 vs 4.75, P = 0.01). In multivariate analyses, simulation training was significantly associated with lower difficulty scores on these three tasks. Residents who had completed Eyesi simulation training had higher confidence in performing the most difficult tasks perceived during phacoemulsification.

Impact of virtual reality simulation on learning barriers of phacoemulsification perceived by residents

PubMed Central

Ng, Danny Siu-Chun; Sun, Zihan; Young, Alvin Lerrmann; Ko, Simon Tak-Chuen; Lok, Jerry Ka-Hing; Lai, Timothy Yuk-Yau; Sikder, Shameema; Tham, Clement C

2018-01-01

Objective To identify residents’ perceived barriers to learning phacoemulsification surgical procedures and to evaluate whether virtual reality simulation training changed these perceptions. Design The ophthalmology residents undertook a simulation phacoemulsification course and proficiency assessment on the Eyesi system using the previously validated training modules of intracapsular navigation, anti-tremor, capsulorrhexis, and cracking/chopping. A cross-sectional, multicenter survey on the perceived difficulties in performing phacoemulsification tasks on patients, based on the validated International Council of Ophthalmology’s Ophthalmology Surgical Competency Assessment Rubric (ICO-OSCAR), using a 5-point Likert scale (1 = least and 5 = most difficulty), was conducted among residents with or without prior simulation training. Mann–Whitney U tests were carried out to compare the mean scores, and multivariate regression analyses were performed to evaluate the association of lower scores with the following potential predictors: 1) higher level trainee, 2) can complete phacoemulsification most of the time (>90%) without supervisor’s intervention, and 3) prior simulation training. Setting The study was conducted in ophthalmology residency training programs in five regional hospitals in Hong Kong. Results Of the 22 residents, 19 responded (86.3%), of which 13 (68.4%) had completed simulation training. Nucleus cracking/chopping was ranked highest in difficulty by all respondents followed by capsulorrhexis completion and nucleus rotation/manipulation. Respondents with prior simulation training had significantly lower difficulty scores on these three tasks (nucleus cracking/chopping 3.85 vs 4.75, P = 0.03; capsulorrhexis completion 3.31 vs 4.40, P = 0.02; and nucleus rotation/manipulation 3.00 vs 4.75, P = 0.01). In multivariate analyses, simulation training was significantly associated with lower difficulty scores on these three tasks. Conclusion Residents who had completed Eyesi simulation training had higher confidence in performing the most difficult tasks perceived during phacoemulsification. PMID:29785084

Everything is ok on YouTube! Quality assessment of YouTube videos on the topic of phacoemulsification in eyes with small pupil.

PubMed

Aykut, Aslan; Kukner, Amber Senel; Karasu, Bugra; Palancıglu, Yeliz; Atmaca, Fatih; Aydogan, Tumay

2018-01-22

Usage of YouTube as an educational tool is gaining attention in academic research. To date, there has been no study on the content and quality of eye surgery videos on YouTube. The aim of this study was to analyze YouTube videos on phacoemulsification in eyes with small pupil. We searched for the phrases "small pupil cataract surgery," "small pupil phacoemulsification," "small pupil cataract surgery complications," and "small pupil phacoemulsification complications" in January 2015. Each resulting video was evaluated by all authors, and Krippendorff's alpha was calculated to measure agreement. Videos were classified according to pupil size (small/very small) in the beginning of the surgery, and whether pupillary diameter was large enough to continue surgery safely after pupillary dilation by the surgeon in the video (safe/not safe). Methods of dilatation were also analyzed. Any stated ocular comorbidity or surgical complications were noted. A total of 96 videos were reviewed. No mechanical intervention for pupillary dilatation was performed in 46 videos. Fifty-eight operated eyes had no stated ocular comorbidity. Ninety-five operations ended successfully without major complication. There was fair agreement between the evaluators regarding pupil sizes (Kα = 0.670) but poor agreement regarding safety (Kα = 0.337). YouTube videos on small pupil phacoemulsification have low complication rates when compared to the literature, although no reliable mechanical dilatation methods are used in almost half of these videos. Until YouTube's place in e-learning becomes clearer, we suggest that viewers be cautious regarding small pupil phacoemulsification videos on YouTube.

Management of iatrogenic crystalline lens injury occurred during intravitreal injection.

PubMed

Erdogan, Gurkan; Gunay, Betul Onal; Unlu, Cihan; Gunay, Murat; Ergin, Ahmet

2016-08-01

To evaluate the approach to management of iatrogenic crystalline lens injury occurred during intravitreal injection (IVI). The patients who were managed operatively or followed-up without intervention after the iatrogenic lens injury due to IVI were included in the study. Capsular breaks remained either quiescent or resulted in cataract formation in the patients with inadvertent crystalline lens capsule damage. Phacoemulsification surgery was performed in patients with cataract formation with lower fluidic settings. A total of 9 cases included in the study. Seven cases underwent phacoemulsification with intraocular lens implantation. Two cases remained as quiescent lens injury during the follow-up. In 2 cases, dislocation of lens fragments occurred during phacoemulsification where pars plana vitrectomy was performed at the same session. After iatrogenic crystalline lens injury, capsular damage could remain quiescent or progress to cataract formation. Although phacoemulsification surgery can be performed with appropriate parameters, lens fragment dislocation can be observed in cases with traumatic lens damage secondary to IVI.

Femtosecond phacoemulsification: the business and the medicine.

PubMed

Uy, Harvey S; Edwards, Keith; Curtis, Nick

2012-01-01

PURPOSE FOR REVIEW: Phacoemulsification is the preferred method for cataract surgery in the developed world. The number of phacoemulsification procedures performed annually is expected to increase as the population ages. Femtosecond cataract surgery offers several surgical advantages over conventional phacoemulsification and has already attained commercial application in some countries. The purpose of this review is to outline the benefits, risks and commercial issues of femtosecond lasers as applied to cataract surgery. Cataract surgeons are adopting femtosecond technology to perform laser capsulotomy, lens fragmentation, clear cornea incisions and limbal relaxing incisions. Femtosecond lasers clearly perform these surgical steps with greater precision and reproducibility. Further benefits such as improved postoperative refractive results and reduced complication rates are being investigated. Commercial issues have invariably arisen such as cost of installation and operation, value proposition and return on investment. Femtosecond cataract surgery is an evolving procedure that can potentially lead to better and safer surgical outcomes. This review presents the currently available scientific evidence and discusses some of the relevant financial issues concerning this technology.

A Cataract Surgery Training Program: 2-Year Outcome After Launching.

PubMed

Yu, A-Yong; Wang, Qin-Mei; Li, Jin; Huang, Fang; Golnik, Karl

2016-01-01

To investigate whether a short-term training program can produce competent cataract surgeons. This observational pilot study enrolled 12 trainees who could not perform phacoemulsification independently. The training consisted of 2 phases. During the first 3-month phase, trainees were taught phacoemulsification through wet laboratory exposure and deliberate practice in patients at the training center in the Eye Hospital of Wenzhou Medical University in China. The second phase consisted of performing 50 cases at the trainees׳ home institution with supports from instructors of the first phase. Trainees׳ surgical results were followed-up. The surgical skill as measured by the Ophthalmology Surgical Competency Assessment Rubric (OSCAR) and surgical outcomes were analyzed. During the first phase trainees performed 193.3 ± 95.4 wet laboratory cases and 557 eyes in patients. The complication rate was 0.54%. The OSCAR scores improved significantly (p < 0.01) in the first phase. At the second phase, all the trainees could carry out phacoemulsification at their home hospital and the complication rate was 1.87%. During the long-term follow-up, 4936 cases of phacoemulsification were performed and the complication rate was 0.87%. Trainees succeeded in performing phacoemulsification safely and skillfully through a limited short period of training by wet laboratory exposure, deliberate practice in patients, and frequent formative feedback provided by the OSCAR tool. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Comparison of torsional and longitudinal modes using phacoemulsification parameters.

PubMed

Rekas, Marek; Montés-Micó, Robert; Krix-Jachym, Karolina; Kluś, Adam; Stankiewicz, Andrzej; Ferrer-Blasco, Teresa

2009-10-01

To compare phacoemulsification parameters of torsional and longitudinal ultrasound modes. Ophthalmology Department, Military Health Service Institute, Warsaw, Poland. This prospective study evaluated eyes 1, 7, and 30 days after phacoemulsification with an Infiniti Vision System using the torsional or longitudinal ultrasound (US) mode. Cataract classification was according to the Lens Opacities Classification System II. Nucleus fragmentation was by the phaco-chop and quick-chop methods. Primary outcome measures were phaco time, mean phaco power, mean torsional amplitude, and aspiration time. Total energy, defined as cumulative dissipated energy (CDE) x aspiration time, and the effective coefficient, defined as aspiration time/phaco time, were also calculated. Four hundred eyes were evaluated. The CDE was statistically significantly lower in the torsional mode for nucleus grades I, II, and III (P<.001) but not for grade IV (P>.05). Aspiration time was statistically significantly shorter in the torsional mode than in the longitudinal mode for nucleus grades III and IV (P<.05). Total energy was significantly lower in the torsional mode for all nucleus densities (P<.05). The effective coefficient was significantly lower in the longitudinal mode except for nucleus grade I (P<.05). Torsional phacoemulsification was more effective than longitudinal phacoemulsification in the amount of applied fluid and the quantity of US energy expended. With the torsional method, it was possible to maintain a constant ratio of amount of fluid flow to quantity of US energy used, regardless of nucleus density.

Bilateral phacoemulsification in an orangutan (Pongo pygmaeus).

PubMed

Montiani-Ferreira, Fabiano; Lima, Leandro; Bacellar, Marianna; D'Otaviano Vilani, Ricardo G; Fedullo, José Daniel; Lange, Rogério R

2010-09-01

A 14-year-old, female, captive-born orangutan (Pongo pygmaeus) developed bilateral cataracts. Ultrasonography, electroretinography and cataract correction using phacoemulsification were performed bilaterally. This case report aims to describe the ophthalmic procedures performed in this animal critically endangered of extinction. The surgery successfully restored vision and normal activity to the patient.

Using the phacoemulsification crescent knife in dacryocystorhinostomy.

PubMed

Fong, K S; Koh, A H; Choo, C T

1998-04-01

Dacryocystorhinostomy is an effective treatment for nasolacrimal duct obstruction. Most techniques employ a conventional blade or knife in making the incision of the nasal mucosa and lacrimal sac. The authors describe the use of a phacoemulsification crescent knife for this purpose. This technique can be effective and at the same time safer and easier to perform.

[Computer-assisted phacoemulsification for hard cataracts].

PubMed

Zemba, M; Papadatu, Adriana-Camelia; Sîrbu, Laura-Nicoleta; Avram, Corina

2012-01-01

to evaluate the efficiency of new torsional phacoemulsification software (Ozil IP system) in hard nucleus cataract extraction. 45 eyes with hard senile cataract (degree III and IV) underwent phacoemulsification performed by the same surgeon, using the same technique (stop and chop). Infiniti (Alcon) platform was used, with Ozil IP software and Kelman phaco tip miniflared, 45 degrees. The nucleus was split into two and after that the first half was phacoemulsificated with IP-on (group 1) and the second half with IP-off (group 2). For every group we measured: cumulative dissipated energy (CDE), numbers of tip closure that needed manual desobstruction the amount of BSS used. The mean CDE was the same in group 1 and in group 2 (between 6.2 and 14.9). The incidence of occlusion that needed manual desobstruction was lower in group 1 (5 times) than in group 2 (13 times). Group 2 used more BSS compared to group 1. The new torsional software (IP system) significantly decreased occlusion time and balanced salt solution use over standard torsional software, particularly with denser cataracts.

Comparison of occlusion break responses and vacuum rise times of phacoemulsification systems.

PubMed

Sharif-Kashani, Pooria; Fanney, Douglas; Injev, Val

2014-07-30

Occlusion break surge during phacoemulsification cataract surgery can lead to potential surgical complications. The purpose of this study was to quantify occlusion break surge and vacuum rise time of current phacoemulsification systems used in cataract surgery. Occlusion break surge at vacuum pressures between 200 and 600 mmHg was assessed with the Infiniti® Vision System, the WhiteStar Signature® Phacoemulsification System, and the Centurion® Vision System using gravity-fed fluidics. Centurion Active FluidicsTM were also tested at multiple intraoperative pressure target settings. Vacuum rise time was evaluated for Infiniti, WhiteStar Signature, Centurion, and Stellaris® Vision Enhancement systems. Rise time to vacuum limits of 400 and 600 mmHg was assessed at flow rates of 30 and 60 cc/minute. Occlusion break surge was analyzed by 2-way analysis of variance. The Centurion system exhibited substantially less occlusion break surge than the other systems tested. Surge area with Centurion Active Fluidics was similar to gravity fluidics at an equivalent bottle height. At all Centurion Active Fluidics intraoperative pressure target settings tested, surge was smaller than with Infiniti and WhiteStar Signature. Infiniti had the fastest vacuum rise time and Stellaris had the slowest. No system tested reached the 600-mmHg vacuum limit. In this laboratory study, Centurion had the least occlusion break surge and similar vacuum rise times compared with the other systems tested. Reducing occlusion break surge may increase safety of phacoemulsification cataract surgery.

Comparison of occlusion break responses and vacuum rise times of phacoemulsification systems

PubMed Central

2014-01-01

Background Occlusion break surge during phacoemulsification cataract surgery can lead to potential surgical complications. The purpose of this study was to quantify occlusion break surge and vacuum rise time of current phacoemulsification systems used in cataract surgery. Methods Occlusion break surge at vacuum pressures between 200 and 600 mmHg was assessed with the Infiniti® Vision System, the WhiteStar Signature® Phacoemulsification System, and the Centurion® Vision System using gravity-fed fluidics. Centurion Active FluidicsTM were also tested at multiple intraoperative pressure target settings. Vacuum rise time was evaluated for Infiniti, WhiteStar Signature, Centurion, and Stellaris® Vision Enhancement systems. Rise time to vacuum limits of 400 and 600 mmHg was assessed at flow rates of 30 and 60 cc/minute. Occlusion break surge was analyzed by 2-way analysis of variance. Results The Centurion system exhibited substantially less occlusion break surge than the other systems tested. Surge area with Centurion Active Fluidics was similar to gravity fluidics at an equivalent bottle height. At all Centurion Active Fluidics intraoperative pressure target settings tested, surge was smaller than with Infiniti and WhiteStar Signature. Infiniti had the fastest vacuum rise time and Stellaris had the slowest. No system tested reached the 600-mmHg vacuum limit. Conclusions In this laboratory study, Centurion had the least occlusion break surge and similar vacuum rise times compared with the other systems tested. Reducing occlusion break surge may increase safety of phacoemulsification cataract surgery. PMID:25074069

Macular edema after uncomplicated cataract surgery: a role for phacoemulsification energy and vitreoretinal interface status?

PubMed

Anastasilakis, Konstantinos; Mourgela, Anna; Symeonidis, Chrysanthos; Dimitrakos, Stavros A; Ekonomidis, Panayiotis; Tsinopoulos, Ioannis

2015-01-01

To study postoperative macular thickness fluctuations measured by spectral-domain optical coherence tomography (SD-OCT) and to investigate a potential correlation among macular edema (ME) incidence, cumulative dissipated energy (CDE) released during phacoemulsification, and vitreoretinal interface status. This is a prospective, cross-sectional study of 106 cataract patients with no macular disorder who underwent phacoemulsification. Best-corrected visual acuity measurement, slit-lamp examination, OCT scans were performed preoperatively and 30 and 90 days postoperatively. The intraoperative parameters measured were CDE and total phacoemulsification time. The SD-OCT parameters assessed were central subfield thickness (CST), cube average thickness (CAT), cube macular volume, vitreoretinal interface status, and presence of cystoid or diffuse ME. Four patients (3.8%) developed subclinical ME. Regarding ME, there was no significant difference between patients with presence or absence of posterior vitreous detachment (chi-square, p = 0.57), although 75% of ME cases were observed in patients with attached posterior vitreous. With regard to comparison between eyes with and without subclinical CME incidence, CDE (p = 0.05), phacoemulsification time (p = 0.001), CST at month 1 (p = 0.002), cube macular volume at month 1 (p = 0.039), and CAT at month 1 (p = 0.050) were significantly higher in the subclinical CME group. This study provides evidence that OCT macular thickness parameters increase significantly at first and third month postoperatively and that the incidence of pseudophakic ME can be affected by CDE.

A Comparative Study of Clear Corneal Phacoemulsification with Rigid IOL Versus SICS; the Preferred Surgical Technique in Low Socio-economic group Patients of Rural Areas.

PubMed

Devendra, Jaya; Agarwal, Smita; Singh, Pankaj Kumar

2014-11-01

Low socio-economic group patients from rural areas often opt for free cataract surgeries offered by charitable organisations. SICS continues to be a time tested technique for cataract removal in such patients. In recent times, camp patients are sometimes treated by clear corneal phacoemulsification with implantation of a rigid IOL, which being more cost effective is often provided for camp patients. This study was undertaken to find out which surgical technique yielded better outcomes and was more suited for high volume camp surgery. To find the better surgical option- phacoemulsification with rigid IOL or SICS, in poor patients from rural areas. A prospective randomised controlled trial of cataract patients operated by two different techniques. One hundred and twelve eyes were selected and were randomly allocated into two groups of 56 eyes each. At completion of the study, data was analysed for 52 eyes operated by clear corneal phacoemulsification and implantation of a rigid IOL, and 56 eyes operated by SICS. Unpaired t-test was used to calculate the p- value. The results were evaluated on the following criteria. The mean post-operative astigmatism at the end of four weeks - was significantly higher in phacoemulsification group as compared to SICS group The BCVA (best corrected visual acuity) at the end of four weeks - was comparable in both groups. Subjective complaints and/ or complications: In phaco group two patients required sutures and seven had striate keratitis , while none in SICS group. Complaint of irritation was similar in both groups. Surgical time- was less for SICS group as compared to phaco group. SICS by virtue of being a faster surgery with more secure wound and significantly less astigmatism is a better option in camp patients from rural areas as compared to phacoemulsification with rigid IOL.

Topical anaesthesia with oxybuprocaine versus sub-Tenon's infiltration with 2% lignocaine for small incision cataract surgery.

PubMed

Chittenden, H B; Meacock, W R; Govan, J A

1997-04-01

To determine whether topical anaesthesia in small incision self-sealing phacoemulsification cataract surgery provides comparable anaesthesia to sub-Tenon's infiltration. Thirty five patients undergoing small incision self-sealing phacoemulsification cataract surgery were allocated randomly to receive topical anaesthesia with 0.4% oxybuprocaine or sub-Tenon's infiltration with 2% lignocaine. Pain experienced during the operation was assessed by asking the patient to score on a visual analogue graphic pain score chart. The median pain score for the topical group (3) was significantly higher than that of the sub-Tenon's group (0) (p = 0.004). Sub-Tenon's infiltration is superior to topical anaesthesia in ensuring patient comfort during small incision scleral tunnel self-sealing phacoemulsification cataract surgery.

The Comparison between Torsional and Conventional Mode Phacoemulsification in Moderate and Hard Cataracts

PubMed Central

Kim, Dong-Hyun; Wee, Won-Ryang; Lee, Jin-Hak

2010-01-01

Purpose To compare the intraoperative performances and postoperative outcomes of cataract surgery performed with longitudinal phacoemulsification and torsional phacoemulsification in moderate and hard cataracts. Methods Of 85 patients who had senile cataracts, 102 eyes were operated on using the Infiniti Vision System. Preoperative examinations (slit lamp examination, mean central corneal thickness, and central endothelial cell counts) were performed for each patient. Cataracts were subdivided into moderate and hard, according to the Lens Opacities Classification System III grading of nucleus opalescence (NO). Eyes in each cataract group were randomly assigned to conventional and torsional phaco-mode. Intraoperative parameters, including ultrasound time (UST), cumulative dissipated energy (CDE), and the balanced salt solution plus (BSSP) volume utilized were evaluated. Best corrected visual acuity (BCVA) was checked on postoperative day 30; mean central corneal thickness and central endothelial cell counts were investigated on postoperative days 7 and 30. Results Preoperative BCVA and mean grading of NO showed no difference in both groups. Preoperative endothelial cell count and central corneal thickness also showed no significant difference in both groups. In the moderate cataract group, the CDE, UST, and BSSP volume were significantly lower in the torsional mode than the longitudinal mode, but they did not show any difference in the hard cataract group. Torsional group showed less endothelial cell loss and central corneal thickening at postoperative day seven in moderate cataracts but showed no significant differences, as compared with the longitudinal group, by postoperative day 30. Conclusions Torsional phacoemulsification showed superior efficiency for moderate cataracts, as compared with longitudinal phacoemulsification, in the early postoperative stage. PMID:21165231

The comparison between torsional and conventional mode phacoemulsification in moderate and hard cataracts.

PubMed

Kim, Dong-Hyun; Wee, Won-Ryang; Lee, Jin-Hak; Kim, Mee-Kum

2010-12-01

To compare the intraoperative performances and postoperative outcomes of cataract surgery performed with longitudinal phacoemulsification and torsional phacoemulsification in moderate and hard cataracts. Of 85 patients who had senile cataracts, 102 eyes were operated on using the Infiniti Vision System. Preoperative examinations (slit lamp examination, mean central corneal thickness, and central endothelial cell counts) were performed for each patient. Cataracts were subdivided into moderate and hard, according to the Lens Opacities Classification System III grading of nucleus opalescence (NO). Eyes in each cataract group were randomly assigned to conventional and torsional phaco-mode. Intraoperative parameters, including ultrasound time (UST), cumulative dissipated energy (CDE), and the balanced salt solution plus (BSSP) volume utilized were evaluated. Best corrected visual acuity (BCVA) was checked on postoperative day 30; mean central corneal thickness and central endothelial cell counts were investigated on postoperative days 7 and 30. Preoperative BCVA and mean grading of NO showed no difference in both groups. Preoperative endothelial cell count and central corneal thickness also showed no significant difference in both groups. In the moderate cataract group, the CDE, UST, and BSSP volume were significantly lower in the torsional mode than the longitudinal mode, but they did not show any difference in the hard cataract group. Torsional group showed less endothelial cell loss and central corneal thickening at postoperative day seven in moderate cataracts but showed no significant differences, as compared with the longitudinal group, by postoperative day 30. Torsional phacoemulsification showed superior efficiency for moderate cataracts, as compared with longitudinal phacoemulsification, in the early postoperative stage.

Comparison of endothelial changes and power settings between torsional and longitudinal phacoemulsification.

PubMed

Reuschel, Anna; Bogatsch, Holger; Barth, Thomas; Wiedemann, Renate

2010-11-01

To compare the intraoperative and postoperative outcomes of conventional longitudinal phacoemulsification and torsional phacoemulsification. Department of Ophthalmology, University of Leipzig, Germany. Randomized single-center clinical trial. Eyes with senile cataract were randomized to have phacoemulsification using the Infiniti Vision System and the torsional mode (OZil) or conventional longitudinal mode. Primary outcomes were corrected distance visual acuity (CDVA) and central endothelial cell density (ECD), calculated according to the Conference on Harmonisation-E9 Guidelines in which missing values were substituted by the median in each group (primary analysis) and the loss was then calculated using actual data (secondary analysis). Secondary outcomes were ultrasound (US) time, cumulative dissipated energy (CDE), and percentage total equivalent power in position 3. Postoperative follow-up was at 3 months. The mean preoperative CDVA was 0.41 logMAR in the torsional group and 0.38 logMAR in the longitudinal group, improving to 0.07 logMAR postoperatively in both groups. The mean ECD loss was 7.2% ± 4.6% in the torsional group (72 patients) and 7.1% ± 4.4% in the longitudinal group (76 patients), with no statistically significant differences in the primary analysis (P = .342) or secondary analysis (P = .906). The mean US time, CDE, and percentage total equivalent power in position 3 were statistically significantly lower in the torsional group (98 patients) than in the longitudinal group (94 patients) (P<.001). The torsional mode was as safe as the longitudinal mode in phacoemulsification for age-related cataract. Copyright © 2010 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Microcoaxial cataract surgery outcomes: comparison of 1.8 mm system and 2.2 mm system.

PubMed

Lee, Kyung-Min; Kwon, Hyung-Goo; Joo, Choun-Ki

2009-05-01

To compare clinical outcomes of a 1.8 mm and a 2.2 mm microcoaxial cataract surgery system. Department of Ophthalmology and Visual Science, Kangnam St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea. In a prospective study, eyes were randomly selected to have phacoemulsification using a Stellaris system or an Intrepid Infiniti system. The initial incision size was 1.8 mm and 2.2 mm, respectively. Measured intraoperative parameters included phacoemulsification time, mean cumulative dissipated ultrasound energy (CDE), change in incision size at each step of surgery, and total volume of balanced salt solution (BSS) used. The best corrected visual acuity (BCVA), corneal astigmatism, corneal thickness, and endothelial cell count were evaluated preoperatively and postoperatively. The study evaluated 86 eyes of 78 patients (43 eyes in each group). There were no significant differences in postoperative BCVA, surgically induced astigmatism, or amount of BSS used between the 2 systems (P >.05). However, for high-density cataracts, the 1.8 mm group had a greater change between the initial incision size and the incision size after phacoemulsification (P = .019, nuclear opalescence [NO] NO3; P = .001, NO4), a longer phacoemulsification time (P = .013, NO3), greater mean CDE (P = .005, NO3; P = .001, NO4), and greater corneal endothelial cell loss (P = .003, NO4). Both systems were safe and effective in microcoaxial phacoemulsification. The 1.8 mm system performed better with cortical-type cataract and the 2.2 mm system, with high-density nuclear-type cataract.

Macular thickness and volume after uncomplicated phacoemulsification surgery evaluated by optical coherence tomography. A one-year follow-up.

PubMed

Kecik, Dariusz; Makowiec-Tabernacka, Marta; Golebiewska, Joanna; Moneta-Wielgos, Joanna; Kasprzak, Jan

2009-01-01

To evaluate changes in the macular thickness and volume using optical coherence tomography in patients after phacoemulsification and intracapsular implantation of a foldable intraocular lens. The study included 82 patients (37 males and 45 females) after phacoemulsification and intracapsular implantaion of the same type of a foldable intraocular lens, without any other eye disease. Phacoemulsification was performed with an INFINITI machine. In all patients, macular thickness and volume were measured with an optical coherence tomograph (Stratus OCT) using the Fast Macular Thickness Map. The OCT evaluation was performed on days 1, 7, 30 and 90 postoperatively. In 58 patients (71%), it was additionally performed at 12 months after surgery and in 52 patients (63%) the macular parameters in the healthy and operated eyes were compared. A statistically significant increase in the minimal retinal thickness was observed on days 30 (p<0.0005) and 90 (p<0.005) postoperatively compared to post-operative day 1. A statistically significant increase in the foveal volume was seen on days 30 (p<0.00005) and 90 (p<0.0005). A statistically significant increase in the volume of the entire macula was found on days 7, 30 and 90 (p<0.00005). Uncomplicated cataract phacoemulsification is followed by increases in the central retinal thickness, foveal volume and volume of the entire macula on days 30 and 90 and at 12 months postoperatively. Further observation of patients is required to confirm whether the macular parameters will return to their values on day 1 postoperatively and if so, when this will occur.

Intraoperative performance and postoperative outcome comparison of longitudinal, torsional, and transversal phacoemulsification machines.

PubMed

Christakis, Panos G; Braga-Mele, Rosa M

2012-02-01

To compare the intraoperative performance and postoperative outcomes of 3 phacoemulsification machines that use different modes. Kensington Eye Institute, Toronto, Ontario, Canada. Comparative case series. This chart and video review comprised consecutive eligible patients who had phacoemulsification by the same surgeon using a Whitestar Signature Ellips-FX (transversal), Infiniti-Ozil-IP (torsional), or Stellaris (longitudinal) machine. The review included 98 patients. Baseline characteristics in the groups were similar; the mean nuclear sclerosis grade was 2.0 ± 0.8. There were no significant intraoperative complications. The torsional machine averaged less phacoemulsification needle time (83 ± 33 seconds) than the transversal (99 ± 40 seconds; P=.21) or longitudinal (110 ± 45 seconds; P=.02) machines; the difference was accentuated in cases with high-grade nuclear sclerosis. The torsional machine had less chatter and better followability than the transversal or longitudinal machines (P<.001). The torsional and longitudinal machines had better anterior chamber stability than the transversal machine (P<.001). Postoperatively, the torsional machine yielded less central corneal edema than the transversal (P<.001) and longitudinal (P=.04) machines, corresponding to a smaller increase in mean corneal thickness (torsional 5%, transversal 10%, longitudinal 12%; P=.04). Also, the torsional machine had better 1-day postoperative visual acuities (P<.001). All 3 phacoemulsification machines were effective with no significant intraoperative complications. The torsional machine outperformed the transversal and longitudinal machines, with a lower mean needle time, less chatter, and improved followability. This corresponded to less corneal edema 1 day postoperatively and better visual acuity. Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Hydroxyl free radical production during torsional phacoemulsification.

PubMed

Aust, Steven D; Hebdon, Thomas; Humbert, Jordan; Dimalanta, Ramon

2010-12-01

To quantitate free radical generation during phacoemulsification using an ultrasonic phacoemulsification device that includes a torsional mode and evaluate tip designs specific to the torsional mode. Chemistry and Biochemistry Department, Utah State University, Logan, Utah, USA. Experimental study. Experiments were performed using the Infiniti Vision System and OZil handpiece. Hydroxyl radical concentrations in the aspirated irrigation solution during torsional phacoemulsification were quantitated as nanomolar malondialdehyde (nM MDA) and determined spectrophotometrically using the deoxyribose assay. The mean free radical production during phacoemulsification with torsional modality at 100% amplitude was 30.1 nM MDA ± 5.1 (SD) using a 0.9 mm 45-degree Kelman tapered ABS tip. With other tip designs intended for use with the torsional modality, free radical production was further reduced when fitted with the 0.9 mm 45-degree Kelman mini-flared ABS tip (13.2 ± 5.6 nM MDA) or the 0.9 mm 45-degree OZil-12 mini-flared ABS tip (14.3 ± 6.7 nM MDA). Although the measurements resulting from the use of the latter 2 tips were not statistically significantly different (P ≈ .25), they were different from those of the tapered tip (P<.0001). The MDA concentration in the aspirated irrigation solution using the torsional modality was approximately one half that reported for the handpiece's longitudinal modality in a previous study using the same bent-tip design (Kelman tapered, P<.0001). The level of MDA was further reduced approximately one half with torsional-specific tips. Copyright © 2010 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Visual outcomes of phacoemulsification cataract surgery in horses: 1990-2013.

PubMed

Brooks, Dennis E; Plummer, Caryn E; Carastro, Susan M; Utter, Mary E

2014-07-01

To evaluate the long-term visual outcome of phacoemulsification lens extraction surgery in foals and horses and identify any unique postoperative complications that affect the visual outcome. This is a retrospective medical records study of phacoemulsification cataract surgery in 95 foals and horses from 1990 to 2013. Cataracts were removed by phacoemulsification from 111 eyes of 95 horses ranging in age from 22 days to 26 years (average 8.0 ± 5.7 years). Forty-four of the 95 animals were foals (46.3%). Sixteen horses or foals had surgery bilaterally. One hundred and two eyes were blind preoperatively with 97 eyes (95.1%) having evidence of vision immediately postoperatively. Ninety of the 95 horses (94.7%) regained vision in the immediate postoperative period. Five horses did not recover vision postoperatively. Twenty-four horses had cataracts associated with equine recurrent uveitis (ERU). Trauma was noted as the cause of cataract in 10 horses, and no specific cause for the cataract identified in 61 horses. The combined visual outcome data from horses with all types of cataracts (n = 95) found 83 (87.3%) horses to be visual ≤1 month postoperatively, 47 (49.4%) horses visual for >1-6 months postoperatively, 33 (34.7%) horses visual from >6 to 12 months postoperatively, and 25 horses (26.3%) visual >24 months postoperatively. The results of phacoemulsification cataract surgery in horses indicate at least 26.3% of horses are still visual and able to continue their natural activity for 2 years or more postoperatively. © 2014 American College of Veterinary Ophthalmologists.

A Computer Based Cognitive Simulation of Cataract Surgery

DTIC Science & Technology

2011-12-01

for zonular absence, assess for notable lenticular astigmatism ** How and when do you decide to use a capsular tension ring? (Expert) Zonular...INTRODUCTION The Virtual Mentor Cataract Surgery Trainer is a computer based, cognitive simulation of phacoemulsification cataract surgery. It is...the Cataract Trainer. BODY Phacoemulsification cataract surgery (phaco) is a difficult procedure to learn, with little margin for error. As in other

Carbon footprint and cost-effectiveness of cataract surgery.

PubMed

Venkatesh, Rengaraj; van Landingham, Suzanne W; Khodifad, Ashish M; Haripriya, Aravind; Thiel, Cassandra L; Ramulu, Pradeep; Robin, Alan L

2016-01-01

This article raises awareness about the cost-effectiveness and carbon footprint of various cataract surgery techniques, comparing their relative carbon emissions and expenses: manual small-incision cataract surgery (MSICS), phacoemulsification, and femtosecond laser-assisted cataract surgery. As the most commonly performed surgical procedure worldwide, cataract surgery contributes significantly to global climate change. The carbon footprint of a single phacoemulsification cataract surgery is estimated to be comparable to that of a typical person's life for 1 week. Phacoemulsification has been estimated to be between 1.4 and 4.7 times more expensive than MSICS; however, given the lower degree of postoperative astigmatism and other potential complications, phacoemulsification may still be preferable to MSICS in relatively resource-rich settings requiring high levels of visual function. Limited data are currently available regarding the environmental and financial impact of femtosecond laser-assisted cataract surgery; however, in its current form, it appears to be the least cost-effective option. Cataract surgery has a high value to patients. The relative environmental impact and cost of different types of cataract surgery should be considered as this treatment becomes even more broadly available globally and as new technologies are developed and implemented.

A VidEo-Based Intelligent Recognition and Decision System for the Phacoemulsification Cataract Surgery.

PubMed

Tian, Shu; Yin, Xu-Cheng; Wang, Zhi-Bin; Zhou, Fang; Hao, Hong-Wei

2015-01-01

The phacoemulsification surgery is one of the most advanced surgeries to treat cataract. However, the conventional surgeries are always with low automatic level of operation and over reliance on the ability of surgeons. Alternatively, one imaginative scene is to use video processing and pattern recognition technologies to automatically detect the cataract grade and intelligently control the release of the ultrasonic energy while operating. Unlike cataract grading in the diagnosis system with static images, complicated background, unexpected noise, and varied information are always introduced in dynamic videos of the surgery. Here we develop a Video-Based Intelligent Recognitionand Decision (VeBIRD) system, which breaks new ground by providing a generic framework for automatically tracking the operation process and classifying the cataract grade in microscope videos of the phacoemulsification cataract surgery. VeBIRD comprises a robust eye (iris) detector with randomized Hough transform to precisely locate the eye in the noise background, an effective probe tracker with Tracking-Learning-Detection to thereafter track the operation probe in the dynamic process, and an intelligent decider with discriminative learning to finally recognize the cataract grade in the complicated video. Experiments with a variety of real microscope videos of phacoemulsification verify VeBIRD's effectiveness.

A VidEo-Based Intelligent Recognition and Decision System for the Phacoemulsification Cataract Surgery

PubMed Central

Yin, Xu-Cheng; Wang, Zhi-Bin; Zhou, Fang; Hao, Hong-Wei

2015-01-01

The phacoemulsification surgery is one of the most advanced surgeries to treat cataract. However, the conventional surgeries are always with low automatic level of operation and over reliance on the ability of surgeons. Alternatively, one imaginative scene is to use video processing and pattern recognition technologies to automatically detect the cataract grade and intelligently control the release of the ultrasonic energy while operating. Unlike cataract grading in the diagnosis system with static images, complicated background, unexpected noise, and varied information are always introduced in dynamic videos of the surgery. Here we develop a Video-Based Intelligent Recognitionand Decision (VeBIRD) system, which breaks new ground by providing a generic framework for automatically tracking the operation process and classifying the cataract grade in microscope videos of the phacoemulsification cataract surgery. VeBIRD comprises a robust eye (iris) detector with randomized Hough transform to precisely locate the eye in the noise background, an effective probe tracker with Tracking-Learning-Detection to thereafter track the operation probe in the dynamic process, and an intelligent decider with discriminative learning to finally recognize the cataract grade in the complicated video. Experiments with a variety of real microscope videos of phacoemulsification verify VeBIRD's effectiveness. PMID:26693249

Weight effect of saline accumulation in surgical drapes.

PubMed

Wiggins, Michael N; Thostenson, Jeff D

2007-10-01

Positive vitreal pressure during phacoemulsification is a known risk factor for posterior capsule rupture. Knowledge of modifiable causes of positive vitreal pressure is imperative to aid in its management intraoperatively. The aim of our study was to determine whether the weight from the accumulation of a large volume of saline in the surgical drapes could have an effect on intraocular pressure in patients. Such an effect could indicate a source of posterior vitreal pressure in patients undergoing prolonged phacoemulsification. In 23 adult patients undergoing phacoemulsification at the Jones Eye Institute at the University of Arkansas for Medical Sciences, intraocular pressure readings were taken before and after the addition of 500 cc of saline to the surgical drapes and taken again after removal of the saline. Statistically significant differences in intraocular pressure were found between the baseline measurement, the measurement with saline, and the measurement after saline removal. No differences in the rise in intraocular pressure were found according to age, race, sex, or which eye was tested. Accumulation of a large volume of saline in surgical drapes has a modest effect on intraocular pressure. This may indicate a contributing cause of posterior vitreal pressure during prolonged phacoemulsification.

Bilateral Mycobacterium chelonae Keratitis after Phacoemulsification Cataract Surgery.

PubMed

Martinez, Jaime D; Amescua, Guillermo; Lozano-Cárdenas, Jesus; Suh, Leejee H

2017-01-01

The purpose of this manuscript is to report the case of an 81-year-old patient who presented with bilateral keratitis after phacoemulsification surgery. Cultures came back positive for Mycobacterium chelonae . Despite aggressive topical and systemic antimicrobial treatment, the patient developed a corneal perforation in both eyes, treated with corneal glue in the right eye and corneoscleral patch in the left eye. After two years of follow-up, patient was free of infection in the right eye with visual acuity of 20/200 and the left eye progressed to phthisis bulbi. We present an unusual case of bilateral Mycobacterium chelonae keratitis associated with phacoemulsification cataract surgery. This case represents the importance of making clinicians aware of this devastating infection and highlights the need for better management to improve outcomes.

Outcomes of Phacoemulsification Using Different Size of Clear Corneal Incision in Eyes with Previous Radial Keratotomy.

PubMed

Zhang, Jing Shang; Liu, Xue; Wang, Jin Da; Xiong, Ying; Li, Jing; Li, Xiao Xia; Zhao, Jing; You, Qi Sheng; Huang, Yao; Tsai, Frank; Baum, Larry; Jhanji, Vishal; Wan, Xiu Hua

2016-01-01

To evaluate visual outcomes and complications after phacoemulsification in eyes with cataract and previous radial keratotomy (RK) cuts using different sizes of clear corneal incisions. The study was a retrospective study. Thirty eyes with cataract and previous RK underwent phacoemulsification and intraocular lens (IOL) implantation. Among them 7 eyes had 8 RK cuts, 13 eyes had 12 RK cuts, and 10 eyes had 16 RK cuts. Phacoemulsification and IOL implantation were performed through a 2.0-3.2 mm clear corneal incision by a single surgeon. In the 8 RK cuts group, 3.2 mm clear corneal incisions were used in 4 eyes, and 3.0 mm clear corneal incisions were used in 3 eyes. In the 12 RK cuts group, 3.2 mm clear corneal incisions were used in 6 eyes, and 2.2 mm clear corneal incisions were used in 7 eyes. In the 16 RK cuts group, 3.2 mm clear corneal incisions were used in 5 eyes, and 2.0 mm clear corneal incisions were used in 5 eyes. Patients were followed up 1 day, 1 week, 1 month, 3 months, 6 months, 1 year, 2 years, and 3 years postoperatively and were examined for the dehiscence of RK cuts during or after the surgery, post-operative best-corrected visual acuity (BCVA), corneal astigmatism, corneal endothelial cell density and complications. Successful phacoemulsification with IOL implantation was performed in all eyes. No wound dehiscence was noted in any eyes with 8 or 12 RK cuts. Wound dehiscence was noted in 2 eyes with 16 RK cuts. The dehiscence of RK cuts was closed successfully by injecting an air bubble with or without viscoelastic agent into the anterior chamber at the end of surgery. During the follow-up, the cuts were well apposed in all eyes, and no new dehiscence of RK cuts was noted. At the last follow-up, mean BCVA (0.2 ± 0.18 logMAR) was better than preoperative BCVA(0.45±0.19 logMAR) (P < 0.001). There was no significant difference between the long-term preoperative and postoperative mean corneal astigmatism (P = 0.3). However, there was a significant reduction in postoperative corneal endothelial cell density (1866.5±773.9 / mm2 vs 2421.7±655.7 / mm2) (P < 0.001). Phacoemulsification and IOL implantation with clear corneal incisions in eyes with previous RK were associated with good surgical outcomes. Wound dehiscence was not specificaly related to the size of clear corneal incision during phacoemulsification in these eyes.

Comparison of cumulative dissipated energy delivered by active-fluidic pressure control phacoemulsification system versus gravity-fluidics.

PubMed

Gonzalez-Salinas, Roberto; Garza-Leon, Manuel; Saenz-de-Viteri, Manuel; Solis-S, Juan C; Gulias-Cañizo, Rosario; Quiroz-Mercado, Hugo

2017-08-22

To compare the cumulative dissipated energy (CDE), aspiration time and estimated aspiration fluid utilized during phacoemulsification cataract surgery using two phacoemulsification systems . A total of 164 consecutive eyes of 164 patients undergoing cataract surgery, 82 in the active-fluidics group and 82 in the gravity-fluidics group were enrolled in this study. Cataracts graded NII to NIII using LOCS II were included. Each subject was randomly assigned to one of the two platforms with a specific configuration: the active-fluidics Centurion ® phacoemulsification system or the gravity-fluidics Infiniti ® Vision System. CDE, aspiration time (AT) and the mean estimated aspiration fluid (EAF) were registered and compared. A mean age of 68.3 ± 9.8 years was found (range 57-92 years), and no significant difference was evident between both groups. A positive correlation between the CDE values obtained by both platforms was verified (r = 0.271, R 2  = 0.073, P = 0.013). Similarly, a significant correlation was evidenced for the EAF (r = 0.334, R 2  = 0.112, P = 0.046) and AT values (r = 0.156, R 2  = 0.024, P = 0.161). A statistically significantly lower CDE count, aspiration time and estimated fluid were obtained using the active-fluidics configuration when compared to the gravity-fluidics configuration by 19.29, 12.10 and 9.29%, respectively (P = 0.001, P < 0.0001 and P = 0.001). The active-fluidics Centurion ® phacoemulsification system achieved higher surgical efficiency than the gravity-fluidics Infiniti ® IP system for NII and NIII cataracts.

Differences in energy expenditure for conventional and femtosecond-assisted cataract surgery using 2 different phacoemulsification systems.

PubMed

Yesilirmak, Nilufer; Diakonis, Vasilios F; Sise, Adam; Waren, Daniel P; Yoo, Sonia H; Donaldson, Kendall E

2017-01-01

To compare the mean cumulative dissipated energy (CDE) in patients having femtosecond laser-assisted or conventional phacoemulsification cataract surgery using 2 different phacoemulsification platforms. Bascom Palmer Eye Institute, Miami, Florida, USA. Prospective comparative nonrandomized clinical study. Consecutive patients were scheduled to have femtosecond laser-assisted cataract surgery with the Lensx laser or conventional phacoemulsification using an active-fluidics torsional platform (Centurion) or torsional platform (Infiniti). The mean CDE and cataract grade were recorded. The study comprised 570 eyes (570 patients). There was no statistically significant difference in mean age (P = .41, femtosecond group; P = .33, conventional group) or cataract grade (P = .78 and P = .45, respectively) between the active-fluidics and gravity-fluidics platforms. In femtosecond cases (145 eyes), the mean CDE (percent-seconds) was 5.18 ± 4.58 (SD) with active fluidics and 7.00 ± 6.85 with gravity fluidics; in conventional cases (425 eyes), the mean CDE was 7.77 ± 6.97 and 11.43 ± 9.12, respectively. In both femtosecond cases and conventional cases, the CDE was lower with the active-fluidics platform than with the gravity-fluidics platform (P = .029, femtosecond group; P < .001 conventional group). With both fluidics platforms, the mean CDE was significantly lower in the femtosecond group than in the conventional group (both P < .001). The active-fluidics phacoemulsification platform achieved lower CDE values than the gravity-fluidics platform for conventional cataract extraction. Femtosecond laser pretreatment with the active-fluidics platform further reduced CDE. Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Transverse vs torsional ultrasound: prospective randomized contralaterally controlled study comparing two phacoemulsification-system handpieces.

PubMed

Assil, Kerry K; Harris, Lindsay; Cecka, Jeannie

2015-01-01

To compare surgical efficiency and multiple early clinical outcome variables in eyes undergoing phacoemulsification using either transversal or torsional ultrasound systems. Assil Eye Institute, Beverly Hills, CA, USA. Prospective, randomized, clinician-masked, contralaterally controlled single-center evaluation. Patients seeking cataract removal in both eyes with implantation of multifocal intraocular lenses were randomly assigned to one of two treatment rooms for phacoemulsification with either a transverse ultrasound system or torsional handpiece system. The contralateral eye was treated at a later date with the alternate device. A total of 54 eyes of 27 patients having similar degrees of cataract, astigmatism, and visual potential were included. All operative data were collected for analysis, and patients were followed for 3 months after surgery. Similar visual acuity was reported at all postoperative visits between the two groups. Mean phacoemulsification time and total power required were both significantly lower with the transverse system than with the torsional technique (P<0.05 for both). Similarly, mean total balanced salt solution used was significantly less with the transverse system vs torsional (P<0.05). Postoperative safety demonstrated significantly lower endothelial cell loss at 1 day and 1 month (P<0.05) with transverse vs torsional. Macular swelling was less at 1 week, 1 month, and 3 months with transverse vs torsional, although the difference did not achieve significance (P=0.1) at any single time point. Clinically detectable corneal edema was reported less frequently at all postoperative time points with the transverse system. The transverse ultrasound system was found to be possibly associated with less balanced salt-solution use, less phacoemulsification time, and less power required than the torsional phaco system. Postoperative data suggested that improved phaco efficiency may translate to a better overall safety profile for the patient.

Thermal effect of microburst and hyperpulse settings during sleeveless bimanual phacoemulsification with advanced power modulations.

PubMed

Braga-Mele, Rosa

2006-04-01

To assess wound temperature during bimanual sleeveless phacoemulsification using customizable power modulations such as hyperpulse and microburst technology. In vitro laboratory. The Millennium Microsurgical System (Bausch & Lomb) with custom control software (CCS) was used to perform phacoemulsification in 5 porcine eyes with MicroFlow needles (Bausch & Lomb) and with power varied from 20% to 80% in 10% increments. Pulse modes were set for fixed microburst (4 ms on, 4 ms off; and 6 ms on, 12 or 24 ms off) and for hyperpulse (30% duty cycle with 8 or 75 pulses per second [pps]), with and without aspiration-line occlusion. Wound temperatures were measured 3 times per second. Using 80% total power, the wound temperature during 3 minutes of occlusion did not exceed 39.0 degrees C. The maximum temperature with fixed microbursts of 4 ms on, 4 ms off was 29.0 degrees C without occlusion and 37.8 degrees C with occlusion (duration 3 minutes). At 6 ms on, 12 ms off, the maximum temperatures were 28.1 degrees C and 38.7 degrees C, respectively. At 6 ms on, 24 ms off, peak temperatures were 24 degrees C and 23.6 degrees C, respectively. The hyperpulse mode of 30% duty cycle and 8 pps produced maximum temperatures of 25.5 degrees C nonoccluded and 33.4 degrees C occluded. With 30% duty cycle, 75 pps, temperatures were 28 degrees C and 38.0 degrees C, respectively. For all power below 80%, temperatures were lower. Customizable power modulation with microburst and hyperpulse technology further reduced wound temperatures during bimanual sleeveless phacoemulsification. This enhances the safety and effectiveness of phacoemulsification through a sleeveless needle and a small stab incision.

Phacoemulsification surgery in eyes with neovascular age-related macular degeneration.

PubMed

Grixti, Andre; Papavasileiou, Evangelia; Cortis, Dominic; Kumar, Balakrishna Vineeth; Prasad, Som

2014-01-01

Purpose. To evaluate the visual outcomes and effect of phacoemulsification surgery on the progression of neovascular age-related macular degeneration (AMD). Methods. Retrospective, noncomparative, and interventional case series. Thirty eyes from 29 subjects with neovascular AMD treated with intravitreal antivascular endothelial growth factor (VEGF) injections who underwent phacoemulsification and had a postsurgery follow-up of 6 months were included. LogMAR best corrected visual acuity (BCVA) was assessed preoperatively; 1 month, 3 months, and 6 months postoperatively; and finally at the last visit. The frequency of anti-VEGF therapy, calculated as the number of intravitreal injections per month, and central macular thickness (CMT) before and after cataract surgery were determined. Results. Median (range) logMAR BCVA was 0.69 (0.16 to 1.32) preoperatively; 0.55 (-0.04 to 1.32) at 1 month, 0.52 (-0.1 to 1.32) at 3 months, and 0.50 (0.0 to 1.32) at 6 months postoperatively; and 0.6 (0.0 to 1.4) at final visit (P = 0.0011). There was no difference in the frequency of anti-VEGF injections between the immediate 6 months before and after phacoemulsification, which was equal to 0.1667 injections per month (P = 0.6377). Median CMT measured 203  μ m preoperatively, which temporarily increased to 238  μ m at 1 month after surgery (P = 0.0093) and then spontaneously returned to baseline, measuring 212.5  μ m at 3 months postoperatively (P = 0.3811). Conclusion. Phacoemulsification surgery significantly improved vision in patients with neovascular AMD, with no increased need for anti-VEGF injections to keep the macula dry postoperatively.

Phacoemulsification Surgery in Eyes with Neovascular Age-Related Macular Degeneration

PubMed Central

Papavasileiou, Evangelia; Kumar, Balakrishna Vineeth; Prasad, Som

2014-01-01

Purpose. To evaluate the visual outcomes and effect of phacoemulsification surgery on the progression of neovascular age-related macular degeneration (AMD). Methods. Retrospective, noncomparative, and interventional case series. Thirty eyes from 29 subjects with neovascular AMD treated with intravitreal antivascular endothelial growth factor (VEGF) injections who underwent phacoemulsification and had a postsurgery follow-up of 6 months were included. LogMAR best corrected visual acuity (BCVA) was assessed preoperatively; 1 month, 3 months, and 6 months postoperatively; and finally at the last visit. The frequency of anti-VEGF therapy, calculated as the number of intravitreal injections per month, and central macular thickness (CMT) before and after cataract surgery were determined. Results. Median (range) logMAR BCVA was 0.69 (0.16 to 1.32) preoperatively; 0.55 (−0.04 to 1.32) at 1 month, 0.52 (−0.1 to 1.32) at 3 months, and 0.50 (0.0 to 1.32) at 6 months postoperatively; and 0.6 (0.0 to 1.4) at final visit (P = 0.0011). There was no difference in the frequency of anti-VEGF injections between the immediate 6 months before and after phacoemulsification, which was equal to 0.1667 injections per month (P = 0.6377). Median CMT measured 203 μm preoperatively, which temporarily increased to 238 μm at 1 month after surgery (P = 0.0093) and then spontaneously returned to baseline, measuring 212.5 μm at 3 months postoperatively (P = 0.3811). Conclusion. Phacoemulsification surgery significantly improved vision in patients with neovascular AMD, with no increased need for anti-VEGF injections to keep the macula dry postoperatively. PMID:24719771

Topical anaesthesia with oxybuprocaine versus sub-Tenon's infiltration with 2% lignocaine for small incision cataract surgery

PubMed Central

Chittenden, H; Meacock, W; Govan, J

1997-01-01

AIMS—To determine whether topical anaesthesia in small incision self-sealing phacoemulsification cataract surgery provides comparable anaesthesia to sub-Tenon's infiltration.
METHODS—Thirty five patients undergoing small incision self-sealing phacoemulsification cataract surgery were allocated randomly to receive topical anaesthesia with 0.4% oxybuprocaine or sub-Tenon's infiltration with 2% lignocaine. Pain experienced during the operation was assessed by asking the patient to score on a visual analogue graphic pain score chart.
RESULTS—The median pain score for the topical group (3) was significantly higher than that of the sub-Tenon's group (0) (p = 0.004).
CONCLUSION—Sub-Tenon's infiltration is superior to topical anaesthesia in ensuring patient comfort during small incision scleral tunnel self-sealing phacoemulsification cataract surgery.

 PMID:9215056

Comparison of CDE data in phacoemulsification between an open hospital-based ambulatory surgical center and a free-standing ambulatory surgical center

PubMed Central

Chen, Ming; Chen, Mindy

2010-01-01

Mean CDE (cumulative dissipated energy) values were compared for an open hospital- based surgical center and a free-standing surgical center. The same model of phacoemulsifier (Alcon Infiniti Ozil) was used. Mean CDE values showed that surgeons (individual private practice) at the free-standing surgical center were more efficient than surgeons (individual private practice) at the open hospital-based surgical center (mean CDE at the hospital-based surgical center 18.96 seconds [SD = 12.51]; mean CDE at the free-standing surgical center 13.2 seconds [SD = 9.5]). CDE can be used to monitor the efficiency of a cataract surgeon and surgical center in phacoemulsification. The CDE value may be used by institutions as one of the indicators for quality control and audit in phacoemulsification. PMID:21151334

Comparison of CDE data in phacoemulsification between an open hospital-based ambulatory surgical center and a free-standing ambulatory surgical center.

PubMed

Chen, Ming; Chen, Mindy

2010-11-12

Mean CDE (cumulative dissipated energy) values were compared for an open hospital- based surgical center and a free-standing surgical center. The same model of phacoemulsifier (Alcon Infiniti Ozil) was used. Mean CDE values showed that surgeons (individual private practice) at the free-standing surgical center were more efficient than surgeons (individual private practice) at the open hospital-based surgical center (mean CDE at the hospital-based surgical center 18.96 seconds [SD = 12.51]; mean CDE at the free-standing surgical center 13.2 seconds [SD = 9.5]). CDE can be used to monitor the efficiency of a cataract surgeon and surgical center in phacoemulsification. The CDE value may be used by institutions as one of the indicators for quality control and audit in phacoemulsification.

Phacoemulsification combined with posterior capsulorhexis and anterior vitrectomy in the management of malignant glaucoma in phakic eyes.

PubMed

Liu, Xing; Li, Mei; Cheng, Bing; Mao, Zhen; Zhong, Yimin; Wang, Dandan; Cao, Dan; Yu, Fenfen; Congdon, Nathan G

2013-11-01

  To describe sequential phacoemulsification-intraocular lens (IOL) implantation-posterior capsulorhexis-anterior vitrectomy in the management of phakic malignant glaucoma.   Twenty consecutive patients (25 eyes) with phakic malignant glaucoma were enrolled at the Zhongshan Ophthalmic Center, Sun Yat-sen University. All patients underwent phacoemulsification, IOL implantation and posterior capsulorhexis together with anterior vitrectomy via a clear corneal paracentesis. Visual acuity, intraocular pressure (IOP), anterior chamber depth (ACD), surgical complications and medications required after the surgery were recorded.   After surgery, the mean LogMAR visual acuity and ACD increased significantly (visual acuity from -1.56 ± 1.17 to -0.54 ± 0.81, p < 0.001; ACD from 0.367 ± 0.397 mm to 2.390 ± 0.575 mm, p < 0.001), and mean IOP decreased significantly (from 39.6 ± 10.6 mm Hg to 14.5 ± 4.1 mmHg, p < 0.001). No serious perioperative complications occurred, and only five eyes required topical glaucoma medications after surgery.   Combined phacoemulsification-IOL implantation-posterior capsulorhexis-anterior vitrectomy surgery is a safe and effective method for treating patients with phakic malignant glaucoma. © 2012 The Authors. Acta Ophthalmologica © 2012 Acta Ophthalmologica Scandinavica Foundation.

Temperature in the anterior chamber during phacoemulsification.

PubMed

Suzuki, Hisaharu; Oki, Kotaro; Igarashi, Tsutomu; Shiwa, Toshihiko; Takahashi, Hiroshi

2014-05-01

To evaluate changes in the aqueous humor temperature using 2 phacoemulsification units (Stellaris 28.5 kHz device and Whitestar Signature 40 kHz device). Nippon Medical School, Musashikosugi Hospital, Kawasaki City, Kanagawa, Japan. Experimental study. Aqueous humor temperatures were measured with a temperature probe set in the anterior chamber during ultrasound (US) oscillation in porcine eyes under 5 conditions. Continuous longitudinal oscillation caused a rapid rise in aqueous humor temperature, while the pulse and elliptical modes suppressed temperature elevation. Reducing the number of US tip vibrations did not reduce the temperature in the anterior chamber. However, raising the vacuum setting allowed the aspirations to rise to the set value, thereby lowering the temperature in the anterior chamber. Because differences in the phacoemulsification settings can lead to temperature elevations in the anterior chamber, surgeons must carefully monitor these settings to prevent corneal tissue damage. Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Comparison of peristaltic and Venturi pumps in bimanual microincisional cataract surgery.

PubMed

Karaguzel, Hande; Karalezli, Aylin; Aslan, Bekir Sitki

2009-12-01

Comparison of peristaltic and Venturi pumps in bimanual microincision phacoemulsification on the success of the cataract surgery by using sleeveless phaco tip. Bimanual microincision phacoemulsification was done in 49 eyes using a 1.4-mm temporal clear corneal incision. A peristaltic pump was used in 23 eyes, and a Venturi pump was used in 26 eyes for phacoemulsification. Intraoperative complications, anterior chamber stability, and mean duration of surgery were recorded. Duration of surgery was shorter in the Venturi pump group. Anterior chamber stability could not be established in 17 eyes in the peristaltic pump group; it was established in all eyes in the Venturi pump group. Corneal burns were observed in two eyes in the peristaltic pump group and no eyes in the Venturi pump group. Use of a Venturi pump system and a vented gas-forced infusion system can significantly shorten surgery time and reduce risk of thermal burns.

Phacoemulsification using a chisel-shaped illuminator: enhanced depth trench, one-shot crack, and phaco cut.

PubMed

Wi, Jaemin; Seo, Hyejin; Lee, Jong Yeon; Nam, Dong Heun

2016-01-01

To evaluate the efficacy and outcomes of intracameral illuminator-assisted nucleofractis technique in cataract surgery. Since June 2012, this novel technique has been performed in all cataract cases by one surgeon (approximately 300 cases of various densities). Trenching continues until the posterior plate white reflex between an endonucleus and an epinucleus is identified (enhanced depth trench). After trenching, cracking is initiated with minimal separation force, and completion of cracking is confirmed by posterior capsule reflex (one-shot crack). With followability enhanced by an elliptical phaco mode, the divided nucleus is efficiently cut into small fragments by a chisel-shaped illuminator (phaco cut). We have not experienced any capsular bag or zonular complications, and the effective phacoemulsification time seemed to be shorter than that with the conventional technique. This technique simplifies the complete division of the nucleus, which is the most challenging step in safe and efficient phacoemulsification.

Safety and efficacy of phacoemulsification and intraocular lens implantation through a small pupil using minimal iris manipulation.

PubMed

Papaconstantinou, Dimitris; Kalantzis, George; Brouzas, Dimitris; Kontaxakis, Anastasios; Koutsandrea, Chryssanthi; Diagourtas, Andreas; Georgalas, Ilias

2016-01-01

The aim of this study was to compare the results of phacoemulsification through a small pupil using minimal iris manipulation versus phacoemulsification through a well-dilated pupil. This prospective randomized control (comparative) study comprised 78 patients (group I) with a maximally dilated pupil size of ≤4.00 mm and 45 patients (group II) with dilated pupil size of ≥7.00 mm. In group I patients, only viscodilation and minimal push-and-pull iris stretching with two collar-button iris-retractor hooks were utilized without iris manipulation. Phacoemulsification was performed by two senior surgeons and the technique used consisted of either stop and chop or quick chop, infusion/aspiration of lens cortex, capsular bag refill with ocular viscoelastic devices, and implantation of an acrylic foldable intraocular lens. Patients were examined on the first day and 1 month postoperatively. Forty-six eyes of group I patients had pseudoexfoliation syndrome, eleven eyes had previous glaucoma surgery, 14 eyes had angle-closure or open-angle glaucoma, and seven eyes had posterior synechiae with iritis. In group I patients, the mean pupil size measured under an operating microscope was 3.2 mm preoperatively, 4.3 mm after viscoelastic and mechanical pupil dilation, and 4.1 mm at the end of a surgical procedure. Rupture of the zonular fibers occurred in six patients of group I and the intraocular lens was implanted in the sulcus. Small iris-sphincter rupture and small hemorrhages occurred in four eyes during pupillary manipulation, but they were not evident at the end of the surgery. In group II patients, no intraoperative complications occurred. Signs of significant corneal edema and iritis were observed more frequently in group I eyes (26 eyes and 20 eyes, respectively) on the first postoperative day in comparison with group II eyes (ten eyes and six eyes, respectively). Intraocular pressure was <20 mmHg in all eyes of both groups. One month postoperatively, the pupil was round and reactive to light, the anterior chamber was quiet, and the cornea was clear in all eyes. The best-corrected visual acuity on Snellen chart was 20/40 (Monoyer's scale) or better in both groups. Phacoemulsification through a small pupil using minimal iris manipulation can be safe and exhibits the same results as those obtained with phacoemulsification through normal pupils.

Technique, postoperative complications, and visual outcomes of phacoemulsification cataract surgery in 21 penguins (27 eyes): 2011-2015.

PubMed

Church, Melanie L; Priehs, Daniel R; Denis, Heidi; Croft, Lara; DiRocco, Stacy; Davis, Michelle

2018-02-06

To describe surgical technique, postoperative complications, and visual outcome in penguins after phacoemulsification lens extraction surgery. Twenty-one penguins (27 eyes) that had phacoemulsification from 2011 to 2015 at Animal Eye Associates. Species included are as follows: 14 southern Rockhopper (18 eyes, 66.6%), 4 Gentoo (4 eyes, 19%), 2 King (3 eyes, 9.5%), and 1 Chinstrap penguin (2 eyes, 4.8%). Eleven of the penguins were females, and 10 were males with average age at the time of surgery being 27.5 years (range of 22-31 years). This is a retrospective study of phacoemulsification cataract surgery patients from 2011 to 2015. Visual outcome was evaluated by veterinary ophthalmologists at postoperative recheck examinations and subjectively by penguin keepers using individual bird surveys and paired t tests for statistical analysis. All eyes were functionally visual after surgery and at the time of last follow-up. Based on keeper surveys, 81% (17/21) of penguins showed immediate improvements in overall quality of life and 90% (19/21) of penguins exhibited improvement in mobility and behavior within their exhibit following cataract removal. Of the 14 penguins that received 1:5 intracameral atracurium during surgery, 10 (71.4%) had moderate mydriasis, 1 (7.1%) had minimal mydriasis, and 3 (21.4%) showed no effect to the pupil. Seventy percent of the cases had phacoemulsification times less than 60 seconds/eye; the mean time was 72 seconds. Sixteen eyes (59.3%) underwent anterior capsulotomy only, planned anterior and posterior capsulotomies were performed in 3 eyes (11.1%), and the entire lens capsule was removed due to capsular fibrosis and wrinkling in 8 eyes (29.6%). The most common short-term postoperative complication was temporary mild blepharospasm and/or epiphora, reported in 8 eyes (29.6%) from 7 penguins (33.3%). Long-term complications, 2-6 years postoperatively, included posterior synechiation resulting in dyscoria (10 of 24 eyes, 41.7%) and capsular fibrosis in all penguins with residual lens capsule (19/19, 100%). The prognosis for vision and behavioral improvement after phacoemulsification surgery in penguins is good, with low incidence of vision-threatening complications. © 2018 American College of Veterinary Ophthalmologists.

Cumulative sum analysis score and phacoemulsification competency learning curve.

PubMed

Vedana, Gustavo; Cardoso, Filipe G; Marcon, Alexandre S; Araújo, Licio E K; Zanon, Matheus; Birriel, Daniella C; Watte, Guilherme; Jun, Albert S

2017-01-01

To use the cumulative sum analysis score (CUSUM) to construct objectively the learning curve of phacoemulsification competency. Three second-year residents and an experienced consultant were monitored for a series of 70 phacoemulsification cases each and had their series analysed by CUSUM regarding posterior capsule rupture (PCR) and best-corrected visual acuity. The acceptable rate for PCR was <5% (lower limit h) and the unacceptable rate was >10% (upper limit h). The acceptable rate for best-corrected visual acuity worse than 20/40 was <10% (lower limit h) and the unacceptable rate was >20% (upper limit h). The area between lower limit h and upper limit h is called the decision interval. There was no statistically significant difference in the mean age, sex or cataract grades between groups. The first trainee achieved PCR CUSUM competency at his 22 nd case. His best-corrected visual acuity CUSUM was in the decision interval from his third case and stayed there until the end, never reaching competency. The second trainee achieved PCR CUSUM competency at his 39 th case. He could reach best-corrected visual acuity CUSUM competency at his 22 nd case. The third trainee achieved PCR CUSUM competency at his 41 st case. He reached best-corrected visual acuity CUSUM competency at his 14 th case. The learning curve of competency in phacoemulsification is constructed by CUSUM and in average took 38 cases for each trainee to achieve it.

Intraoperative performance and postoperative outcomes of microcoaxial phacoemulsification. Observational study.

PubMed

Vasavada, Viraj; Vasavada, Vaishali; Raj, Shetal M; Vasavada, Abhay R

2007-06-01

To evaluate the intraoperative performance and postoperative outcomes after microcoaxial phacoemulsification. Iladevi Cataract & IOL Research Centre, Ahmedabad, India. A prospective observational case series comprised 84 eyes with age-related uncomplicated cataract having microcoaxial phacoemulsification through a 2.2 mm clear corneal incision by a standard surgical technique. Phacoemulsification parameters (Infiniti Vision System, Alcon) were microburst width, 30 ms; preset power, 50%; vacuum, 650 mm Hg; aspiration flow rate, 25 cc/minute. A single-piece Alcon AcrySof intraocular lens was implanted with the C cartridge (Alcon) cartridge. The incision was measured at the end of surgery. Observations included surgical time (from commencement of sculpting to end of epinucleus removal), cumulative dissipated energy (CDE), wound burns, intraoperative complications, postoperative increase in mean central corneal thickness (CCT) at 1 day and 1 month, mean % decrease in endothelial cell density (ECD), absolute mean change in coefficient of variation (cv) 3 months, and uncorrected visual acuity (UCVA) at 1 day. Data were analyzed using a 1-sample t test with 95% confidence intervals (CIs). The mean follow up was 3 months +/- 0.3 (SD). The mean incision size at the end of surgery was 2.3 +/- .09 mm; mean surgical time, 4.5 +/- 1.5 minutes; and mean CDE, 2.3 +/- 2.2 seconds. No wound burns or other intraoperative complications occurred. The postoperative CCT increased by a mean of 16 microm at 1 day (95% CI, 8-25; P = .66;) and by a mean of 3.14 microm at 1 month (95% CI, 2.26-4.05; P = .92). The ECD decreased by a mean of 5.8% (95% CI, 6.8-3.5; P = .82) and the mean coefficient of variation, by 3.3 (95% CI, 4.5-2.0; P = .65). At 1 day, the UCVA was 20/20 in 29% of cases, 20/20 to 20/40 in 58%, and 20/40 to 20/50 in 12%. Microcoaxial phacoemulsification was safely and effectively performed, achieving consistent and satisfactory postoperative outcomes.

Transverse vs torsional ultrasound: prospective randomized contralaterally controlled study comparing two phacoemulsification-system handpieces

PubMed Central

Assil, Kerry K; Harris, Lindsay; Cecka, Jeannie

2015-01-01

Purpose To compare surgical efficiency and multiple early clinical outcome variables in eyes undergoing phacoemulsification using either transversal or torsional ultrasound systems. Setting Assil Eye Institute, Beverly Hills, CA, USA. Design Prospective, randomized, clinician-masked, contralaterally controlled single-center evaluation. Patients and methods Patients seeking cataract removal in both eyes with implantation of multifocal intraocular lenses were randomly assigned to one of two treatment rooms for phacoemulsification with either a transverse ultrasound system or torsional handpiece system. The contralateral eye was treated at a later date with the alternate device. A total of 54 eyes of 27 patients having similar degrees of cataract, astigmatism, and visual potential were included. All operative data were collected for analysis, and patients were followed for 3 months after surgery. Results Similar visual acuity was reported at all postoperative visits between the two groups. Mean phacoemulsification time and total power required were both significantly lower with the transverse system than with the torsional technique (P<0.05 for both). Similarly, mean total balanced salt solution used was significantly less with the transverse system vs torsional (P<0.05). Postoperative safety demonstrated significantly lower endothelial cell loss at 1 day and 1 month (P<0.05) with transverse vs torsional. Macular swelling was less at 1 week, 1 month, and 3 months with transverse vs torsional, although the difference did not achieve significance (P=0.1) at any single time point. Clinically detectable corneal edema was reported less frequently at all postoperative time points with the transverse system. Conclusion The transverse ultrasound system was found to be possibly associated with less balanced salt-solution use, less phacoemulsification time, and less power required than the torsional phaco system. Postoperative data suggested that improved phaco efficiency may translate to a better overall safety profile for the patient. PMID:26345628

The risk of ischemic optic neuropathy post phacoemulsification cataract surgery.

PubMed

Al-Madani, Mousa Victor; Al-Raqqad, Nancy Khalaf; Al-Fgarra, Naser Abdallah; Al-Thawaby, Amal Mousa; Jaafar, Ahmed Abdelra'of

2017-01-01

The aim was to study the risk of non arteritic ischemic optic neuropathy after phacoemulsification cataract surgery. This study was conducted at King Hussein Medical Center during the period between January 2015 and July 2016. Patients attending ophthalmology clinic complaining of decreased vision due to lens opacity were evaluated. Patients were divided into two groups. First group included patients with no medical illness and second group included patients with diabetes mellitus, hypertension or hyperlipidemia. The two groups were further divided into two subgroups. First subgroup included patients who had phacoemulsification surgery and second subgroup did not have surgery. All patients were followed up for 6 months. They were assessed by neuro-ophthalmologist looking for ischemic optic neuropathy. A total number of 568 patients were enrolled. Group 1A included patients with no medical illness who underwent surgery and group 1B did not undergo surgery. The number of patients in these two subgroups was 119 and 103 respectively. Number of patients in group 2A (medical illness and surgery) was 188 and number of patients in group 2B (medical illness and no surgery) was 130. The incidence of ischemic optic neuropathy was 4.3 % in group 2A, 4.2 % in group 1A, 0.8% in group 2B, and 0% in group 1B. Phacoemulsification is a risk factor for non arteritic ischemic optic neuropathy independent of the presence of medical risk factors. Suggested mechanisms would be local anaesthesia, intraocular pressure fluctuation and local intraocular inflammation.

No-anesthesia clear corneal phacoemulsification versus topical and topical plus intracameral anesthesia. Randomized clinical trial.

PubMed

Pandey, S K; Werner, L; Apple, D J; Agarwal, A; Agarwal, A; Agarwal, S

2001-10-01

To compare the intraoperative pain scores during clear corneal phacoemulsification under no anesthesia, topical anesthesia, and topical plus intracameral anesthesia. Dr. Agarwal's Eye Hospital and Eye Research Center, Chennai, India. Seventy-five patients were randomized to have phacoemulsification under no anesthesia, topical anesthesia, or topical plus intracameral anesthesia. Uncooperative or illiterate patients and those with hard cataract, a shallow anterior chamber, or small pupils were excluded. A protocol was established for supplemental anesthesia in case of breakthrough pain during the surgery. Each patient was asked to grade the overall severity of intraoperative pain immediately after surgery on a 10-point visual analog scale. Also evaluated were the general discomfort during surgery, discomfort from the microscope lights, surgeon stress during surgery, and total surgical time. Comparison among the 3 groups was performed using an analysis of variance. No supplemental anesthesia was required in any group. No significant difference was noted in the mean scores of the subjective sensation of pain with or without topical anesthesia (P =.610). The mean scores of patient discomfort from the microscope lights and surgical time were also statistically insignificant. Patient discomfort and surgeon stress during surgery were significantly greater in the no-anesthesia group than in the topical and topical plus intracameral groups (P =.0235 and P = 0.0206, respectively). No-anesthesia clear corneal phacoemulsification was performed by a highly experienced, skilled surgeon without causing an unacceptable level of pain. However, this technique is not suitable for every cataract surgeon or patient.

Measurements of attenuation coefficient for evaluating the hardness of a cataract lens by a high-frequency ultrasonic needle transducer.

PubMed

Huang, Chih-Chung; Chen, Ruimin; Tsui, Po-Hsiang; Zhou, Qifa; Humayun, Mark S; Shung, K Kirk

2009-10-07

A cataract is a clouding of the lens in the eye that affects vision. Phacoemulsification is the mostly common surgical method for treating cataracts, and determining that the optimal phacoemulsification energy is dependent on measuring the hardness of the lens. This study explored the use of an ultrasound needle transducer for invasive measurements of ultrasound attenuation coefficient to evaluate the hardness of the cataract lens. A 47 MHz high-frequency needle transducer with a diameter of 0.9 mm was fabricated by a polarized PMN-33%PT single crystal in the present study. The attenuation coefficients at different stages of an artificial porcine cataract lens were measured using the spectral shift approach. The hardness of the cataract lens was also evaluated by mechanical measurement of its elastic properties. The results demonstrated that the ultrasonic attenuation coefficient was increased from 0.048 +/- 0.02 to 0.520 +/- 0.06 dB mm(-1) MHz(-1) corresponding to an increase in Young's modulus from 6 +/- 0.4 to 96 +/- 6.2 kPa as the cataract further developed. In order to evaluate the feasibility of combining needle transducer and phacoemulsification probe for real-time measurement during cataract surgery, the needle transducer was mounted on the phacoemulsification probe for a vibration test. The results indicated that there was no apparent damage to the tip of the needle transducer and the pulse-echo test showed that a good performance in sensitivity was maintained after the vibration test.

[Effectivity and Safety of a Modified Tip Design in Torsional Phacoemulsification].

PubMed

Schmidt, Sabine; Hubich, Sophie; Vetter, Jan Markus; Wirbelauer, Christopher

2018-02-16

Torsional mode phacoemulsification results in more effective fragmentation of the nucleus due to a different movement of the phacotip. In this clinical study, we investigated the influence of a modified tip design and active fluidics on the efficacy of phacoemulsification and safety for the corneal endothelium. We conducted a prospective randomized 2 : 1 study in which 40 patients were operated on with the mini-flared Kelman Tip using the Infiniti ® System (group 1), and 20 patients were operated on with the Intrepid ® Balanced Tip and the Centurion ® System. We analyzed the intraoperative cumulative dissipated energy and also the density of the corneal endothelium measured with an endothelial microscope (CEM 530, Nidek) pre- and postoperatively. Both groups did not differ preoperatively in age, sex, axial length of the globe or corneal endothelium cell density nor cataract density (LOCS3). All surgeries were uneventful. The cumulative dissipated energy in group 1 (mini-flared Kelman tip, Infiniti System) was 38% higher than in group 2 (balanced tip, Centurion System; p < 0.05). The endothelial cell loss was 8% in group 1 and 10.3% in group 2 (p > 0.05). The cell size (polymegathism) increased in both groups significantly with + 37 µm in group 1 (p < 0.05) und + 54 µm in group 2 (p < 0.05). There was no statistically significant difference between both groups (p > 0.05). The number of hexagonal cells (pleomorphism) and corneal thickness did not differ in both groups either pre- nor postoperatively. Compared to torsional phacoemulsification with a mini-flared Kelman Tip and gravity fluidics, torsional phacoemulsification with a modified tip design and active fluidics is 38% more effective regarding the cumulative dissipated energy. Endothelial cell loss occurs to a similar extend using both systems. The postoperative changes in cell size (polymegathism), number of hexagonal cells (pleomorphism) and corneal thickness (pachymetry) were similar among both systems. We conclude, that the intraoperative stress on the endothelium is equivalent with both systems used. Georg Thieme Verlag KG Stuttgart · New York.

Predictors of intraocular pressure change after phacoemulsification in patients with pseudoexfoliation syndrome.

PubMed

Moghimi, Sasan; Johari, Mohammadkarim; Mahmoudi, Alireza; Chen, Rebecca; Mazloumi, Mehdi; He, Mingguang; Lin, Shan C

2017-03-01

To evaluate anterior chamber biometric factors and intraoperative metrics associated with the intraocular pressure (IOP) reduction after phacoemulsification in non-glaucomatous pseudoexfoliative syndrome (PXS) eyes. Thirty-three patients were enrolled in this prospective interventional study. Images were excluded if they had poor quality, poor perpendicularity or inability to locate sclera spurs. Anterior chamber depth (ACD), anterior chamber area (ACA), iris thickness, iris area, iris curvature, lens vault, angle opening distance (AOD500, AOD750) and trabecular iris space area (TISA500, TISA750) were measured in qualified images using the Zhongshan Angle Assessment Program and compared preoperatively and 3 months postoperatively. Cumulative dissipated energy (CDE), aspiration time and infusion fluid usage during cataract surgery were obtained from the phacoemulsification machine's metrics record. Postoperative IOP change was compared with these anatomical and intraoperative metric parameters. Mean IOP was 18.1±3.4 mm Hg preoperatively and decreased by 3.3 mm Hg (18%) to 14.8±3.6 mm Hg at 3 months postoperatively (p<0.001). All angle parameters, ACD and ACA increased significantly postoperatively (p<0.001 for all) and iris curvature decreased (p<0.001). In univariate analysis, preoperative IOP (B=-0.668, p=0.002), infusion fluid usage (B=-0.040, p=0.04) and aspiration time (B=-0.045, p=0.003) were negatively associated with IOP decrease after phacoemulsification. Changes in IOP did not demonstrate significant associations with CDE measurements or anterior segment optical coherence tomography measurements, including preoperative angle, iris or anterior segment parameters. In the final multivariate regression model, preoperative IOP (B=-0.668, p=0.002) and infusion fluid usage (B=-0.041, p=0.04) were significantly associated with IOP drop and together can predict 45.1% (p=0.002) of the variability in IOP change. Non-glaucomatous patients with PXS experience moderate IOP reduction following phacoemulsification, and this effect is correlated with preoperative IOP, aspiration time and infusion fluid used intraoperatively. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Coarsened Exact Matching of Phaco-Trabectome to Trabectome in Phakic Patients: Lack of Additional Pressure Reduction from Phacoemulsification

PubMed Central

Parikh, Hardik A.; Bussel, Igor I.; Schuman, Joel S.; Brown, Eric N.; Loewen, Nils A.

2016-01-01

Purpose To compare intraocular pressure (IOP) after trabectome-mediated ab interno trabeculectomy surgery in phakic patients (T) and trabectome with same session phacoemulsification (PT) using Coarsened Exact Matching. Although phacoemulsification is associated with IOP reduction when performed on its own, it is not known how much it contributes in PT. Methods Subjects were divided into phakic T and PT. Exclusion criteria were follow-up for <12 months and additional glaucoma surgery. Demographics were compared by the Mann-Whitney U test and chi-squared test for continuous and categorical variables, respectively. Multiple imputation was utilized to avoid eliminating data with missing values. Groups were then matched using Coarsened Exact Matching based on age, race, type of glaucoma, baseline IOP, and number of preoperative glaucoma medications. Univariate linear regression was used to examine IOP reduction after surgery; those variables that were statistically significant were included in the final multivariate regression model. Results A total of 753 cases were included (T: 255, PT: 498). When all variables except for age were kept constant, there was an additional IOP reduction of 0.05±0.01 mmHg conferred for every yearly increment in age. Every 1 mmHg increase in baseline IOP correlated to an additional IOP reduction of 0.80±0.02 mmHg. Phacoemulsification was not found to be a statistically significant contributor to IOP when comparing T and PT (p≥0.05). T had a 21% IOP reduction to 15.9±3.5 mmHg (p<0.01) while PT had an 18% reduction to 15.5±3.6 mmHg (p<0.01). Number of medications decreased (p<0.01) in both groups from 2.4±1.2 to 1.9±1.3 and from 2.3±1.1 to 1.7±1.3, respectively. Conclusion Phacoemulsification does not make a significant contribution to postoperative IOP or number of medications when combined with trabectome surgery in phakic patients. PMID:26895293

Sulcus implantation of a 3-piece, 6.0 mm optic, hydrophobic foldable acrylic intraocular lens in phacoemulsification complicated by posterior capsule rupture.

PubMed

Brazitikos, Periklis D; Balidis, Miltiadis O; Tranos, Paris; Androudi, Sofia; Papadopoulos, Nick T; Tsinopoulos, Ioannis T; Karabatakis, Vasilios; Stangos, Nikolaos T

2002-09-01

To evaluate the safety of implanting a 3-piece, 6.0 mm optic, foldable acrylic intraocular lens (IOL) in cases of posterior capsule rupture during phacoemulsification. Department of Ophthalmology, Ahepa Hospital, Aristotle University Medical School, and Interbalkan Medical Center, Thessaloniki, Greece. This prospective noncomparative case series included 28 eyes (28 patients) having phacoemulsification complicated by extensive posterior capsule rupture with or without vitreous loss. In all eyes, a 3-piece, 6.0 mm optic, foldable acrylic IOL (AcrySof MA60BM, Alcon) was implanted in the sulcus. Postoperative examination included best corrected visual acuity (BCVA), anterior segment biomicroscopy, IOL centralization and position, intraocular pressure (IOP), and fundus biomicroscopy. The follow-up was 6 months. The most common postoperative complications were transient corneal edema in 12 eyes and increased IOP in 11 eyes. Slight asymptomatic decentralization from the center of the pupil (1.0 to 2.0 mm) and pseudophacodonesis were observed in 5 eyes each. Friction of the IOL with the iris occurred in 1 eye. Clinically significant cystoid macular edema occurred in 3 eyes. The final BCVA was between 20/15 and 20/25 in 18 patients, 20/30 in 2, between 20/40 and 20/50 in 4, and between 20/60 and 20/200 in 4. AcrySof IOL implantation in the sulcus during phacoemulsification complicated by posterior capsule rupture preserved the advantages of small-incision surgery. The postoperative behavior and centralization of the IOLs resembled those of poly(methyl methacrylate) lenses.

Clear corneal incision leakage after phacoemulsification--detection using povidone iodine 5%.

PubMed

Chee, Soon-Phaik

2005-01-01

The purpose of this work was to study the incidence of clear corneal wound leakage at the conclusion of standard co-axial phacoemulsification in a prospective observational series of 100 consecutive cataract cases in a single surgeon's institutional practice. At the conclusion of standard co-axial phacoemulsification using a 2.75 mm temporal single plane clear corneal incision with a 1 mm clear corneal side-port incision, the wounds were hydrated and checked for water-tightness. Povidone iodine 5% (P-I) was then evenly dripped over the cornea and the wounds were inspected visually. Any leakage of aqueous observed was recorded. The amount of leakage was graded as small or large from each wound. Leaky wounds were further hydrated and retested with P-I until sealed. Wound integrity was reassessed on the first postoperative day by use of fluorescein. Of the 100 cases, wound leakage was observed for 31 eyes (31%)-ten main incisions, nineteen side-port incisions, and both incisions in two cases. Wound leakage was easily detected as a ribbon of clear fluid streaming from the incision amid a pool of brown solution. Povidone iodine was not observed within the tract in any incision. All wound leakage was small except for one from the main incision and two from the side-port incision. None of the eyes developed wound leakage the day after surgery and none developed endophthalmitis. In conclusion, leakage from clear corneal incisions at the conclusion of phacoemulsification occurs in almost a third of cases, predominantly from the side incision. It is easily detected by use of the P-I test.

Comparison of different types of phacoemulsification tips. I. Quantitative analysis of elemental composition and tip surface microroughness.

PubMed

Tsaousis, Konstantinos T; Werner, Liliana; Perez, Jesus Paulo; Li, He J; Reiter, Nicholas; Guan, Jia J; Mamalis, Nick

2016-09-01

To evaluate the elemental composition of phacoemulsification tips and their surface roughness in the microscale. John A. Moran Eye Center and Utah Nanofab, College of Engineering, University of Utah, Salt Lake City, Utah, USA. Experimental study. Seven types of phacoemulsification tips were studied. The phaco tips were examined through energy-dispersive x-ray spectroscopy (EDS) and x-ray photoelectron spectroscopy (XPS) for elemental composition. In addition, the roughness of the opening in all tips was assessed through 3-dimensional white-light interferometry. Elemental analysis showed considerable differences in the surface layers between manufacturers. Alcon tips had a thinner oxidized titanium (Ti) layer in their surface. Through XPS, vanadium was not detected in the superficial layers of any tip, but only in deeper levels. The microroughness surface analysis showed comparable results regarding their root-mean-square (RMS) metric. Maximum peak valley distance values varied and appeared to be dependent on the quality of material process rather than the material itself. Phacoemulsification tips are made of Ti alloys and showed differences between models, especially regarding their composition in the superficial layers. Their opening end roughness showed an overall appropriate RMS value of less than 1.0 μm in all cases. The existence of small defected areas highlights the importance of adequate quality control of these critical surgical instruments. None of the authors has a financial or proprietary interest in any material or method mentioned. Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Outcomes of torsional microcoaxial phacoemulsification performed by 12-degree and 22-degree bent tips.

PubMed

Helvacioglu, Firat; Yeter, Celal; Tunc, Zeki; Sencan, Sadik

2013-08-01

To compare the safety and efficacy of Ozil Intelligent Phaco torsional microcoaxial phacoemulsification surgeries performed with 12-degree and 22-degree bent tips using the Infiniti Vision System. Maltepe University School of Medicine Department of Ophthalmology, Istanbul, Turkey. Comparative case series. Eyes were assigned to 2.2 mm microcoaxial phacoemulsification using the torsional mode with a 22-degree bent tip (Group 1) or a 12-degree bent tip (Group 2). The primary outcome measures were ultrasound time (UST), cumulative dissipated energy (CDE), longitudinal and torsional ultrasound (US) amplitudes, mean surgical time, mean volume of balanced salt solution used, and surgical complications. Both groups included 45 eyes. The mean UST, CDE, longitudinal US amplitude, and torsional US amplitude were 65 seconds ± 27.23 (SD), 11.53 ± 6.99, 0.22 ± 0.26, and 42.86 ± 15.64, respectively, in Group 1 and 84 ± 45.04 seconds, 16.68 ± 10.66, 0.48 ± 0.68, and 46.27 ± 14.74, respectively, in Group 2. The mean UST, CDE, and longitudinal amplitudes were significantly lower in Group 1 (P=.003, P=.008, and P=.022, respectively). The mean volume of balanced salt solution was 73.33 ± 28.58 cc in Group 1 and 82.08 ± 26.21 cc in Group 2 (P=.134). Torsional phacoemulsification performed with 22-degree bent tips provided more effective lens removal than 12-degree bent tips, with a lower UST and CDE. Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

The Effect of Eye Patching on Clear Corneal Incision Architecture in Phacoemulsification: A Randomized Controlled Trial.

PubMed

Ho, Fui Li; Salowi, Mohamad Aziz; Bastion, Mae-Lynn Catherine

2017-01-01

To investigate the effects of postoperative eye patching on clear corneal incision architecture in phacoemulsification. A single-center, randomized controlled trial. A total of 132 patients with uncomplicated phacoemulsification were randomly allocated to the intervention or control group. The intervention group received postoperative eye patching for approximately 18 hours, whereas the control group received eye shield. The clear corneal incision architecture was examined postoperatively at 2 hours, 1 day, and 7 days after surgery using optical coherence tomography. Epithelial gaping was significantly reduced on postoperative day 1 in the intervention group (52.4%) compared with control (74.2%) (P = 0.01). No differences were found for other architectural defects. Descemet membrane detachment was associated with lower intraocular pressure on postoperative day 7 (P = 0.02). Presence of underlying diabetes mellitus did not seem to influence architectural defects. Postoperative eye patching facilitated epithelial healing and reduced the occurrence of epithelial gaping on postoperative day 1. It may play a role in protecting and improving corneal wounds during the critical immediate postoperative period. Copyright 2017 Asia-Pacific Academy of Ophthalmology.

Performance index for virtual reality phacoemulsification surgery

NASA Astrophysics Data System (ADS)

Söderberg, Per; Laurell, Carl-Gustaf; Simawi, Wamidh; Skarman, Eva; Nordqvist, Per; Nordh, Leif

2007-02-01

We have developed a virtual reality (VR) simulator for phacoemulsification (phaco) surgery. The current work aimed at developing a performance index that characterizes the performance of an individual trainee. We recorded measurements of 28 response variables during three iterated surgical sessions in 9 subjects naive to cataract surgery and 6 experienced cataract surgeons, separately for the sculpting phase and the evacuation phase of phacoemulsification surgery. We further defined a specific performance index for a specific measurement variable and a total performance index for a specific trainee. The distribution function for the total performance index was relatively evenly distributed both for the sculpting and the evacuation phase indicating that parametric statistics can be used for comparison of total average performance indices for different groups in the future. The current total performance index for an individual considers all measurement variables included with the same weight. It is possible that a future development of the system will indicate that a better characterization of a trainee can be obtained if the various measurements variables are given specific weights. The currently developed total performance index for a trainee is statistically an independent observation of that particular trainee.

Comparison of torsional and microburst longitudinal phacoemulsification: a prospective, randomized, masked clinical trial.

PubMed

Vasavada, Abhay R; Raj, Shetal M; Patel, Udayan; Vasavada, Vaishali; Vasavada, Viraj

2010-01-01

To compare intraoperative performance and postoperative outcome of three phacoemulsification technologies in patients undergoing microcoaxial phacoemulsification through 2.2-mm corneal incisions. The prospective, randomized, single-masked study included 360 eyes randomly assigned to torsional (Infiniti Vision System; Alcon Laboratories, Fort Worth, TX), microburst with longitudinal (Infiniti), or microburst with longitudinal (Legacy Everest, Alcon Laboratories) ultrasound. Assessments included surgical clock time, fluid volume, and intraoperative complications, central corneal thickness on day 1 and months 1 and 3 postoperatively, and endothelial cell density at 3 months postoperatively. Comparisons among groups were conducted. Torsional ultrasound required significantly less surgical clock time and fluid volume than the other groups. There were no intraoperative complications. Change in central corneal thickness and endothelial cell loss was significantly lower in the torsional ultrasound group at all postoperative visits (P < .001, Kruskal-Wallis test) compared to microburst longitudinal ultrasound modalities. Torsional ultrasound demonstrated quantitatively superior intraoperative performance and showed less increase in corneal thickness and less endothelial cell loss compared to microburst longitudinal ultrasound. Copyright 2010, SLACK Incorporated.

Posterior Capsule Opacification After Phacoemulsification: Annual Review.

PubMed

Vasavada, Abhay R; Praveen, Mamidipudi R

2014-01-01

The purpose of this article is to provide a clinical update on posterior capsule opacification (PCO) after phacoemulsification by reviewing the literature from the last 12 months. This article is a literature review. The authors conducted a 1-year literature search in the English language on PCO using PubMed. The period used to conduct the literature search was from January 1, 2013, to January 1, 2014. The following search terms were used during the PubMed search: phacoemulsification, microcoaxial incision, posterior capsule opacification, long-term evaluation of intraocular lens (IOL) implantation, IOL edge design and material, surgical technique, anterior capsule overlap on the IOL optic, diabetes mellitus, myopia, pseudoexfoliation, retinitis pigmentosa, uveitis, and neodymium: yttrium-aluminum-garnet laser capsulotomy. This review incorporates original articles that provided fresh insights and updates on PCO. Particular attention was paid to observational, randomized, controlled clinical trials, as well as analyses of larger cohorts with a prospective and retrospective study design. Letters to the editor, unpublished works, experimental trials and abstracts were not considered. This annual review provides a brief update on PCO that might be of interest to the practicing clinical ophthalmologist.

Virtual phacoemulsification surgical simulation using visual guidance and performance parameters as a feasible proficiency assessment tool.

PubMed

Lam, Chee Kiang; Sundaraj, Kenneth; Sulaiman, Mohd Nazri; Qamarruddin, Fazilawati A

2016-06-14

Computer based surgical training is believed to be capable of providing a controlled virtual environment for medical professionals to conduct standardized training or new experimental procedures on virtual human body parts, which are generated and visualised three-dimensionally on a digital display unit. The main objective of this study was to conduct virtual phacoemulsification cataract surgery to compare performance by users with different proficiency on a virtual reality platform equipped with a visual guidance system and a set of performance parameters. Ten experienced ophthalmologists and six medical residents were invited to perform the virtual surgery of the four main phacoemulsification cataract surgery procedures - 1) corneal incision (CI), 2) capsulorhexis (C), 3) phacoemulsification (P), and 4) intraocular lens implantation (IOL). Each participant was required to perform the complete phacoemulsification cataract surgery using the simulator for three consecutive trials (a standardized 30-min session). The performance of the participants during the three trials was supported using a visual guidance system and evaluated by referring to a set of parameters that was implemented in the performance evaluation system of the simulator. Subjects with greater experience obtained significantly higher scores in all four main procedures - CI1 (ρ = 0.038), CI2 (ρ = 0.041), C1 (ρ = 0.032), P2 (ρ = 0.035) and IOL1 (ρ = 0.011). It was also found that experience improved the completion times in all modules - CI4 (ρ = 0.026), C4 (ρ = 0.018), P6 (ρ = 0.028) and IOL4 (ρ = 0.029). Positive correlation was observed between experience and anti-tremor - C2 (ρ = 0.026), P3 (ρ = 0.015), P4 (ρ = 0.042) and IOL2 (ρ = 0.048) and similarly with anti-rupture - CI3 (ρ = 0.013), C3 (ρ = 0.027), P5 (ρ = 0.021) and IOL3 (ρ = 0.041). No significant difference was observed between the groups with regards to P1 (ρ = 0.077). Statistical analysis of the results obtained from repetitive trials between two groups of users reveal that augmented virtual reality (VR) simulators have the potential and capability to be used as a feasible proficiency assessment tool for the complete four main procedures of phacoemulsification cataract surgery (ρ < 0.05), indicating the construct validity of the modules simulated with augmented visual guidance and assessed through performance parameters.

Thermal study of longitudinal and torsional ultrasound phacoemulsification: tracking the temperature of the corneal surface, incision, and handpiece.

PubMed

Jun, Bokkwan; Berdahl, John P; Kim, Terry

2010-05-01

To evaluate the change and difference in the corneal surface, incision, and handpiece temperatures during longitudinal and torsional ultrasound (US) phacoemulsification with standard incisions (2.75 mm) and microincisions (2.20 mm) and the thermal effect on wounds. Department of Ophthalmology, Duke University, Durham, North Carolina, USA. In this prospective study, human cadaver eyes had simulated phacoemulsification. Group 1 had a 2.75 mm incision with 100% longitudinal US; Group 2, a 2.20 mm incision with 100% longitudinal US; Group 3, a 2.75 mm incision with 100% torsional US; and Group 4, a 2.20 mm incision with 100% torsional US. During phacoemulsification, the corneal incision was evaluated by surgical microscopy and scanning electron microscopy (SEM) and images of the corneal surface, incision, and handpiece were captured with an infrared camera. Twelve eyes (3 each group) were evaluated. The maximum incision temperature was higher in the longitudinal groups than in the torsional groups. With the same US modality, the maximum microincision temperature was higher than the maximum standard incision temperature. After application of full power for 40 seconds, wound burn was observed in all eyes in the longitudinal groups and no eyes in the torsional groups. On SEM, there was more extensive loss of Descemet membrane in the longitudinal groups than in the torsional groups. Incision temperature was influenced by US modality and was significantly lower with torsional US than with longitudinal US. Using torsional US with smaller incisions may decrease the risk for wound burn in eyes with denser cataracts. (c) 2010 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Rabbits with naturally occurring cataracts referred for phacoemulsification and intraocular lens implantation: a preliminary study of 12 cases.

PubMed

Sanchez, Rick F; Everson, Richard; Hedley, Joanna; Dawson, Charlotte; Lam, Richard; Priestnall, Simon L; Garcia de Carellan, Alejandra; de Miguel, Cristina; Seymour, Christopher

2017-12-04

To describe the presentation of 15 rabbits with naturally occurring cataracts referred for phacoemulsification surgery, the procedure in 13 cases and the follow-up in 12. Fifteen rabbits (30 eyes), nine of which stopped following visual cues in association with cataract progression. Rabbits underwent preoperative ophthalmic and ocular ultrasound examination. Thirteen rabbits (22 eyes) had mature cataracts. Ten were bilateral and three unilateral. Two rabbits had an anterior chamber abscess. The cataract in one of these was incipient. One rabbit had bilateral immature cataracts. One rabbit had a subluxated lens, and one had a retinal detachment. Thirteen rabbits (22 eyes) underwent phacoemulsification. Eighteen, 13.5-mm capsular tension rings (CTRs) and seventeen, 13-mm IOLs (Acrivet ® , Berlin, Germany) were fitted including one 41D 60V-model, and three 49D and thirteen 58D 20S-models. Intraoperative complications included one unilateral posterior-capsular tear, one lens subluxation, and one expulsive choroidal hemorrhage. One rabbit died during anesthetic recovery. Nine cases were PCR-tested for Encephalitozoon cuniculi, and only three were positive. The median follow-up time was 12 months (4-24 months). Rabbits that were not following visual cues preoperatively did so postoperatively, and surgery resulted in a clear visual axis for the follow-up period in every case except in two, due to reasons other than the surgery. Phacoemulsification with CTR and IOL implantation offers good long-term results and can improve the quality of life of pet rabbits. Retinal detachment, lens luxation, expulsive choroidal hemorrhage, and anesthetic death are potential complications. © 2017 American College of Veterinary Ophthalmologists.

Combined Phacoemulsification and Ahmed Glaucoma Drainage Implant Surgery for Patients With Refractory Glaucoma and Cataract.

PubMed

Valenzuela, Felipe; Browne, Andrew; Srur, Miguel; Nieme, Carlos; Zanolli, Mario; López-Solís, Remigio; Traipe, Leonidas

2016-02-01

To examine the indications, safety, efficacy, and complications of combined phacoemulsification and Ahmed glaucoma drainage implant surgery. A retrospective case review of 35 eyes (31 patients) subjected to combined phacoemulsification and Ahmed glaucoma drainage implant surgery. Demographic characteristics of the study population, indications for combined surgery, and operative and postoperative complications were recorded. Visual acuity, intraocular pressure (IOP), and number of glaucoma medications were evaluated preoperatively and postoperatively. Complete success was defined as IOP ≤ 21 mm Hg without medication, qualified success if IOP ≤ 21 mm Hg with ≥ 1 medications, and failure if IOP>21 mm Hg or ≤ 5 mm Hg on ≥ 2 consecutive visits. Mean follow-up was 29.5 months (range, 6 to 87 mo). The most common indication for combined surgery was a history of prior failed trabeculectomy (60%). Postoperative visual acuity improved in 30 of 35 eyes (85%) (P<0.01) regardless of the indication for combined surgery. IOP was reduced from a mean of 24.7 to 15.0 mm Hg at the last follow-up visit (P<0.01). The number of IOP-lowering medications was reduced from a median of 3.1 preoperatively to 1.7 at the last follow-up (P<0.01). Overall, there were 31 eyes (89%) classified as qualified success and 4 eyes (11%) as complete success. The most common postoperative complication was a hypertensive phase in 18 eyes (51%). Combined phacoemulsification and Ahmed glaucoma drainage implant surgery seems to be a safe and effective surgical option, providing good visual rehabilitation and control of IOP for patients with refractory glaucoma and cataract.

Microincision bimanual phacoemulsification and Thinoptx implantation through a 1.70 mm incision.

PubMed

Prakash, P; Kasaby, H E; Aggarwal, R K; Humfrey, S

2007-02-01

To prospectively assess the efficacy of bimanual phacoemulsification and implantation of Thinoptx, an injectable intraocular lens (IOL), inserted through 1.70 mm clear corneal incision. Department of Ophthalmology, Southend Hospital NHS Trust, UK. A total of 50 eyes of 49 randomly selected patients with cataracts had microincision clear corneal bimanual phacoemulsification (MICS) with implantation of Thinoptx IOL in the capsular bag. All patients underwent full preoperative assessment. Postoperative assessment was carried out at 3 and 6 weeks and at 15 months. In all 50 cases the IOL was inserted through 1.70 mm clear corneal incision. The mean best-corrected visual acuity was 0.02 (6/6-1) at 6 weeks and was 0.17 (6/10) at the final follow-up. The mean final surgically induced astigmatism at 6 weeks was 0.0106. Coloured haloes around artificial lights were perceived by 69.23% of patients at 6 weeks and by 61.29% at the final follow-up. One patient underwent IOL exchange for this. Posterior capsular opacification was noticed in 31.26% at 6 weeks and in 64.51% at 15 months. Anterior capsular opacification was noticed in 5.26% at 6 weeks and in 16.12% at 15 months. In one patient the IOL had to be exchanged because of tilt and displacement of the IOL due to anterior capsular phimosis. We conclude Thinoptx can be safely inserted through 1.70 mm incision used for bimanual phacoemulsification. Distance and near visual acuity achieved with this IOL is satisfactory. There is no significant change in keratometric astigmatism following this procedure. However, posterior capsular opacification rate was significantly higher with this IOL. Haloes around light sources were significant.

Cost-effectiveness of Phacoemulsification Versus Combined Phacotrabeculectomy for Treating Primary Angle Closure Glaucoma.

PubMed

Chan, Poemen P; Li, Emmy Y; Tsoi, Kelvin K F; Kwong, Yolanda Y; Tham, Clement C

2017-10-01

The purpose of this study is to compare the cost effectiveness of phacoemulsification and combined phacotrabeculectomy for lowering intraocular pressure (IOP) in primary angle closure glaucoma (PACG) eyes with coexisting cataract. Real-life data of 2 previous randomized control trials that involved 51 medically uncontrolled PACG eyes and 72 medically controlled PACG eyes were utilized to calculate the direct cost of treatment. They were followed-up for 2 years. Cost of preoperative assessments, surgical interventions, additional procedures for managing complications and maintenance of filtration, postoperative follow-up, and cost of medications were considered. Cost data of 3 different regions (The United States, People's Republic of China, and Hong Kong) were used for comparison. The corresponding average costs for treating 1 eye with newly diagnosed PACG by phacoemulsification alone and combined phacotrabeculectomy were US$3479 and US$2439 in the United States, US$1051 and US$861 in China, and US$6856 and US$12087 in Hong Kong. Surgical and medications costs were the 2 key contributors. Combined phacotrabeculectomy was more cost-effective for IOP reduction when calculating with the United States and China cost data, but was less cost-effective when calculating with the Hong Kong cost data. The cost-effectiveness was insensitive to the costs of follow-up visit and investigations, the cost of surgical operations, and the cost of postoperative procedures, but sensitive to the cost fluctuation of medications. Furthermore, for the medically uncontrolled PACG group, phacoemulsification alone became more cost-effective when the cost of medication was reduced by >75%. Combined phacotrabeculectomy is a more cost-effective option for lowering IOP in PACG eyes with coexisting cataract, over a 2-year follow-up period.

Effect of latanoprost/timolol and dorzolamide/tiomolol on intraocular pressure after phacoemulsification surgery

PubMed Central

Erdogan, Haydar; Ozec, Ayse Vural; Caner, Cengiz; Toker, Mustafa Ilker; Arici, Mustafa Kemal; Topalkara, Aysen

2011-01-01

AIM To evalaute the effect of fixed-combination latanoprost 0.005%/timolol maleate 0.5% and dorzolamide hydrochloride 2%/timolol maleate 0.5% on postoperative intraocular pressure after phacoemulsification cataract surgery. METHODS This study is a prospective, randomized, double-masked and placebo-controlled. The study included 90 eyes of 90 patients which were scheduled to have phacoemulsification surgery. Patients were randomly assigned preoperatively to 1 of 3 groups (30 eyes of 30 patients). Two hour before surgery, the patients received one drop latanoprost/timolol (group 1), dorzolamide/timolol (group 2) and placebo (group 3, control group). The IOPs were measured at preoperative and postoperative 4, 8, and 24 hours. RESULTS The preoperative mean intraocular pressure was not statistically significant between both drug groups and control group. In group 1 and 2, the postoperative mean IOP [group1: (14.03±3.15)mmHg and group 2: (14.16±4.43)mmHg] at 24 hours were significantly lower than the control group [(16.93±3.70)mmHg, (P<0.05)]. In addition, the postoperative mean IOP of group 1 [(14.90±3.69)mmHg] at 8 hours was significantly lower than the control group [(17.70±3.89)mmHg, (P<0.05)], but there was no significant difference between group 2 [(16.16±5.23)mmHg] and control group at 8 hours (P>0.05). CONCLUSION When compared with placebo, the use of preoperative fixed combination of latanoprost/timolol and dorzolamide/timolol is an effective method for preventing intraocular pressure elevation in 24 hours after phacoemulsification surgery, but did not completely prevent IOP spikes. PMID:22553640

Meta-analysis of the efficacy and safety of combined surgery in the management of eyes with coexisting cataract and open angle glaucoma.

PubMed

Jiang, Nan; Zhao, Gui-Qiu; Lin, Jing; Hu, Li-Ting; Che, Cheng-Ye; Wang, Qian; Xu, Qiang; Li, Cui; Zhang, Jie

2018-01-01

To conduct a systematic review and quantitative Meta-analysis of the efficacy and safety of combined surgery for the eyes with coexisting cataract and open angle glaucoma. We performed a systematic search of the related literature in the Cochrane Library, PubMed, EMBASE, Web of Science databases, CNKI, CBM and Wan Fang databases, with no limitations on language or publication date. The primary efficacy estimate was identified by weighted mean difference of the percentage of intraocular pressure reduction (IOPR%) from baseline to end-point, the percentage of number of glaucoma medications reduction from pre- to post-operation, and the secondary efficacy evaluations were performed by odds ratio (OR) and 95% confidence interval (CI) for complete and qualified success rate. Besides, ORs were applied to assess the tolerability of adverse incidents. Meta-analyses of fixed or random effect models were performed using RevMan software 5.2 to gather the consequences. Heterogeneity was evaluated by Chi 2 test and the I 2 measure. Ten studies enrolling 3108 patients were included. The combined consequences indicated that both glaucoma and combined cataract and glaucoma surgery significantly decreased IOP. For deep sclerectomy vs deep sclerectomy plus phacoemulsification and canaloplasty vs phaco-canaloplasty, the differences in IOPR% were not all statistically significant while trabeculotomy was detected to gain a quantitatively greater IOPR% compared with trabeculotomy plus phacoemulsification. Furthermore, there was no statistical significance in the complete and qualified success rate, and the rates of adverse incidents for trabeculotomy vs trabeculotomy plus phacoemulsification. Compared with trabeculotomy plus phacoemulsification, trabeculectomy alone is more effective in lowering IOP and the number of glaucoma medications, while the two surgeries can not demonstrate statistical differences in the complete success rate, qualified success rate, or incidence of adverse incidents.

Safety and efficacy of gas-forced infusion (air pump) in coaxial phacoemulsification.

PubMed

Chaudhry, Prashaant; Prakash, Gaurav; Jacob, Soosan; Narasimhan, Smita; Agarwal, Sunita; Agarwal, Amar

2010-12-01

To evaluate the safety and efficacy of gas-forced infusion (air pump) in uncomplicated coaxial phacoemulsification. Dr. Agarwal's Eye Hospital, Chennai, India. Comparative case series. Specular microscopy and optical coherence tomography were used to analyze the endothelium, central macular thickness (CMT), and peripapillary retinal nerve fiber layer (RNFL) thickness before and approximately 1, 7, 30, and 90 days after coaxial phacoemulsification with (infusion group) or without (control group) gas-forced infusion. Surgical time, surge, phaco energy, irrigation fluid volume, surgical ease, complications, and visual gain in the 2 groups were compared. The mean endothelial cell loss was lower in the infusion group than in the control group (6.98% ± 8.46% [SD] versus 10.54% ± 11.24%; P = .045) and the irrigation/aspiration time significantly shorter (54 ± 39 seconds versus 105 ± 84 seconds; P = .0001). The surgery was rated as easier with gas-forced infusion (scale 1 to 10: mean 8.3 ± 2.1 versus 6.6 ± 1.6; P = .00002). However, the amount of irrigating fluid volume was higher in the infusion group (117 ± 37 mL versus 94 ± 41 mL; P = .003). No surge occurred in the infusion group; it occurred a mean of 3.00 ± 4.16 times in the control group (P<.0001). The rate of visual gain, CMT, peripapillary RNFL thickness, phaco time, and amount of phaco energy were comparable in the 2 groups. Gas-forced infusion was safe and effective in controlling surge and increased the safety, ease, and speed of coaxial phacoemulsification. Copyright © 2010 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Pain Perception in Phacoemulsification with Topical Anesthesia and Evaluation of Factors Related with Pain

PubMed Central

Dadacı, Zeynep; Borazan, Mehmet; Öncel Acır, Nurşen

2016-01-01

Objectives: Evaluation of pain during and after phacoemulsification with topical anesthesia in patients with senile cataract and investigation of factors related with pain. Materials and Methods: Ninety-two adult patients scheduled for routine clear corneal phacoemulsification with topical anesthesia who had no previous cataract surgery in their fellow eyes were included in the study. Verbal pain scale and visual analog scale were used to measure pain intensity. Demographic characteristics, concomitant systemic diseases, drug consumption, need of additional anesthesia during surgery, surgical complications, duration of surgery and surgeon comfort were also evaluated for each patient. Results: Seventy-two patients (78.3%) reported pain during surgery and 68 patients (73.9%) reported pain in the period after the surgery. When the intensity of pain during the surgery was evaluated, the percentage of patients reporting mild, moderate and intense pain was 35.9%, 25.0% and 17.4%, respectively. The average verbal pain score during the surgery was 1.4±1.0 (0-3). Reported pain level was not associated with age or gender (p>0.05). Diabetic patients and patients who consumed nonsteroidal anti-inflammatory drugs in the morning before operation reported less pain during and after the surgery (p<0.05). There were no complications except posterior capsule rupture in one patient. Duration of surgery was longer in patients who reported pain during surgery (p<0.05). There was no significant difference between pain reported during surgery and surgeon comfort (p>0.05). Conclusion: Patients frequently experience pain during phacoemulsification with topical anesthesia. Although pain perception does not affect surgical success, preoperative administration of analgesics in suitable patients or giving additional anesthesia to patients reporting severe pain during surgery may increase patient comfort. PMID:28058148

Determining optimal torsional ultrasound power for cataract surgery with automatic longitudinal pulses at maximum vacuum ex vivo.

PubMed

Ronquillo, Cecinio C; Zaugg, Brian; Stagg, Brian; Kirk, Kevin R; Gupta, Isha; Barlow, William R; Pettey, Jeff H; Olson, Randall J

2014-12-01

To determine the optimal longitudinal power settings for Infiniti OZil Intelligent Phaco (IP) at varying torsional amplitude settings; and to test the hypothesis that increasing longitudinal power is more important at lower torsional amplitudes to achieve efficient phacoemulsification. Laboratory investigation. setting: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah. procedure: Individual porcine nuclei were fixed in formalin, then cut into 2.0 mm cubes. Lens cube phacoemulsification was done using OZil IP at 60%, 80%, and 100% torsional amplitude with 0%, 10%, 20%, 30%, 50%, 75%, or 100% longitudinal power. All experiments were done using a 20 gauge 0.9 mm bent reverse bevel phaco tip at constant vacuum (550 mm Hg), aspiration rate (40 mL/min), and bottle height (50 cm). main outcome measure: Complete lens particle phacoemulsification (efficiency). Linear regression analysis showed a significant increase in efficiency with increasing longitudinal power at 60% torsional amplitude (R(2) = 0.7269, P = .01) and 80% torsional amplitude (R(2) = 0.6995, P = .02) but not at 100% amplitude (R(2) = 0.3053, P = .2). Baseline comparison of 60% or 80% vs 100% torsional amplitude without longitudinal power showed increased efficiency at 100% (P = .0004). Increasing longitudinal power to 20% abolished the efficiency difference between 80% vs 100% amplitudes. In contrast, 75% longitudinal power abolished the efficiency difference between 60% vs 100% torsional amplitudes. Results suggest that longitudinal power becomes more critical at increasing phacoemulsification efficiencies at torsional amplitudes less than 100%. Increasing longitudinal power does not further increase efficiency at maximal torsional amplitudes. Copyright © 2014 Elsevier Inc. All rights reserved.

Effect of the angle of the operating microscope light beam on visual recovery after phacoemulsification: Randomized trial.

PubMed

Harman, Francesca E; Corbett, Melanie C; Stevens, Julian D

2010-08-01

To evaluate differences in visual recovery after phacoemulsification with direct or tilted surgical microscope illumination using a macular photostress test. Western Eye Hospital, Imperial College Health Care National Health Service Trust, London, United Kingdom. This randomized double-masked controlled trial enrolled patients presenting to a daycare unit for single-eye cataract surgery. Inclusion criteria were no ocular pathology other than cataract, corneal keratometric astigmatism less than 1.50 diopters, intended target of emmetropia in the operated eye, and cataract grade 1 to 3 (Lens Opacification Classification System II). Exclusion criteria were an abnormal preoperative photostress test. Patients were randomized to have phacoemulsification with the operating microscope angled 15 degrees nasal to the fovea (study group) or with the operating microscope directly overhead around the optic disc region (control group). The same surgeon performed all phacoemulsification procedures using a standardized technique and topical anesthesia. Outcome measures were uncorrected (UDVA) and corrected (CDVA) distance visual acuity 10 minutes and 60 minutes postoperatively. In the 30 patients evaluated, the mean UDVA 10 minutes postoperatively was 0.40 logMAR +/- 0.26 (SD) in the study group and 0.72 +/- 0.36 logMAR in the control group (P<.01). The mean CDVA was 0.18 +/- 0.26 logMAR and 0.44 +/- 0.30 logMAR, respectively (P = .016). There was no significant between-group difference in acuity at 60 minutes. Tilting the microscope beam away from the fovea resulted in faster visual recovery and less macular photic stress. No author has a financial or proprietary interest in any material or method mentioned. Copyright 2010 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

[Analysis of the Effect of Non-phacoemulsification Cataract Operation on Corneal Endothelial Cell Nucleus Division].

PubMed

Huang, Zufeng; Miao, Xiaoqing

2015-09-01

To investigate the effect of non-phacoemulsification cataract operation in two different patterns of nucleus delivery on the quantity and morphology of corneal endothelial cells and postoperative visual acuity. Forty patients diagnosed with cataract underwent cataract surgery and were assigned into the direct nuclear delivery and semi-nuclear delivery groups. Lens density was measured and divided into the hard and soft lenses according to Emery-little lens nucleus grading system. Non-phacoemulsification cataract operation was performed. At 3 d after surgery, the quantity and morphology of corneal endothelium were counted and observed under corneal endothelial microscope. During 3-month postoperative follow-up, the endothelial cell loss rate, morphological changes and visual acuity were compared among four groups. Corneal endothelial cell loss rate in the direct delivery of hard nucleus group significantly differed from those in the other three groups before and 3 months after operation (P < 0.01), whereas no statistical significance was found among the direct delivery of soft nucleus, semi-delivery of hard nucleus and semi-delivery soft nucleus groups (all P > 0.05). Preoperative and postoperative 2-d visual acuity did not differ between the semi-delivery of hard nucleus and direct delivery of soft nucleus groups (P = 0.49), significantly differed from those in the semi-delivery of soft nucleus (P = 0.03) and direct delivery of hard nucleus groups (P = 0.14). Visual acuity at postoperative four months did not differ among four groups (P = 0.067). During non-phacoemulsification cataract surgery, direct delivery of hard nucleus caused severe injury to corneal endothelium and semi-delivery of soft nucleus yielded mild corneal endothelial injury. Slight corneal endothelial injury exerted no apparent effect upon visual acuity and corneal endothelial morphology at three months after surgery.

Toric intraocular lens implantation versus astigmatic keratotomy to correct astigmatism during phacoemulsification.

PubMed

Titiyal, Jeewan S; Khatik, Mukesh; Sharma, Namrata; Sehra, Sri Vatsa; Maharana, Parfulla K; Ghatak, Urmimala; Agarwal, Tushar; Khokhar, Sudarshan; Chawla, Bhavana

2014-05-01

To compare toric intraocular lens (IOL) implantation and astigmatic keratotomy (AK) in correction of astigmatism during phacoemulsification. Tertiary care hospital. Prospective randomized trial. Consecutive patients with visually significant cataract and moderate astigmatism (1.25 to 3.00 diopters [D]) were randomized into 2 groups. Temporal clear corneal 2.75 mm phacoemulsification with toric IOL implantation was performed in the toric IOL group and with 30-degree coupled AK at the 7.0 mm optic zone in the keratotomy group. The uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, keratometry, topography, central corneal thickness, and endothelial cell density were evaluated preoperatively and 1 day, 1 week, and 1 and 3 months postoperatively. The study enrolled 34 eyes (34 patients), 17 in each group. There was no difference in UDVA or CDVA between the 2 groups at any follow-up visit. The mean preoperative and postoperative refractive cylinder was 2.00 D ± 0.49 (SD) and 0.33 ± 0.17 D, respectively, in the toric IOL group and 1.95 ± 0.47 D and 0.57 ± 0.41 D, respectively, in the keratotomy group (P=.10). The mean residual astigmatism at 3 months was 0.44 ± 1.89 @ 160 in the toric IOL group and 0.77 ± 1.92 @ 174 in the keratotomy group (P=.61). All eyes in the toric IOL group and 14 eyes (84%) in the keratotomy group achieved a residual refractive cylinder of 1.00 D or less (P=.17). Toric IOL implantation was comparable to AK in eyes with moderate astigmatism having phacoemulsification. Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Microinterventional endocapsular nucleus disassembly: novel technique and results of first-in-human randomised controlled study.

PubMed

Ianchulev, Tsontcho; Chang, David F; Koo, Edward; MacDonald, Susan; Calvo, Ernesto; Tyson, Farrell Toby; Vasquez, Andrea; Ahmed, Iqbal Ike K

2018-04-18

To assess the safety and efficacy of microinterventional endocapsular nuclear fragmentation in moderate to severe cataracts. This was a prospective single-masked multisurgeon interventional randomised controlled trial (ClinicalTrials.gov NCT02843594) where 101 eyes of 101 subjects with grade 3-4+ nuclear cataracts were randomised to torsional phacoemulsification alone (controls) or torsional phacoemulsification with adjunctive endocapsular nuclear fragmentation using a manual microinterventional nitinol filament loop device (miLOOP group). Outcome measures were phacoemulsification efficiency as measured by ultrasound energy (cumulative dispersed energy (CDE) units) and fluidics requirements (total irrigation fluid used) as well as incidence of intraoperative and postoperative complications. Only high-grade advanced cataracts were enrolled with more than 85% of eyes with baseline best corrected visual acuity (BCVA) of 20/200 or worse in either group. Mean CDE was 53% higher in controls (32.8±24.9 vs 21.4±13.1 with miLOOP assistance) (p=0.004). Endothelial cell loss after surgery was low and similar between groups (7-8%, p=0.561) One-month BCVA averaged 20/27 Snellen in miLOOP eyes and 20/24 in controls. No direct complications were caused by the miLOOP. In two cases, capsular tears occurred during IOL implantation and in all remaining cases during phacoemulsification, with none occurring during the miLOOP nucleus disassembly part of the procedure. Microinterventional endocapsular fragmentation with the manual, disposable miLOOP device achieved consistent, ultrasound-free, full-thickness nucleus disassembly and significantly improved overall phaco efficiency in advanced cataracts. NCT02843594. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Combined clear corneal phacoemulsification and ab interno trabeculectomy: three-year case series.

PubMed

Ferrari, Ettore; Bandello, Francesco; Roman-Pognuz, Derri; Menchini, Francesca

2005-09-01

To evaluate the efficacy and safety of a novel surgical approach, ab interno trabeculectomy, in a combined procedure (clear corneal phacoemulsification + ab interno trabeculectomy) for the management of concurrent cataract and glaucoma with prognostic factors for filtration failure. Department of Ophthalmology, Palmanova Hospital, Udine, Italy. A prospective noncomparative case series of 11 eyes of 11 consecutive cataract patients with medically uncontrolled primary open-angle glaucoma or pseudoexfoliation glaucoma was performed. Each patient had phacoemulsification + intraocular lens implantation + ab interno trabeculectomy, which consisted of a gonioscopically controlled ab interno removal of a quadrant (3 clock hours) of the trabecular meshwork. The main outcome measures were intraocular pressure (IOP), the number of antiglaucomatous medications used, and complications. Ten patients completed a 3-year follow-up. One patient had further surgery because of poor IOP control; in this case, the last valid observation was carried forward for IOP calculation. Mean preoperative IOP and IOPs measured 1, 3, 6, 12, 24, and 36 months after surgery were 25.0, 15.8, 15.4, 15.4, 15.2, 15.0, and 15.3 (-38.56%) mm Hg respectively. The number of medications averaged 2.4 before surgery and dropped to 0.8 at the end of follow-up. No major complications occurred during the follow-up period. The new surgical procedure combining phacoemulsification with ab interno trabeculectomy can induce a clinically relevant decrease in IOP in eyes with cataract and glaucoma with poor prognosis for filtering surgery. However, a randomized controlled clinical trial with a more extended follow-up and a larger series of patients is needed to ascertain the actual effectiveness and safety of this procedure.

Clear lens phacoemulsification in Alport syndrome: refractive results and electron microscopic analysis of the anterior lens capsule.

PubMed

Bayar, Sezin Akca; Pinarci, Eylem Yaman; Karabay, Gulten; Akman, Ahmet; Oto, Sibel; Yilmaz, Gursel

2014-01-01

To report the ocular findings of patients with Alport syndrome and the results of clear lens extraction in this patient group. Twenty-three eyes of 15 patients with a diagnosis of Alport syndrome were included in this study. Clear corneal phacoemulsification and intraocular foldable lens implantation was performed in eyes with indeterminate refractive errors and/or poor visual acuity and anterior capsule samples were analyzed with electron microscopy. All patients had a history of hereditary nephritis and/or deafness as systemic involvement. Ophthalmologic examination revealed anterior lenticonus with high myopia and/or irregular astigmatism in all patients. The mean best-corrected visual acuity (BCVA) was 0.67 ± 0.17 logMAR (range 1.0-0.4) preoperatively and 0.17 ± 0.08 logMAR (range 0.3-0.0) postoperatively. Postoperative refractive lenticular astigmatism dramatically decreased and no ocular complications arose during the follow-up period. Transmission electron microscopic analysis of the lens capsules supported the diagnosis of Alport syndrome. Clear lens phacoemulsification and foldable intraocular lens implantation is a safe and effective therapeutic choice for the management of uncorrectable refractive errors and low visual acuity due to anterior lenticonus in patients with Alport syndrome.

Measuring performance in virtual reality phacoemulsification surgery

NASA Astrophysics Data System (ADS)

Söderberg, Per; Laurell, Carl-Gustaf; Simawi, Wamidh; Skarman, Eva; Nordh, Leif; Nordqvist, Per

2008-02-01

We have developed a virtual reality (VR) simulator for phacoemulsification surgery. The current work aimed at developing a relative performance index that characterizes the performance of an individual trainee. We recorded measurements of 28 response variables during three iterated surgical sessions in 9 experienced cataract surgeons, separately for the sculpting phase and the evacuation phase of phacoemulsification surgery and compared their outcome to that of a reference group of naive trainees. We defined an individual overall performance index, an individual class specific performance index and an individual variable specific performance index. We found that on an average the experienced surgeons performed at a lower level than a reference group of naive trainees but that this was particularly attributed to a few surgeons. When their overall performance index was further analyzed as class specific performance index and variable specific performance index it was found that the low level performance was attributed to a behavior that is acceptable for an experienced surgeon but not for a naive trainee. It was concluded that relative performance indices should use a reference group that corresponds to the measured individual since the definition of optimal surgery may vary among trainee groups depending on their level of experience.

Refractive aim and visual outcome after phacoemulsification: A 2-year review from a Tertiary Private Eye Hospital in Sub-Saharan Africa.

PubMed

Oderinlo, O; Hassan, A O; Oluyadi, F O; Ogunro, A O; Okonkwo, O N; Ulaikere, M O; Ashano, O

2017-02-01

To review the short-term visual outcome of phacoemulsification in adults with uncomplicated cataracts in Eye Foundation Hospital, Lagos, Nigeria. A retrospective review of records of patients that had phacoemulsification between January 2012 and December 2013 in Eye Foundation Hospital, Lagos, Nigeria, was done. Preoperative visual acuity, refractive aim, intraoperative complications, postoperative unaided, and best-corrected visual acuity at 1 and 3 months were analyzed. Only eyes of adults that had phacoemulsification for uncomplicated cataracts were included in the study, all pediatric cataracts and eyes with ocular comorbidities were excluded. Common ocular comorbidities excluded were corneal opacity/corneal scar, glaucoma, uveitis, pseudo exfoliation syndrome, moderate and severe nonproliferative diabetic retinopathy, macula edema, proliferative diabetic retinopathy, eye trauma, age-related macular degeneration, previous corneal surgery, glaucoma surgery, and previous or simultaneous vitreoretinal surgery. A total of 157 eyes of 119 patients who met the inclusion criteria were analyzed. There were 60 (50.4%) females and 59 (49.6%) males, with age range from 31 to 91 years and a mean of 65.3 ± 11.10 years. Only eyes with available data were analyzed at 1 and 3 months postoperatively. In 112 eyes (85.7%), the refractive aim was met, 21 eyes (14.3%) did not meet their refractive aim, 20 eyes (12.7%) were excluded, the refractive aim could not be determined from the records as surgeons did not specify, and in 4 eyes, the required information was missing from the case files. An unaided visual acuity of 6/18 and better was achieved in 134 eyes (85.4%) at 1 month and 126 eyes (85.9%) at 3 months whereas best-corrected vision of 6/18 and better was achieved by 145 eyes (92.4%) at 1 month and 146 eyes (98.0%) at 3 months. Surgical outcomes after phacoemulsification are comparable with international benchmarks for good outcomes, with 85.4% of eyes achieving within 1 D of spherical equivalent of the refractive aim, 92.4% and 98.0% of eyes also achieving best-corrected visual acuities of 6/18 and better at 1 and 3 postoperative months, respectively. Unaided vision of 6/18 and better was also achieved in 85.4% and 85.9% at 1 and 3 postoperative months, respectively.

Manual small incision cataract surgery (MSICS) with posterior chamber intraocular lens versus phacoemulsification with posterior chamber intraocular lens for age-related cataract.

PubMed

Riaz, Yasmin; de Silva, Samantha R; Evans, Jennifer R

2013-10-10

Age-related cataract is a major cause of blindness and visual morbidity worldwide. It is therefore important to establish the optimal technique of lens removal in cataract surgery. To compare manual small incision cataract surgery (MSICS) and phacoemulsification techniques. We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2013, Issue 6), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to July 2013), EMBASE (January 1980 to July 2013), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to July 2013), Web of Science Conference Proceedings Citation Index - Science (CPCI-S) (January 1970 to July 2013), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 23 July 2013. We included randomised controlled trials (RCTs) for age-related cataract that compared MSICS and phacoemulsification. Two authors independently assessed all studies. We defined two primary outcomes: 'good functional vision' (presenting visual acuity of 6/12 or better) and 'poor visual outcome' (best corrected visual acuity of less than 6/60). We collected data on these outcomes at three and 12 months after surgery. Complications such as posterior capsule rupture rates and other intra- and postoperative complications were also assessed. In addition, we examined cost effectiveness of the two techniques. Where appropriate, we pooled data using a random-effects model. We included eight trials in this review with a total of 1708 participants. Trials were conducted in India, Nepal and South Africa. Follow-up ranged from one day to six months, but most trials reported at six to eight weeks after surgery. Overall the trials were judged to be at risk of bias due to unclear reporting of masking and follow-up. No studies reported presenting visual acuity so data were collected on both best-corrected (BCVA) and uncorrected (UCVA) visual acuity. Most studies reported visual acuity of 6/18 or better (rather than 6/12 or better) so this was used as an indicator of good functional vision. Seven studies (1223 participants) reported BCVA of 6/18 or better at six to eight weeks (pooled risk ratio (RR) 0.99 95% confidence interval (CI) 0.98 to 1.01) indicating no difference between the MSICS and phacoemulsification groups. Three studies (767 participants) reported UCVA of 6/18 or better at six to eight weeks, with a pooled RR indicating a more favourable outcome with phacoemulsification (0.90, 95% CI 0.84 to 0.96). One trial (96 participants) reported UCVA at six months with a RR of 1.07 (95% CI 0.91 to 1.26).Regarding BCVA of less than 6/60: there were only 11/1223 events reported. The pooled Peto odds ratio was 2.48 indicating a more favourable outcome using phacoemulsification but with wide confidence intervals (0.74 to 8.28) which means that we are uncertain as to the true effect.The number of complications reported were also low for both techniques. Again this means the review is underpowered to detect a difference between the two techniques with respect to these complications. One study reported on cost which was more than four times higher using phacoemulsification than MSICS. On the basis of this review, removing cataract by phacoemulsification may result in better UCVA in the short term (up to three months after surgery) compared to MSICS, but similar BCVA. There is a lack of data on long-term visual outcome. The review is currently underpowered to detect differences for rarer outcomes, including poor visual outcome. In view of the lower cost of MSICS, this may be a favourable technique in the patient populations examined in these studies, where high volume surgery is a priority. Further studies are required with longer-term follow-up to better assess visual outcomes and complications which may develop over time such as posterior capsule opacification.

[Treatment option for intralamellar corneo-scleral abscesses in the zone of tunnel incision after phacoemulsification].

PubMed

Kasparova, E A; Kasparov, A A

2012-01-01

The article provides data on clinical diagnosis (4 patients, 4 eyes) and early surgical treatment of corneal intralamellar abscesses (ICA) in the zone of corneo-scleral tunnel incision after phacoemulsification (PE). ICA developed via corneo-scleral incision was a relatively reliable biomicroscopic sign of the beginning chronic endophthalmitis. Despite of massive nonsurgical treatment (antibiotics, glucocorticoids, non-steroid anti-inflammatory agents etc.) inflammation was not arrested completely, it recurred within 2,5-6 months after PE. Reconstructive conjunctivo-sclerokeratoplasty resulted in arrest of inflammation and visual function recovery in 3 patients. In one patient this procedure was not possible to perform because of total loss of visual functions due to chronic endophthalmitis.

Alcaligenes xylosoxidans endophthalmitis following phacoemulsification and intraocular lens implantation.

PubMed

Robert, Pierre-Yves; Chainier, Delphine; Garnier, Fabien; Ploy, Marie-Cécile; Parneix, Pierre; Adenis, Jean-Paul; Martin, Christian

2008-01-01

Five consecutive cases of endophthalmitis that developed after cataract extraction by a single surgeon using the same operating room during one morning session are described. Following preoperative topical administration of ciprofloxacin, surgery consisted of phacoemulsification with peristaltic pump and fluid venting, polymethylmethacrylate intraocular lens implantation, and corneal suture. No complications occurred during surgery. All five patients developed endophthalmitis caused by infection with Alcaligenes xylosoxidans in less than 24 hours. Pulsed-field gel electrophoresis was used to prove similarity between strains. Bacterial inquiry on contamination of the operating room environment revealed massive colonization of phacoemulsifier irrigation channels by Pseudomonas fluorescens bacteria from an unestablished source. Four of the five patients ultimately recovered visual acuity better than 20/60.

A Comparison of Endothelial Cell Loss in Combined Cataract and MIGS (Hydrus) Procedure to Phacoemulsification Alone: 6-Month Results

PubMed Central

Fea, Antonio M.; Consolandi, Giulia; Pignata, Giulia; Cannizzo, Paola Maria Loredana; Lavia, Carlo; Billia, Filippo; Rolle, Teresa; Grignolo, Federico M.

2015-01-01

Purpose. To compare the corneal endothelial cell loss after phacoemulsification, alone or combined with microinvasive glaucoma surgery (MIGS), in nonglaucomatous versus primary open angle glaucoma (POAG) eyes affected by age-related cataract. Methods. 62 eyes of 62 patients were divided into group 1 (n = 25, affected by age-related cataract) and group 2 (n = 37, affected by age-related cataract and POAG). All patients underwent cataract surgery. Group 2 was divided into subgroups A (n = 19, cataract surgery alone) and B (n = 18, cataract surgery and MIGS). Prior to and 6 months after surgery the patients' endothelium was studied. Main outcomes were CD (cell density), SD (standard deviation), CV (coefficient of variation), and 6A (hexagonality coefficient) variations after surgeries. Results. There were no significant differences among the groups concerning preoperative endothelial parameters. The differences in CD before and after surgery were significant in all groups: 9.1% in group 1, 17.24% in group 2A, and 11.71% in group 2B. All endothelial parameters did not significantly change after surgery. Conclusions. Phacoemulsification determined a loss of endothelial cells in all groups. After surgery the change in endothelial parameters after MIGS was comparable to the ones of patients who underwent cataract surgery alone. PMID:26664740

Stereo-PIV study of flow inside an eye under cataract surgery

NASA Astrophysics Data System (ADS)

Sakakibara, Jun; Yamashita, Masaki; Kobayashi, Tatsuya; Kaji, Yuichi; Oshika, Tetsuro

2012-04-01

We measured velocity distributions in the anterior chamber of porcine eyes under simulated cataract surgery using stereoscopic particle image velocimetry (stereo-PIV). The surface of the cornea was detected based on the images of laser-induced fluorescent light emitted from fluorescent dye solution introduced in a posterior chamber. A coaxial phacoemulsification procedure was simulated with standard size (standard coaxial phacoemulsification) and smaller (micro coaxial phacoemulsification) surgical instruments. In both cases, an asymmetric flow rate of irrigation was observed, although both irrigation ports had the same dimensions prior to insertion into the eye. In cases where the tip of the handpiece was placed farther away from the top of the cornea, i.e., closer to the crystalline lens, direct impingement of irrigation flow onto the cornea surface was avoided and the flow turned back toward the handpiece along the surface of the corneal endothelium. Viscous shear stress on the corneal endothelium was computed based on the measured mean velocity distribution. The maximum shear stress for most cases exceeded 0.1 Pa, which is comparable to the shear stress that caused detachment of the corneal endothelial cells reported by Kaji et al. in Cornea 24:S55-S58, (2005). When direct impingement of the irrigation flow was avoided, the shear stress was reduced considerably.

Hydropolish: a controlled trial on a technique to eradicate residual cortical lens fibers in phacoemulsification cataract surgery.

PubMed

Wang, Sarah B; Quah, Xhian M; Amjadi, Shahriar; Tong, Jessica; Francis, Ian C

2015-01-01

To assess the efficacy and safety of a noncontact, fluid-based capsular polishing technique (hydropolish) to remove residual cortical fibers (RCFs) and epithelial cells from the posterior and equatorial capsule in phacoemulsification cataract surgery. Hydropolish involved manual irrigation of the posterior and equatorial capsule after irrigation/aspiration, using a 27-G hydrodissection cannula. This prospective, consecutive, single surgeon controlled trial was conducted at a dedicated ophthalmic surgery center in Sydney, Australia, between December 20, 2006, and July 14, 2010. Single eyes of consecutive patients underwent cataract surgery without use of hydropolish (control group), while those on or after July 21, 2010, underwent hydropolish (intervention group). Corrected distance visual acuity (CDVA) up to 1 month postoperatively, surgical complications, and hydropolish time were documented. A total of 1531 eyes were included in this study (hydropolish n = 682; control n = 849). After adjusting for age, sex, and nuclear sclerosis grade, no significant difference was found between hydropolish and control groups when preoperative CDVA was compared against postoperative CDVA at 1 day, 1 week, and 1 month (p>0.05). Hydropolish is a rapid and safe technique that can remove RCFs from the posterior and equatorial capsule in phacoemulsification cataract surgery. It does not compromise postoperative CDVA.

Phacoemulsification with intravitreal bevacizumab injection in diabetic patients with macular edema and cataract.

PubMed

Akinci, Arsen; Batman, Cosar; Ozkilic, Ersel; Altinsoy, Ali

2009-01-01

The purpose of this study was to evaluate the results of phacoemulsification with intravitreal bevacizumab injection in patients with diabetic clinically significant macular edema and cataract. The records of 31 patients with diabetic clinically significant macular edema and cataract, which would interfere with macular laser photocoagulation, who have undergone phacoemulsification with intravitreal injection of 1.25 mg bevacizumab were retrospectively evaluated. All patients had undergone focal or modified grid laser photocoagulation 1 month after the surgery. All patients were evaluated by spectral optical coherence tomography/optical coherence tomography SLO before and 1 and 3 months after the surgery beyond complete ophthalmologic examination. The best-corrected visual acuity (BCVA) levels and central macular thickness (CMT) recorded at the first and third months after the surgery were compared with the initial values. Paired samples t test was used for statistical analysis. The mean initial BCVA was 0.10 +/- 0.04 (range, 0.05-0.2). The mean BCVA at the first and third months after the surgery were 0.47 +/- 0.16 (standard deviation) (range, 0.2-0.5) and 0.51 +/- 0.12 (standard deviation) (range, 0.3-0.6), respectively. The BCVA level recorded at the first and third months after the surgery were significantly higher than the initial BCVA (P = 0.004). The mean initial CMT was 387.5 +/- 109.5 microm. The mean CMT at the first and third months after the surgery were 292.7 +/- 57.2 and 275.5 +/- 40.3. The CMT recorded at the first and third months after the surgery were significantly lower than the initial CMT (P < 0.001, P < 0.001). Phacoemulsification with intravitreal injection of bevacizumab provides improvement in clinically significant macular edema with a gain in BCVA in patients with diabetes with clinically significant macular edema and cataract.

Surgically induced astigmatism after phacoemulsification by temporal clear corneal and superior clear corneal approach: a comparison.

PubMed

Nikose, Archana Sunil; Saha, Dhrubojyoti; Laddha, Pradnya Mukesh; Patil, Mayuri

2018-01-01

Cataract surgery has undergone various advances since it was evolved from ancient couching to the modern phacoemulsification cataract surgery. Surgically induced astigmatism (SIA) remains one of the most common complications. The introduction of sutureless clear corneal incision has gained increasing popularity worldwide because it offers several advantages over the traditional sutured limbal incision and scleral tunnel. A clear corneal incision has the benefit of being bloodless and having an easy approach, but SIA is still a concern. In this study, we evaluated the SIA in clear corneal incisions with temporal approach and superior approach phacoemulsification. Comparisons between the two incisions were done using keratometric readings of preoperative and postoperative refractive status. It was a hospital-based prospective interventional comparative randomized control trial of 261 patients conducted in a rural-based tertiary care center from September 2012 to August 2014. The visual acuity and detailed anterior segment and posterior segment examinations were done and the cataract was graded according to Lens Opacification Classification System II. Patients were divided for phacoemulsification into two groups, group A and group B, who underwent temporal and superior clear corneal approach, respectively. The patients were followed up on day 1, 7, 30, and 90 postoperatively. The parameters recorded were uncorrected visual acuity, best-corrected visual acuity, slit lamp examination, and keratometry. The mean difference of SIA between 30th and 90th day was statistically evaluated using paired t -test, and all the analyses were performed using SPSS 18.0 (SPSS Inc.) software. The mean postoperative SIA in group A was 0.998 D on the 30th day, which reduced to 0.768 D after 90 days, and in group B the SIA after 30 days was 1.651 D, whereas it reduced to 1.293 D after 90 days. Temporal clear corneal incision is evidently better than superior clear corneal incision as far as SIA is concerned.

Application of Corvis ST to evaluate the effect of femtosecond laser-assisted cataract surgery on corneal biomechanics.

PubMed

Wei, Yinjuan; Xu, Lingxiao; Song, Hui

2017-08-01

The aim of the present study was to evaluate the effects of femtosecond laser-assisted cataract surgery (FLACS) and phacoemulsification on corneal biomechanics using corneal visualization Scheimpflug technology. The medical records of 50 eyes from 50 patients who received phacoemulsification and intraocular lens implantation because of age-related factors between June 2014 and September 2014 were retrospectively analyzed. FLACS was used in 12 eyes (FLACS group), and conventional phacoemulsification in 38 eyes (PHACO group). The evaluation of corneal biomechanical parameters included the first/second applanation time (A-time1/A-time2), the first/second applanation length (A-length1/A-length2), corneal velocity during the first/second applanation moment (Vin/Vout), highest concavity time, highest concavity-radius (HC-radius), peak distance (PD), deformation amplitude (DA), central corneal thickness (CCT), and intraocular pressure (IOP). The differences in A-length1/A-length2, IOP, CCT, PD, and DA were significant in the PHACO group between those before, 1 week after, and 1 month after surgery. No significant differences in corneal biomechanical parameters were found between those at 1 month after surgery and before surgery. There were significant differences in IOP and CCT in the FLACS group between those before, 1 week after, and 1 month after surgery. There were no significant differences in the other corneal biomechanical parameters. No significant differences were found in corneal biomechanical parameters between those 1 month after surgery and before surgery. There were significant differences in A-length1/A-length2, CCT, PD, and DA between the two groups at 1 week after surgery. There were no significant differences in corneal biomechanical parameters between the two groups at 1 month after surgery. In conclusion, the effect of FLACS on corneal biomechanics is smaller than that of phacoemulsification. The corneal biomechanical parameters are restored to preoperative levels with the healing of the incision, and the reduction of swelling of the tissue near the incision.

[Preliminary evaluation of the femtosecond laser-assisted cataract surgery in 300 cases].

PubMed

Wang, Yong; Bao, Xianyi; Zhou, Yanli; Xu, Rong; Peng, Tingting; Sun, Ming; Cao, Danmin; He, Ling

2015-09-01

To evaluate the clinical outcome of the femtosecond laser-assisted cataract surgery (FLACS) in our first 300 cases. In this retrospective study, the study group comprised 300 cases (300 eyes) in which FLACS was done. The control group comprised 300 cases (300 eyes) in which phacoemulsification was performed. The steps of the FLACS included capsulotomy, lens fragmentation, corneal incisions, and creation of incisions within the peripheral cornea to aid the correction of pre-existing astigmatism. After the FLACS, 2.2-mm coaxial micro-incision phacoemulsification and implantation of an intraocular lens were operated. The preoperative best corrected visual acuity (BCVA) and postoperative uncorrected visual acuity (UCVA), the cumulative dissipated energy (CDE) of the phacoemulsification, and the parameters of the FLACS, including the docking time, the suction time and the laser time, were recorded. The complications of the FLACS were analyzed. The FLACS was successfully completed in 99.33% of the cases. The docking time was (24.6 ± 16.8) sec, the suction time was (101.27 ± 20.09) sec, and the laser time was (23.3 ± 5.5) sec. The most common complications of the FLACS included suction break (7/300, 2.33%), subconjunctival hemorrhage (58/300, 19.33%), pupillary constriction (47/300, 15.67%), incision at a wrong site (13/300, 4.33%), anterior capsular tag (17/300, 5.67%), decentration of the capsulorhexis (11/300, 3.67%), failure to split the lens nucleus (5/300, 1.67%), and posterior capsular ruptures (1/300, 0.33%). The CDE was 5.52 ± 5.18 in the FLACS group and 8.37 ± 7.91 in the traditional phaco group (P < 0.05). The UCVA was 0.12 ± 0.08 and 0.13 ± 0.11 at 1 month after the FLACS and traditional phaco, respectively (P > 0.05). Compared with the conventional phacoemulsification surgery, the FLACS can achieve less CDE and better early postoperative visual acuity. Long-term effects remain to be investigated.

Determining the local origin of hydroxyl radical generation during phacoemulsification.

PubMed

Aust, Steven D; Terry, Scott; Hebdon, Thomas; Gunderson, Broc; Terry, Michael; Dimalanta, Ramon

2011-06-01

To determine the local origin of hydroxyl radicals during phacoemulsification using an ultrasonic phacoemulsification device that includes longitudinal and torsional modalities. Chemistry and Biochemistry Department, Utah State University, Logan, Utah, USA. Experimental study. Experiments were conducted using the Infiniti Vision System and Ozil handpiece. Hydroxyl radical concentrations during longitudinal and torsional phacoemulsification were quantitated as malondialdehyde (MDA) determined spectrophotometrically using the deoxyribose assay. The difference between the total concentration found in the aspirated solution at steady-state concentrations and the pre-aspirate levels deductively determined the concentration of MDA formed along the interior of the sonicating tip. The time to reach 50% of steady state as a function of reaction vessel volume was determined. The mean maximum for torsional ultrasound at 100% amplitude was 7.70 nM ± 0.38 (SD), 91.1% of which was generated outside the tip. During longitudinal ultrasound at 100% power, MDA concentration in the aspirated solution was 29.5 ± 0.3 nM, 71.6% of which was generated outside the tip. The time (seconds) to reach 50% of maximum for longitudinal ultrasound using 5 mL, 10 mL, and 20 mL reaction vessels was 12.6 ± 1.5, 21.0 ± 1.5, and 25.3 ± 3.4, respectively. Although a significantly greater proportion of the hydroxyl radicals generated during ultrasound modality were formed outside the phaco tip (91.1% torsional; 71.6% longitudinal), torsional ultrasound generated only about one-fourth the amount of MDA as longitudinal ultrasound in total and about one-third that generated outside the tip (7.02 nM versus 21.1 nM). No author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes. Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Effect of H-7 on secondary cataract after phacoemulsification in the live rabbit eye.

PubMed

Tian, Baohe; Heatley, Gregg A; Filla, Mark S; Kaufman, Paul L

2010-12-01

This study is aimed to determine if the serine-threonine kinase inhibitor H-7 inhibits secondary cataract after phacoemulsification in the live rabbit eye. Eighteen rabbits underwent extracapsular lens extraction by phacoemulsification in 1 eye. The eye was treated with intravitreal H-7 (300 or 1,200 μM; n = 6 or 5) or balanced salt solution (BSS) (n = 7) immediately after the surgery and twice weekly for 10 weeks. Each eye received slit lamp biomicroscopy once a week, during which posterior capsule opacification (PCO) was evaluated. The eye was then enucleated and the lens capsule was prepared, fixed, and imaged. PCO was evaluated again on the isolated lens capsule under a phase microscope. Soemmering's ring area (SRA) and the entire lens capsule area were measured from capsule images on a computer and the percentage of SRA (PSRA) in the entire capsule area was calculated. Wet weight of the capsule (WW) was determined on a balance. No significant difference in PCO was observed in any comparison. No significant differences in SRA, PSRA, and WW were observed between the 300 μM H-7-treated eye and the BSS-treated eye. However, SRA, PSRA, and WW in the 1,200 μM H-7-treated eye were significantly smaller than those in the BSS-treated eye [28.3 ± 16.2 vs. 61.4 ± 8.86 mm(2) (P = 0.001), 33% ± 20% vs. 65% ± 15% (P = 0.01), and 65.6 ± 27.9 vs. 127.0 ±37.3 mg (P = 0.01)]. Intravitreal H-7 (1,200 μM) significantly inhibits Soemmering's ring formation in the live rabbit eye, suggesting that agents that inhibit the actomyosin system in cells may prevent secondary cataract after phacoemulsification.

Effect of topical ketorolac 0.4%, nepafenac 0.1%, and bromfenac 0.09% on postoperative inflammation using laser flare photometry in patients having phacoemulsification.

PubMed

Sahu, Sabin; Ram, Jagat; Bansal, Reema; Pandav, Surinder S; Gupta, Amod

2015-10-01

To study the effect of topical ketorolac 0.4% (Acular LS), bromfenac 0.09% (Megabrom), and nepafenac 0.1% (Nevanac) on postoperative inflammation using laser flare photometry in patients having phacoemulsification with posterior chamber intraocular lens (PC IOL) implantation. Tertiary care center, Chandigarh, India. Prospective randomized case series. Patients with age-related cataract having phacoemulsification with PC IOL implantation were randomized into 4 groups receiving topical ketorolac 0.4% (Group A), bromfenac 0.09% (Group B), nepafenac 0.1% (Group C), or no nonsteroidal antiinflammatory drugs (NSAIDs) (Group D, control). The topical NSAIDs were started 1 day prior to the surgery and continued for 6 weeks postoperatively. All patients received a standard regimen of moxifloxacin 0.5% (Vigamox) and prednisolone acetate 1.0% (Pred Forte) eyedrops in tapering doses postoperatively. Visual acuity, intraocular pressure (IOP), laser flare photometry, and fundus examination were done preoperatively and postoperatively at 1 day and 1, 2, 4, and 8 weeks. The study comprised 120 patients (120 eyes) (Group A = 33 patients, Group B = 30 patients, Group C = 31 patients, and Group D = 26 patients). The laser flare photometry values at the end of 4 weeks and 8 weeks were minimal in the nepafenac group compared with the other NSAID groups and the no-NSAID group (P = .032 at 4 weeks and P = .252 at 8 weeks). The topical NSAIDs ketorolac 0.4%, bromfenac 0.09%, and nepafenac 0.1% were effective for the reduction of postoperative inflammation following phacoemulsification. Compared with ketorolac tromethamine, bromfenac, and the control, nepafenac was significantly effective 1 month postoperatively in reducing anterior chamber flare, as evidenced by decreased laser flare photometry. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2015 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

[Results of combined endotrabeculectomy and phacoemulsification surgery].

PubMed

Novytskyy, I Ya; Novytskyy, M I

2015-01-01

to identify indications and evaluate the efficacy of combined endotrabeculectomy and phacoemulsification surgery. A total of 172 patients (193 eyes) with open-angle glaucoma and cataract were enrolled. Group 1 included 102 patients (118 eyes), who were considered surgical candidates due to decompensation of IOP, group 2--70 patients (75 eyes), in whom IOP control could only be achieved with a multidrug regimen (two or more ocular hypotensive medications). The mean preoperative IOP measured with Maklakov tonometer was 26.4 ± 1.8 mmHg in group 1 and 20.5 ± 1.7 mmHg in group 2. In 134 eyes the extent of retention of intraocular fluid was determined intraoperatively by provoking blood reflux into Schlemm's canal. In 6 out of 134 eyes (4.5%) Schlemm's canal was not at all filled with blood, which was considered a contraindication for endotrabeculectomy. Partial filling of Schlemm's canal with blood was observed in 26 out of 134 eyes (19.4%), complete--in 102 eyes (76.1%). All but 6 patients underwent endotrabeculectomy (ab interno trabecular excision with original forceps through the anterior chamber angle) combined with cataract phacoemulsification and intraocular lens implantation. In 11 out of 126 cases, insignificant bleeding occurred during sample acquisition. No other complications were registered. Six months after the surgery, IOP was reduced by the mean of 7.0 ± 0.6 mmHg (26.5% from the baseline) in group 1 and by 2.2 ± 0.2 mmHg (10.7% from the baseline) in group 2. The number of hypotensive medications by that time has been decreased from 2.3 ± 0.3 to 0.8 ± 0.2 in group 1 and from 1.6 ± 0.3 to 0.4 ± 0.1 in group 2. Combined endotrabeculectomy and phacoemulsification surgery is a pathogenically oriented procedure, which improves ocular hydrodynamics and has a significant hypotensive effect.

Laser-assisted cataract surgery versus standard ultrasound phacoemulsification cataract surgery.

PubMed

Day, Alexander C; Gore, Daniel M; Bunce, Catey; Evans, Jennifer R

2016-07-08

Cataract is the leading cause of blindness in the world, and cataract surgery is one of the most commonly performed operations in the Western world. Preferred surgical techniques have changed dramatically over the past half century with associated improvements in outcomes and safety. Femtosecond laser platforms that can accurately and reproducibly perform key steps in cataract surgery, including corneal incisions, capsulotomy and lens fragmentation, are now available. The potential advantages of laser-assisted surgery are broad, and include greater safety and better visual outcomes through greater precision and reproducibility. To compare the effectiveness of laser-assisted cataract surgery with standard ultrasound phacoemulsification cataract surgery by gathering evidence on safety from randomised controlled trials (RCTs). We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 4), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to May 2016), EMBASE (January 1980 to May 2016), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to May 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov), the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en) and the U.S. Food and Drugs Administration (FDA) website (www.fda.gov). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 10 May 2016. We included randomised controlled trials where laser-assisted cataract surgery was compared to standard ultrasound phacoemulsification cataract surgery. We graded the certainty of the evidence using GRADE. Two review authors independently screened the search results, assessed risk of bias and extracted data using the standard methodological procedures expected by Cochrane. The primary outcome for this review was intraoperative complications in the operated eye, namely anterior capsule and posterior capsule tears. The secondary outcomes were visual acuity (corrected distance visual acuity (CDVA) and uncorrected distance visual acuity (UDVA)), refractive outcomes, quality of vision (as measured by any validated visual function score), postoperative complications and cost-effectiveness. We included 16 RCTs conducted in Germary, Hungary, Italy, India, China and Brazil that enrolled a total of 1638 eyes of 1245 adult participants. Overall, the studies were at unclear or high risk of bias. In 11 of the studies the authors reported financial links with the manufacturer of the laser platform evaluated in their studies. Five of the studies were within-person (paired-eye) studies with one eye allocated to one procedure and the other eye allocated to the other procedure. These studies were reported ignoring the paired nature of the data.The number of anterior capsule and posterior capsule tears reported in the included studies for both laser cataract surgery and manual phacoemulsification cataract surgery were low. There were four anterior capsule tears and one posterior capsule tear in 1076 eyes reported in 10 studies (2 anterior capsule tears in laser arms, 2 anterior capsule tears and 1 posterior capsule tear in standard phacoemulsification arms). We are very uncertain as to the effect of laser-assisted surgery compared to standard phacoemulsification surgery with respect to these two outcomes. For postoperative cystoid macular oedema and elevated postoperative intraocular pressures, again the evidence was inconclusive (odds ratio (OR) 0.58, 95% confidence interval (CI) 0.20 to 1.68; 957 eyes, 9 studies, low certainty evidence; and OR 0.57, 95% CI 0.11 to 2.86; 903 eyes, 8 studies, low certainty evidence).We found little evidence of any important difference in postoperative visual acuity between laser-assisted and standard phacoemulsification arms. There was a small advantage for laser-assisted cataract surgery at six months in CDVA. However, the mean difference (MD) was -0.03 logMAR (95% CI -0.05 to -0.00; 224 eyes, 3 studies, low certainty evidence) which is equivalent to 1.5 logMAR letters and is therefore, clinically insignificant. No studies reported patient-reported outcome measures such as visual function.There were no data reported on costs or resource use but three studies reported the time taken to do the surgery. There was little evidence of any major difference between the two procedures in this respect (MD 0.1 minutes, 95% CI -0.02 to 0.21; 274 eyes, low certainty evidence). The evidence from the 16 randomised controlled trials RCTs included in this review could not determine the equivalence or superiority of laser-assisted cataract surgery compared to standard manual phacoemulsification for our chosen outcomes due to the low to very low certainty of the evidence available from these studies. As complications occur rarely, large, adequately powered, well designed, independent RCTs comparing the safety and efficacy of laser-assisted cataract surgery with standard phacoemulsification cataract surgery are needed. Standardised reporting of complications and visual and refractive outcomes for cataract surgery would facilitate future synthesis. Data on patient-reported outcomes and cost-effectiveness are needed. Paired-eye studies should be analysed and reported appropriately.

Anterior capsule tear after laser iridotomy complicating phacoemulsification

PubMed Central

Vivien Cherng Hui, Yip; Sanjay, Srinivasan; Benjamin Chong-Ming, Chang

2011-01-01

A 70-year-old Indian lady had a history of bilateral laser peripheral iridotomy (LPI) for primary angle closure. Subsequently she developed cataract in both the eyes. Right eye cataract surgery was complicated by an anterior capsule rupture, which was discovered intra-operatively at the site of the LPI. Trypan blue was used to stain the anterior capsule to delineate the anterior capsule defect. An attempt at continuous curvilinear capsulorhexis was unsuccessful, and the anterior capsulotomy was completed with scissors. To the best of our knowledge the surgical management of cataract in the presence of anterior capsule rupture as a result of LPI has not been reported. Awareness of this potential complication of LPI will aid in planning for successful phacoemulsification cataract surgery. PMID:23960943

Satisfaction level with topical versus peribulbar anesthesia experienced by same patient for phacoemulsification.

PubMed

Ahmad, Nauman; Zahoor, Abdul; Motowa, Saeed A; Jastaneiah, Saba; Riad, Waleed

2012-01-01

Various studies have assessed patient satisfaction with topical versus peribulbar anesthesia with conflicting results. Aim of study was to determine satisfaction level in same patient who gets topical anesthesia in one eye and peribulbar block in another eye. We propose that evaluation of various indicators of patient satisfaction will enable better selection of cases for topical anesthesia in the future. Eighty patients scheduled for phacoemulsification were enrolled in prospective, randomized, double-blind study. Each patient scheduled twice for one eye under topical anesthesia and other in peribulbar block. Pain, discomfort and pressure during application of local anesthetic, during phacoemulsification and at 2 hours after procedure were assessed on standard scales. Before discharge patient satisfaction level was checked with Iowa satisfaction with anesthesia scale (ISAS). The Student's t-test was used to determine the significance of IOWA score in both groups. P<0.05 was considered significant. Feeling of pain, pressure and discomfort scores during administration of topical anesthesia were all significantly lower compared to peribulbar anesthesia (P=0.004, 0.000, 0.002, respectively). In contrast, intraoperative scores were significantly higher in the topical anesthesia group compared to peribulbar anesthesia (P=0.022, 0.000, 0.000, respectively). Patient satisfaction measured with ISAS shows that peribulbar anesthesia with P=0.000 is strongly significant. Peribulbar anesthesia provided significantly better patient satisfaction in comparison with topical anesthesia when used for cataract surgery.

Comparison of the Infiniti vision and the series 20,000 Legacy systems.

PubMed

Fernández de Castro, Luis E; Solomon, Kerry D; Hu, Daniel J; Vroman, David T; Sandoval, Helga P

2008-01-01

To compare the efficiency of the Infiniti vision system and the Series 20,000 Legacy system phacoemulsification units during routine cataract extraction. Thirty-nine eyes of 39 patients were randomized to have their cataract removed using either the Infiniti or the Legacy system, both using the Neosonix handpiece. System settings were standardized. Ultrasound time, amount of balanced salt solution (BSS) used intraoperatively, and postoperative visual acuity at postoperative days 1, 7 and 30 were evaluated. Preoperatively, best corrected visual acuity was significantly worse in the Infiniti group compared to the Legacy group (0.38 +/- 0.23 and 0.21 +/- 0.16, respectively; p = 0.012). The mean phacoemulsification time was 39.6 +/- 22.9 s (range 6.0-102.0) for the Legacy group and 18.3 +/-19.1 s (range 1.0-80.0) for the Infiniti group (p = 0.001). The mean amounts of intraoperative BSS used were 117 +/- 37.7 ml (range 70-195) in the Legacy group and 85.3 +/- 38.9 ml (range 40-200) in the Infiniti group (p = 0.005). No differences in postoperative visual acuity were found. The ability to use higher flow rates and vacuum settings with the Infiniti vision system allowed for cataract removal with less phacoemulsification time than when using the Legacy system. Copyright 2008 S. Karger AG, Basel.

Comparison of vacuum rise time, vacuum limit accuracy, and occlusion break surge of 3 new phacoemulsification systems.

PubMed

Han, Young Keun; Miller, Kevin M

2009-08-01

To compare vacuum rise time, vacuum limit accuracy, and occlusion break surge of 3 new phacoemulsification machines. Jules Stein Eye Institute and Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA. The vacuum rise time under normal and enhanced aspiration modes, vacuum limit accuracy, and occlusion break surge of the Infiniti Vision System, Stellaris Vision Enhancement System, and WhiteStar Signature Phacoemulsification System were tested. Vacuum rise time and limit accuracy were measured at limit settings of 400 mm Hg and 600 mm Hg. Surge area was recorded at vacuum limit settings of 200 mm Hg, 300 mm Hg, 400 mm Hg, and 500 mm Hg. The Infiniti had the fastest vacuum rise times under normal and enhanced aspiration modes. At 4 seconds, the vacuum limit accuracy was greatest with the Infiniti at the 400 mm Hg limit and the Signature at the 600 mm Hg limit. The Stellaris did not reach either vacuum target. The Infiniti performed better than the other 2 machines during testing of occlusion break surge at all vacuum limit settings above 200 mm Hg. Under controlled laboratory test conditions, the Infiniti had the fastest vacuum rise time, greatest vacuum limit accuracy at 400 mm Hg, and least occlusion break surge. These results can be explained by the lower compliance of the Infiniti system.

Long-term Outcome of Argon Laser Peripheral Iridoplasty in the Management of Plateau Iris Syndrome Eyes.

PubMed

Peterson, Jeffrey R; Anderson, John W; Blieden, Lauren S; Chuang, Alice Z; Feldman, Robert M; Bell, Nicholas P

2017-09-01

To report long-term (>5 y) outcomes of plateau iris syndrome patients treated with argon laser peripheral iridoplasty (ALPI). A retrospective chart review was performed on all patients with plateau iris syndrome treated with ALPI from 1996 to 2007. The study included 22 eyes from 22 patients with plateau iris after peripheral iridotomy that were followed for at least 1 year after ALPI. The primary outcome was incidence of needing any intraocular pressure (IOP)-lowering medications or surgery (either a filtering procedure or phacoemulsification). Demographic and baseline clinical data were summarized by mean (±SD) or frequency (percentage). Snellen best-corrected visual acuity was converted to logMAR. The paired t test was used to compare IOP changes, number of IOP-lowering medications, and best-corrected visual acuity from baseline to annual follow-up. Mean follow-up was 76 months. Only 2 (9%) eyes maintained an IOP<21 mm Hg without requiring medication or surgery. Seventeen (77%) eyes underwent surgery at an average of 49.1±7.9 months after ALPI. Eight (36%) eyes underwent filtering surgery, and 9 (41%) eyes underwent phacoemulsification. Three months after cataract extraction, no eyes required IOP-lowering medication. The beneficial effects of ALPI last for <4 years, with the majority of patients (77%) requiring surgery. Phacoemulsification alone was a successful treatment for plateau iris in our patient population.

[Slit lamp optical coherence tomography study of anterior segment changes after phacoemulsification and foldable intraocular lens implantation].

PubMed

Yan, Pi-song; Zhang, Zhen-ping; Lin, Hao-tian; Wu, Wen-jie; Bai, Ling

2009-09-01

To investigate quantitative changes of the anterior segment configuration after clear corneal incision phacoemulsification and foldable intraocular lens (IOL) implantation with slit-lamp-adapted optical coherence tomography (SL-OCT). In prospective consecutive case series, clear corneal incision phacoemulsification and foldable intraocular lens implantation were performed in 44 eyes of 40 patients. The changes of the anterior segment configuration were performed by SL-OCT before and 1 day, 1 week, 2 weeks and 1 month after surgery. SPSS 16.0 software was used to analyze statistical difference. For all patients, the central corneal thickness (CCT) and the incisional corneal thickness (ICT) increased significantly 1 day after surgery (CCT increased 99.59 microm, ICT increased 234.57 microm; P = 0.490). At 1 month, the CCT almost had returned to baseline, but the ICT had been thicker about 19.25 microm than baseline(P = 0.001). The measurements of ACD, AOD500, AOD750, TISA500, TISA750 also increased significantly 1 day after surgery. Although the ACD had no changes within 2 weeks (all P < 0.05), it had been not stable. The changes of the width of the anterior chamber had been stable in the early period after surgery (all P > 0.05). The SL-OCT could impersonality and quantificationally evaluate the anterior segment changes induced by cataract surgery.

Topical Anesthesia for Cataract Surgery: The Patients' Perspective

PubMed Central

Apil, Aytekin; Ekinci, Metin; Cagatay, Halil Huseyin; Keles, Sadullah; Ceylan, Erdinc; Cakici, Ozgur

2014-01-01

Purpose. To evaluate the analgesic efficacy of 0.5% propacaine hydrochloride as topical anesthesia during phacoemulsification surgery. Methods. Intraoperative pain intensity was assessed using a 5-category verbal rating scale during each of three surgical stages. Pain scores from each surgical stage and total pain scores were compared for the factors of patient age, gender, cataract laterality, and type. Results. In comparison of cataract type subgroups, the mean total pain scores and mean stage 2 pain scores in both white mature cataract (WMC) and corticonuclear plus posterior subcapsular cataract (CN + PSC) groups were significantly higher than in the PSC-only (PSC) group (P < 0.05). Conclusion. Phacoemulsification with topical anesthesia is not a completely painless procedure. Pain intensity varies with cataract type and stage of surgery. PMID:25050180

Outpatient cataract surgery: incident and procedural risk analysis do not support current clinical ophthalmology guidelines.

PubMed

Koolwijk, Jasper; Fick, Mark; Selles, Caroline; Turgut, Gökhan; Noordergraaf, Jeske I M; Tukkers, Floor S; Noordergraaf, Gerrit J

2015-02-01

To evaluate whether an ophthalmologist-led, non-anesthesia-supported, limited monitoring pathway for phacoemulsification/intraocular lens cataract surgery, can be performed safely with only a medical emergency team providing support. Retrospective, observational, cohort study. All patients who underwent elective phacoemulsification/intraocular lens surgery under topical anesthesia in the ophthalmology outpatient unit between January 1, 2011, and December 31, 2012. Cataract surgery was performed by phacoemulsification under topical anesthesia. The intake process mainly embraced ophthalmic evaluation, obtaining a medical history, and proposing the procedure. A staff ophthalmologist performed the procedure assisted by 2 registered nurses in an independent outpatient clinic operating room within the hospital. The clinical pathway was without dedicated presence of or access to anesthesia service. Perioperative monitoring was limited to blood pressure and plethysmography preoperatively and intraoperatively. Patients were offered supportive care and instructed to avoid fasting and continue all their chronic medication. The primary outcome measure was the incidence of adverse events requiring medical emergency team (MET) interventions throughout the pathway. Secondary outcome measures were surgical ocular complication rates, use of oral sedatives, and reported reasons to perform the surgery in the classical operation room complex. Within the cataract pathway, 6961 cases (4347 patients) were eligible for analysis. Three MET interventions related to the phacoemulsification/intraocular lens pathway occurred in the 2-year study period, resulting in an intervention rate of 0.04%. None of the interventions was intraoperative. All 3 patients were diagnosed as vasovagal collapse and recuperated uneventfully. No hospital admittance was required. Eight other incidents occurred within the general ophthalmology outpatient unit population during the study period. Cataract surgery can be safely performed in an outpatient clinic, in the absence of the anesthesia service and with limited workup and monitoring. Basic first aid and basic life support skills seem to be sufficient in case of an adverse event. An MET provides a generous failsafe for this low-risk procedure. Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Comparative analysis of corneal morphological changes after transversal and torsional phacoemulsification through 2.2 mm corneal incision.

PubMed

Assaf, Ahmed; Roshdy, Maged Maher

2013-01-01

This paper compares and evaluates the corneal morphological changes occurring after cataract surgery through a 2.2 mm corneal incision. We use two platforms for comparison and evaluation, transversal and torsional phacoemulsification. This study includes 139 consecutive cataractous eyes (nuclear color 2-4, according to the Lens Opacities Classification System III [LOCSIII]) of 82 patients undergoing cataract surgery through a 2.2 mm corneal incision. Two different phacoemulsification platforms were used and assigned randomly: we used the WhiteStar Signature(®) system with the Ellips™ FX transversal continuous ultrasound (US) mode for group I (mean age: 65.33 ± 6.97 years), and we used the Infiniti(®) system with the OZil(®) Intelligent Phaco (IP) torsional US mode for group II (mean age: 64.02 ± 7.55 years). The corneal endothelium and pachymetry were evaluated preoperatively and at 1 month postoperatively. Incision size changes were also evaluated. All surgeries were uneventful. Before intraocular lens implantation, the mean incision size was 2.24 ± 0.06 mm in both groups (P = 0.75). In terms of corneal endothelial cell density, neither preoperative (I vs II: 2304.1 ± 122.5 cell/mm(2) vs 2315.6 ± 83.1 cell/mm(2), P = 0.80) nor postoperative (I vs II: 2264.1 ± 124.3 cell/mm(2) vs 2270.3 ± 89.9 cell/mm(2), P = 0.98) differences between the groups were statistically significant. The mean endothelial cell density loss was 1.7% ± 1.6% and 2.0% ± 1.4% in groups I and II, respectively. Furthermore, no significant differences between groups I and II were found preoperatively (P = 0.40) and postoperatively (P = 0.68) in central pachymetry. With surgery, the mean increase in central pachymetry was 28.1 ± 23.6 μm and 24.0 ± 24.0 μm in groups I and II, respectively (P = 0.1). Ellips™ FX transversal and OZil(®) IP torsional phacoemulsification modes are safe for performing cataract surgery, inducing minimal corneal thickness and endothelial changes.

Comparative analysis of corneal morphological changes after transversal and torsional phacoemulsification through 2.2 mm corneal incision

PubMed Central

Assaf, Ahmed; Roshdy, Maged Maher

2013-01-01

Purpose This paper compares and evaluates the corneal morphological changes occurring after cataract surgery through a 2.2 mm corneal incision. We use two platforms for comparison and evaluation, transversal and torsional phacoemulsification. Patients and methods This study includes 139 consecutive cataractous eyes (nuclear color 2–4, according to the Lens Opacities Classification System III [LOCSIII]) of 82 patients undergoing cataract surgery through a 2.2 mm corneal incision. Two different phacoemulsification platforms were used and assigned randomly: we used the WhiteStar Signature® system with the Ellips™ FX transversal continuous ultrasound (US) mode for group I (mean age: 65.33 ± 6.97 years), and we used the Infiniti® system with the OZil® Intelligent Phaco (IP) torsional US mode for group II (mean age: 64.02 ± 7.55 years). The corneal endothelium and pachymetry were evaluated preoperatively and at 1 month postoperatively. Incision size changes were also evaluated. Results All surgeries were uneventful. Before intraocular lens implantation, the mean incision size was 2.24 ± 0.06 mm in both groups (P = 0.75). In terms of corneal endothelial cell density, neither preoperative (I vs II: 2304.1 ± 122.5 cell/mm2 vs 2315.6 ± 83.1 cell/mm2, P = 0.80) nor postoperative (I vs II: 2264.1 ± 124.3 cell/mm2 vs 2270.3 ± 89.9 cell/mm2, P = 0.98) differences between the groups were statistically significant. The mean endothelial cell density loss was 1.7% ± 1.6% and 2.0% ± 1.4% in groups I and II, respectively. Furthermore, no significant differences between groups I and II were found preoperatively (P = 0.40) and postoperatively (P = 0.68) in central pachymetry. With surgery, the mean increase in central pachymetry was 28.1 ± 23.6 μm and 24.0 ± 24.0 μm in groups I and II, respectively (P = 0.1). Conclusion Ellips™ FX transversal and OZil® IP torsional phacoemulsification modes are safe for performing cataract surgery, inducing minimal corneal thickness and endothelial changes. PMID:23326184

Wound and surface temperatures in vivo in torsional and longitudinal modalities of ultrasound in coaxial microincisional cataract surgery

PubMed Central

Nair, Swapna; Nair, Ramachandran Unnikrishnan

2017-01-01

Background To study phacoemulsification probe shaft/wound and corneal surface/tip temperatures in vivo during longitudinal, torsional and combined phacoemulsification modes and their relationship to machine parameters. Design This was a prospective study at Chaithanya Eye Hospital and Research Institute, Trivandrum, India (tertiary). Participants Twenty-two eyes of 22 patients were randomized into six groups depending on the grade of nuclear sclerosis (NS) and the type of ultrasound used: Group 1, torsional in NS2; Group 2, torsional in NS3; Group 3, torsional with intermittent longitudinal in NS2; Group 4, torsional with intermittent longitudinal in NS3; Group 5, longitudinal in NS2; Group 6, longitudinal in NS3. Methods Patients underwent phacoemulsification by torsional, longitudinal or combined modalities. A thermal camera was used to measure phaco probe temperatures. Main outcome measures The mean probe shaft and tip temperatures were documented for different ultrasound modalities. Results The mean shaft and tip temperatures were: Group 1, 29.22°C±0.71°C and 28.4°C±0.88°C; Group 2, 32.12°C±0.62°C and 31.88°C±0.84°C; Group 3, 30.25°C±0.71°C and 29.35°C±0.62°C; Group 4, 31.95°C±0.65°C and 32.01°C±1.31°C; Group 5, 23°C and 27.6°C and Group 6, 23°C and 29.68°C, respectively. In all groups using longitudinal ultrasound, the phaco tip surface temperatures were higher than the shaft temperatures, except in Group 3. Shaft temperatures were higher than tip temperatures in cases using torsional phaco, except in Group 4. The mean temperature difference between groups was significant only for shaft temperatures (P=0.001). On thermal imaging, for torsional phaco, the rise in temperature of the probe from shaft to tip was dependent on the amplitude of ultrasound applied (P=0.009). Conclusion The shaft temperatures were higher than over the phaco tip during torsional phacoemulsification. PMID:28184151

A Single Drop of 0.5% Proparacaine Hydrochloride for Uncomplicated Clear Corneal Phacoemulsification

PubMed Central

Joshi, Rajesh Subhash

2013-01-01

Purpose: The purpose of this study was to compare the efficacy of a single drop of 0.5% proparacaine hydrochloride in uncomplicated cataract surgery with phacoemulsification. Materials and Methods: Two hundred and ninety five patients scheduled for the phacoemulsification were divided into 2 groups based on the anesthetic agents they were to receive: 146 patients who received a single drop of 0.5% proparacaine 2 min before the start of the surgery (proparacaine group) and; 149 patients who received supplementation of 0.5% intracameral preservative free xylocaine (xylocaine group). A single surgeon performed all surgeries. Intraoperative and post-operative pain scores were evaluated on a visual analog scale. The surgeon noted his subjective impression of corneal clarity, discomfort while performing the surgery any supplemental anesthesia required and intraoperative complications. An anesthetist noted vital parameters and the need for intravenous sedation. Total surgical time was noted. Comparison of parameters was performed with the Chi-square test, and A P value less than 0.05 was considered as statistically significant. Results: No statistically significant difference was seen in the intraoperative (P = 0.24) and post-operative (P = 0.164) pain scores between groups. There was no pain (0 score) in 41.8% of patients in the proparacaine group and 46.3% of patients in the xylocaine group. The average surgical time (P = 0.279) and surgeon discomfort (P = 0.07) were not statistically significantly different between groups. No patients required supplemental anesthesia. There were no surgical complications that could compromise the visual outcome. An equal number of patients in both groups preferred same type of anesthetic technique for the fellow eye cataract surgery (89.11% for the proparacaine group and 90.18% for the xylocaine group). No patients in either group had changes in vital parameters or required intravenous sedation. Conclusion: A single drop pre-operatively, of proparacaine hydrochloride was comparable to the intracameral supplementation of preservative free xylocaine for phacoemulsification in uncomplicated cataract surgery without compromising the visual outcome. However, we recommend individualizing the anesthetic technique according to the requirements of the surgeon. PMID:24014985

[The effect of yellow filter intraocular lens on the macula after cataract phacoemulsification in patients with age macular degeneration].

PubMed

Shpak, A A; Maliugin, B É; Fadeeva, T V

2012-01-01

Macula changes diagnosed with optical coherence tomography (OCT) within a year after cataract phacoemulsification (PE) with intraocular lens implantation with and without yellow filter are presented. 32 patients (36 eyes) with early stages of age macular degeneration (AMD) were included into the experimental group and 35 patients (36 eyes) served as controls. IOLs with yellow filter were implanted in 21 eyes, and in 15 cases IOLs without filter were used in each group. According to OCT data thickening of fovea and increasing of macula volume developed within 6 months after cataract PE. Implantation of yellow filter IOLs reduced the intensity of these changes after surgery in patients with AMD. The progression of early AMD into advanced stages within a year after PE was not observed.

Surgical outcome of cats treated for aqueous humor misdirection syndrome: a case series.

PubMed

Atkins, Rosalie M; Armour, Micki D; Hyman, Jennifer A

2016-07-01

To evaluate the clinical outcome of cats treated surgically for aqueous humor misdirection syndrome. A retrospective analysis of cats treated surgically between January 1, 2006, and January 1, 2013, for aqueous humor misdirection syndrome was performed. Signalment, medical therapy, eyes affected, intraocular pressures prior to and after surgery, surgical procedures performed, postoperative complications, and visual status were evaluated. Seven cats (nine eyes) fit the inclusion criteria. Six of seven cats were female, and five of seven cats were diagnosed with bilateral aqueous humor misdirection syndrome. Three surgical approaches were evaluated as follows: (i) phacoemulsification and posterior capsulotomy, (ii) phacoemulsification, posterior capsulotomy and anterior vitrectomy, and (iii) phacoemulsification, posterior capsulotomy, anterior vitrectomy, and endocyclophotocoagulation. The mean age at diagnosis was 12.9 years. Seven of nine eyes had controlled intraocular pressure (≤25 mmHg) during the first 6 months postoperatively. All cats were visual with controlled intraocular inflammation at 1 year postoperatively; however, one eye had an elevated intraocular pressure. All cats were continued on topical antiglaucoma and anti-inflammatory medications following surgery with the mean number of drops per day decreasing from 3.9 drops/day prior to surgery to 2.2 drops/day postoperatively. Surgical management for feline aqueous humor misdirection syndrome may be a viable option to maintain a visual and normotensive status in cats that no longer have successful control of intraocular pressure with medical therapy. © 2016 American College of Veterinary Ophthalmologists.

The incidence of posterior capsule disruption during phacoemulsification and associated postoperative complication rates in dogs: 244 eyes (1995-2002).

PubMed

Johnstone, Nancy; Ward, Daniel A

2005-01-01

The objective of this retrospective study was to report the incidence of posterior capsule disruption during routine phacoemulsification and to document the postoperative outcomes and complications in eyes with posterior capsule disruption compared with eyes with intact posterior capsules. Records of 143 dogs (244 eyes) were reviewed. Data collected included whether the posterior capsule was disrupted, whether the disruption was planned or accidental, whether an intraocular lens was implanted, and visual outcome. Records were reviewed for postoperative complications. Intraocular lens implantation rates, complication rates, and visual outcomes were compared between intact and disrupted posterior capsule groups using Chi-square analyses. The posterior capsule was disrupted in 33/244 eyes (14%). Planned capsulotomies accounted for 36% of the disruptions. Intraocular lenses were implanted in 76% of eyes without a disruption of the posterior capsule and in 31% of eyes with a posterior capsule disruption. Intraocular lenses were more likely to be implanted in eyes with a planned disruption of the posterior capsule (7/12; 58%) than in eyes with an accidental disruption (3/20; 15%). There were no significant differences in postoperative complications or visual outcome between eyes with posterior capsule disruption and those without. The most significant complication of posterior capsule disruption during phacoemulsification is the inability to implant an intraocular lens. Intraocular lenses are more likely to be placed in eyes with intentional disruptions of the posterior capsule than those with accidental ruptures.

Prospective study of Centurion® versus Infiniti® phacoemulsification systems: surgical and visual outcomes.

PubMed

Oh, Lawrence J; Nguyen, Chu Luan; Wong, Eugene; Wang, Samuel S Y; Francis, Ian C

2017-01-01

To evaluate surgical outcomes (SOs) and visual outcomes (VOs) in cataract surgery comparing the Centurion ® phacoemulsification system (CPS) with the Infiniti ® phacoemulsification system (IPS). Prospective, consecutive study in a single-site private practice. Totally 412 patients undergoing cataract surgery with either the CPS using the 30-degree balanced ® tip ( n =207) or the IPS using the 30-degree Kelman ® tip ( n =205). Intraoperative and postoperative outcomes were documented prospectively up to one month follow-up. Nuclear sclerosis (NS) grade, cumulated dissipated energy (CDE), preoperative corrected distance visual acuity (CDVA), and CDVA at one month were recorded. CDE was 13.50% less in the whole CPS compared with the whole IPS subcohort. In eyes with NS grade III or greater, CDE was 28.87% less with CPS ( n =70) compared with IPS ( n =44) ( P =0.010). Surgical complications were not statistically different between the two subcohorts ( P =0.083), but in the one case of vitreous loss using the CPS, CDVA of 6/4 was achieved at one month. The mean CDVAs (VOs) at one month for NS grade III and above cataracts were -0.17 logMAR (6/4.5) in the CPS and -0.15 logMAR (6/4.5) in the IPS subcohort respectively ( P =0.033). CDE is 28.87% less, and VOs are significantly improved, in denser cataracts in the CPS compared with the IPS. The authors recommend the CPS for cases with denser nuclei.

Results of endocapsular phacofracture debulking of hard cataracts.

PubMed

Davison, James A

2015-01-01

To present a phacoemulsification technique for hard cataracts and compare postoperative results using two different ultrasonic tip motions during quadrant removal. A phacoemulsification technique which employs in situ fracture and endocapsular debulking for hard cataracts is presented. The prospective study included 56 consecutive cases of hard cataract (LOCS III NC [Lens Opacification Classification System III, nuclear color], average 4.26), which were operated using the Infiniti machine and the Partial Kelman tip. Longitudinal tip movement was used for sculpting for all cases which were randomized to receive longitudinal or torsional/interjected longitudinal (Intelligent Phaco [IP]) strategies for quadrant removal. Measurements included cumulative dissipated energy (CDE), 3 months postoperative surgically induced astigmatism (SIA), and corneal endothelial cell density (ECD) losses. No complications were recorded in any of the cases. Respective overall and longitudinal vs IP means were as follows: CDE, 51.6±15.6 and 55.7±15.5 vs 48.6±15.1; SIA, 0.36±0.2 D and 0.4±0.2 D vs 0.3±0.2 D; and mean ECD loss, 4.1%±10.8% and 5.9%±13.4% vs 2.7%±7.8%. The differences between longitudinal and IP were not significant for any of the three categories. The endocapsular phacofracture debulking technique is safe and effective for phacoemulsification of hard cataracts using longitudinal or torsional IP strategies for quadrant removal with the Infiniti machine and Partial Kelman tip.

Corneal endothelial morphology and function after torsional and longitudinal ultrasound mode phacoemulsification.

PubMed

Módis, László Jr; Szalai, Eszter; Flaskó, Zsuzsa; Németh, Gábor

2016-01-01

To study the endothelial cell morphology and corneal thickness changes after phacoemulsification by using the OZil torsional and longitudinal ultrasound techniques (Infiniti Vision System, Alcon Laboratories). Department of Ophthalmology, Clinical Center, University of Debrecen, Debrecen, Hungary. 52 patients with cataract were randomly assigned to longitudinal ultrasound and torsional mode group. All surgeries were performed through a 2.2 mm clear corneal incision, the method employed being divide and conquer. The endothelial morphometry such as cell density (ECD), mean cell area, coefficient of variation of cell area, and central corneal thickness were examined with specular microscopy (EM-1000, Tomey) preoperatively and 4, 8 weeks postoperatively. ECD values decreased significantly in both surgical groups (P < .001, repeated- mesures ANOVA), the postoperative endothelial cell loss was higher in the longitudinal ultrasound mode group (3.5% and 6.5%, at 4 and 8 weeks after surgery) than in the torsional group (3.3% and 5.5%, at 4 and 8 weeks after surgery), the difference not being significant between the two groups (P = .164 and P = .479, at 4 and 8 weeks after surgery, Mann-Whitney test). There was no statistically significant difference in any of the assessed parameters between the two surgical groups (P > .05). No significant correlation was found between the endothelial cell loss and the nucleus density. Both phacoemulsification techniques were safe and effective. The torsional handpiece performs oscillatory movements and delivers less energy into the eye than the longitudinal ultrasound technique, therefore providing more favorable energy and thermal safety profile.

Effect of intracameral carbachol in phacoemulsification surgery on macular morphology and retinal vessel caliber.

PubMed

Pekel, Gökhan; Yagci, Ramazan; Acer, Semra; Cetin, Ebru Nevin; Cevik, Ali; Kasikci, Alper

2015-03-01

To investigate the effects of intracameral carbachol in phacoemulsification surgery on central macular thickness (CMT), total macular volume (TMV) and retinal vessel caliber (RVC). In this prospective consecutive case series, 82 patients underwent uneventful phacoemulsification and in-the-bag intraocular lens implantation. Unlike patients in the control group (43 eyes), patients in the study group (42 eyes) were injected with intracameral 0.01% carbachol during surgery. Spectral-domain optical coherence tomography (OCT) was used to analyze the parameters of CMT, TMV and RVC. On the first postoperative day, mean CMT and TMV decreased markedly in the carbachol group, though these values did not change significantly in the control group. During follow-up visits, no statistically significant differences between the groups occurred regarding changes in mean CMT (p = 0.25, first day; p = 0.80, first week; p = 0.95, first month). However, change in mean TMV between groups on the first postoperative day was statistically significant (p = 0.01, first day; p = 0.96, first week; p = 0.68, first month). RVC values were similar on the preoperative and postoperative first days in both groups (p > 0.05). Results suggest that the effect of intracameral carbachol on macular OCT is related to pharmacological effects, as well as optic events (e.g. miosis). Intracameral carbachol given during cataract surgery decreases macular thickness and volume in the early postoperative period but does not exert any gross effect on RVC.

Fluid temperature at the corneal endothelium during phacoemulsification: comparison of an ophthalmic viscosurgical device and balanced salt solution using the finite element method.

PubMed

Reepolmaha, Somporn; Limtrakarn, Wiroj; Uthaisang-Tanechpongtamb, Wanlaya; Dechaumphai, Pramote

2010-01-01

The purpose of this study was to estimate and compare the temperatures of two different anterior chamber solutions at the corneal endothelial level during phacoemulsification. An ophthalmic viscosurgical device (OVD) and balanced salt solution (BSS) were compared using the finite element method (FEM). The thermal properties of an OVD (IAL-F) and BSS were studied in an experimental setting. A computer-aided design model of ocular anatomy was created in two dimensions. The phaco needle was considered to be the only source of heat generation. Then, the FEM was used to demonstrate the transient temperature distribution in the two ocular models at 10, 20, 30, 40, 50 and 60 s. In these models, the anterior chamber was filled with IAL-F (IAL-F model) or BSS (BSS model). The heat generation rate of the phaco needle was 0.0004 cal/s/mm(2). The maximum corneal endothelial temperatures for the two models at 60 s were 52.67 and 41.57 degrees C, respectively. The experimental IAL-F model showed fewer changes in temperature for any given time and location. At larger distances from the heat source, less temperature variation was detected. Phacoemulsification is a potential heat-generating procedure performed between the delicate anterior chamber structures. During this procedure, IAL-F protects the endothelium against heat better than BSS. Copyright 2009 S. Karger AG, Basel.

Complications of cataract surgery in eyes filled with silicone oil.

PubMed

Kanclerz, Piotr; Grzybowski, Andrzej; Schwartz, Stephen G; Lipowski, Paweł

2018-03-01

The aim of the study was to evaluate complications of cataract surgery in eyes filled with silicone oil. This retrospective, noncomparative, consecutive case series analyzed medical files of patients with eyes filled with silicone oil undergoing cataract surgery. Phacoemulsification with posterior chamber intraocular lens implantation was conducted with or without concurrent silicone oil removal. In this study, 121 eyes of 120 patients were included. In 32 eyes (26.4%) with evident silicone oil microemulsification or silicone oil-associated open-angle glaucoma, silicone oil was removed prior to phacoemulsification through a pars plana incision and no cases of posterior capsular rupture occurred during the subsequent cataract surgery. In the remaining 89 eyes, phacoemulsification was performed with silicone oil in the vitreous cavity. In these eyes, the rate of posterior capsular rupture was 9/89 (10.1%) and the rate of silicone oil migration into the anterior chamber through an apparently intact posterior capsule was 5/89 (5.6%). In 94 eyes (77.7%), an intraocular lens was inserted into the capsular bag, in 3 eyes (2.5%) into the sulcus, and in 1 eye (0.8%) a transscleral suturing was performed. In this series, complications related to the silicone oil were not uncommon during cataract surgery. In the majority of patients without evident silicone oil microemulsification or silicone oil-associated open-angle glaucoma, cataract surgery and posterior chamber intraocular lens implantation were performed while leaving the silicone oil in place.

[Original method of extracapsule fragmentation of the lens nucleus during phacoemulsification].

PubMed

Avetisov, S E; Iusef, Iusef Naim; Mamikonian, V R; Vvedenskiĭ, A S; Iusef, Said Naim; Mutonen, N V

2002-01-01

Clinical estimation of different modifications of phacoemulsification revealed the formation of the second tunnel in the nucleus for its division into quadrants in "four-quadrant phaco" increases the required duration of ultrasonography (US) and irrigation, which causes greater endothelial losses associated with the use of nuclear breakdown by means of a chopper tunnel. When the authors used their own methods of "extracapsular half-nuclei" fragmentation, endothelial losses are rather greater than those with the similar method "stop & "chop", which is associated with closer disposition of the US tip to the posterior corneal surface. At the same time nuclear breakdown by means a chapper in the capsular sac by the "stop & chop" method causes dilation of Zinn's ligaments, fraught by their rupture, particularly if latent derangement or defects of the zonular apparatus, and increases the risk of damage to the posterior capsule by the chopper.

Controlled retrospective study of the effects of eyedrops containing phenylephrine hydrochloride and scopolamine hydrobromide on mean arterial blood pressure in anesthetized dogs.

PubMed

Martin-Flores, Manuel; Mercure-McKenzie, Tara M; Campoy, Luis; Erb, Hollis N; Ludders, John W; Gleed, Robin D

2010-12-01

To determine whether dogs that received eyedrops containing phenylephrine and scopolamine would have a higher mean arterial blood pressure (MAP) when anesthetized than would dogs that did not receive the eyedrops. 37 nondiabetic and 29 diabetic dogs anesthetized for phacoemulsification and 15 nondiabetic dogs anesthetized for corneal ulcer repair (control dogs). Medical records were reviewed to identify study dogs. Dogs undergoing phacoemulsification received 2 types of eyedrops (10% phenylephrine hydrochloride and 0.3% scopolamine hydrobromide) 4 times during a 2-hour period prior to the procedure. Control dogs did not receive these eyedrops. Heart rate and MAP were measured before surgery in all dogs 10 and 5 minutes before, at the time of (t0), and 5 (t5) and 10 (t10) minutes after atracurium administration. MAP was greater in the 2 groups that received the eyedrops than in the control group at t0 and t5; at t10, it was greater only for the nondiabetic dogs that received eyedrops. Nine nondiabetic dogs and 1 diabetic dog anesthetized for phacoemulsification had at least 1 MAP value>131 mm Hg; 73% of MAP values>131 mm Hg were detected within 10 minutes after atracurium administration. At no time did a control dog have an MAP value>131 mm Hg. Anesthetized dogs pretreated with eyedrops containing phenylephrine and scopolamine had higher MAP values than dogs that did not receive the eyedrops, suggesting the drops caused hypertension. Atracurium may interact with the eyedrops and contribute to the hypertension.

Vector Analysis of Corneal Astigmatism After Combined Femtosecond-Assisted Phacoemulsification and Arcuate Keratotomy.

PubMed

Chan, Tommy C Y; Cheng, George P M; Wang, Zheng; Tham, Clement C Y; Woo, Victor C P; Jhanji, Vishal

2015-08-01

To evaluate the outcomes of femtosecond-assisted arcuate keratotomy combined with cataract surgery in eyes with low to moderate corneal astigmatism. Retrospective, interventional case series. This study included patients who underwent combined femtosecond-assisted phacoemulsification and arcuate keratotomy between March 2013 and August 2013. Keratometric astigmatism was evaluated before and 2 months after the surgery. Vector analysis of the astigmatic changes was performed using the Alpins method. Overall, 54 eyes of 54 patients (18 male and 36 female; mean age, 68.8 ± 11.4 years) were included. The mean preoperative (target-induced astigmatism) and postoperative astigmatism was 1.33 ± 0.57 diopters (D) and 0.87 ± 0.56 D, respectively (P < .001). The magnitude of error (difference between surgically induced and target-induced astigmatism) (-0.13 ± 0.68 D), as well as the correction index (ratio of surgically induced and target-induced astigmatism) (0.86 ± 0.52), demonstrated slight undercorrection. The angle of error was very close to 0, indicating no significant systematic error of misaligned treatment. However, the absolute angle of error showed a less favorable range (17.5 ± 19.2 degrees), suggesting variable factors such as healing or alignment at an individual level. There were no intraoperative or postoperative complications. Combined phacoemulsification with arcuate keratotomy using femtosecond laser appears to be a relatively easy and safe means for management of low to moderate corneal astigmatism in cataract surgery candidates. Misalignment at an individual level can reduce its effectiveness. This issue remains to be elucidated in future studies. Copyright © 2015 Elsevier Inc. All rights reserved.

Optimized constants for an ultraviolet light-adjustable intraocular lens.

PubMed

Conrad-Hengerer, Ina; Dick, H Burkhard; Hütz, Werner W; Haigis, Wolfgang; Hengerer, Fritz H

2011-12-01

To determine the accuracy of intraocular lens (IOL) power calculations and to suggest adjusted constants for implantation of ultraviolet light-adjustable IOLs. Center for Vision Science, Ruhr University Eye Clinic, Bochum, Germany. Cohort study. Eyes with a visually significant cataract that had phacoemulsification with implantation of a light-adjustable IOL were evaluated. IOLMaster measurements were performed before phacoemulsification and IOL implantation and 4 weeks after surgery before the first adjustment of the IOL. The difference in the expected refraction and estimation error was studied. The study evaluated 125 eyes. Using the surgical constants provided by the manufacturer of the light-adjustable IOL, the SRK/T formula gave a more hyperopic refraction than the Hoffer Q and Holladay 1 formulas. The mean error of prediction was 0.93 diopter (D) ± 0.69 (SD), 0.91 ± 0.63 D, and 0.86 ± 0.65 D, respectively. The corresponding mean absolute error of prediction was 0.98 ± 0.61 D, 0.93 ± 0.61 D, and 0.90 ± 0.59 D, respectively. With optimized constants for the formulas, the mean error of prediction was 0.00 ± 0.63 D for Hoffer Q, 0.00 ± 0.64 D for Holladay 1, and 0.00 ± 0.66 D for SRK/T. The expected refraction after phacoemulsification and implantation of a light-adjustable IOL toward the hyperopic side of the desired refraction could be considered when using the optimized constants for all formulas. Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Calcification of Hydrophilic Acrylic Intraocular Lenses With a Hydrophobic Surface: Laboratory Analysis of 6 Cases.

PubMed

Gartaganis, Sotirios P; Prahs, Philipp; Lazari, Eftichia D; Gartaganis, Panos S; Helbig, Horst; Koutsoukos, Petros G

2016-08-01

To investigate the nature and characteristic features of deposits causing opacification of intraocular lenses (IOLs) based on the examination of clinical findings using scanning electron microscopy (SEM) and energy-dispersive x-ray spectroscopy (EDX) analysis. Retrospective, observational case series. This is a multicenter study of 6 hydrophilic acrylic IOLs (Lentis LS-502-1; Oculentis GmbH, Berlin, Germany) with a hydrophobic surface that were explanted from 5 patients because of opacification. Three patients had an uncomplicated phacoemulsification. One patient underwent combined phacoemulsification and pars plana vitrectomy for retinal detachment and later silicone oil endotamponade owing to redetachment. The last patient had a pars plana vitrectomy and silicone oil instillation combined with phacoemulsification for tractive retinal detachment and diabetic retinopathy. The explanted lenses were submitted to our laboratory and were examined by SEM and EDX in order to identify the morphologic features and the composition of the deposits. SEM and EDX analyses confirmed the presence of calcific deposits in the interior of the opacified hydrophilic IOLs, with a pattern showing the formation of lumps on the surface. The lumps were due to subsurface formation of calcium phosphate crystalline deposits. The crystallite clusters seemed to diffuse from the IOL interior to the surface. We demonstrated the calcification pattern of the hydrophilic IOL (Lentis LS-502-1) with a hydrophobic surface. Although hydrophilic acrylic lenses have a hydrophobic surface, the development of calcification is a possible threat initiating from the hydrophilic subsurface of the IOLs. Copyright © 2016 Elsevier Inc. All rights reserved.

Er:YAG phacoemulsification with fiber

NASA Astrophysics Data System (ADS)

Cozean, Colette D.

1994-07-01

Forty years ago, a leading cataract surgeon in the United States announced, with an air of finality, that the "perfect operation' for cataract extraction had been developed.' He believed cataract surgeons had reached their zenith and that no more time should be wasted looking for alternatives or refinements. The procedure he was describing was an intracapsular cataract extraction. The cataract was delivered at that time with forceps, often with "just a little vitreous". Sutures were just beginning to be used, but weeks of postoperative immobilization were still the norm. Patients undergoing the procedure could look forward to a lifetime of visual impairment and to a loss of confidence and self-esteem brought about by both the functional impairment and the unflattering appearance of these spectacles. This "perfect operation" marked the end of the productive life for most individuals. With the introduction of the first ultrasonic phacoemulsification equipment in the 1970's and the development of small incision intraocular lenses in the 1980's, all of us have witnessed a remarkable leap in the evolution of cataract surgery. Like our colleague forty years ago, some of us think that we have reached a plateau, but this evolution will continue. What is needed in ophthalmic surgery today is a single, versatile, reliable, and inexpensive multipurpose device which can perform all these surgical functions with equivalent or superior results. Such a device would allow cost-conscious surgery facilities to offer a full range of state-of-the-art surgery, while purchasing only a single unit - a unit which would be no more expensive than existing phacoemulsification devices.

Incision integrity and postoperative outcomes after microcoaxial phacoemulsification performed using 2 incision-dependent systems.

PubMed

Vasavada, Vaishali; Vasavada, Abhay R; Vasavada, Viraj A; Srivastava, Samaresh; Gajjar, Devarshi U; Mehta, Siddharth

2013-04-01

To compare incision integrity and clinical outcomes of 2 microcoaxial phacoemulsification systems. Iladevi Cataract & IOL Research Centre, Ahmedabad, India. Prospective randomized clinical trial. Eyes were randomized to have phacoemulsification using a 1.8 mm clear corneal incision (CCI) system (Group 1, Stellaris system) or a 2.2 mm CCI system (Group 2, Intrepid Infiniti system). Incision enlargement at end of surgery was measured. At the conclusion of surgery, trypan blue was applied over the conjunctival surface, anterior chamber aspirate withdrawn, and ingress into anterior chamber measured. Postoperative observations included evaluation of the CCI using anterior segment optical coherence tomography (AS-OCT), change in central corneal thickness (CCT), and anterior segment inflammation at 1 day, 1 week, and 1 month and endothelial cell loss and surgically induced astigmatism (SIA) at 3 months. Incision enlargement (P<.001) and trypan blue ingress in the anterior chamber (mean 1.7 log units ± 0.6 [SD] versus 3.8 ± 0.6 log units, P<.001) was significantly greater in Group 1 (n = 50) than in Group 2 (n = 50). On AS-OCT, endothelial misalignment and gaping were more frequent in Group 1 at 1 day (P=.001) and 1 week (P=.018). There were no significant differences in SIA, change in CCT, endothelial cell loss, or anterior segment inflammation (P>.05). At the end of surgery, it is not the initial incision size alone but also the distortion of the incision during subsequent stages of surgery that determine the integrity of the CCI. Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Prospective study of Centurion® versus Infiniti® phacoemulsification systems: surgical and visual outcomes

PubMed Central

Oh, Lawrence J.; Nguyen, Chu Luan; Wong, Eugene; Wang, Samuel S.Y.; Francis, Ian C.

2017-01-01

AIM To evaluate surgical outcomes (SOs) and visual outcomes (VOs) in cataract surgery comparing the Centurion® phacoemulsification system (CPS) with the Infiniti® phacoemulsification system (IPS). METHODS Prospective, consecutive study in a single-site private practice. Totally 412 patients undergoing cataract surgery with either the CPS using the 30-degree balanced® tip (n=207) or the IPS using the 30-degree Kelman® tip (n=205). Intraoperative and postoperative outcomes were documented prospectively up to one month follow-up. Nuclear sclerosis (NS) grade, cumulated dissipated energy (CDE), preoperative corrected distance visual acuity (CDVA), and CDVA at one month were recorded. RESULTS CDE was 13.50% less in the whole CPS compared with the whole IPS subcohort. In eyes with NS grade III or greater, CDE was 28.87% less with CPS (n=70) compared with IPS (n=44) (P=0.010). Surgical complications were not statistically different between the two subcohorts (P=0.083), but in the one case of vitreous loss using the CPS, CDVA of 6/4 was achieved at one month. The mean CDVAs (VOs) at one month for NS grade III and above cataracts were -0.17 logMAR (6/4.5) in the CPS and -0.15 logMAR (6/4.5) in the IPS subcohort respectively (P=0.033). CONCLUSION CDE is 28.87% less, and VOs are significantly improved, in denser cataracts in the CPS compared with the IPS. The authors recommend the CPS for cases with denser nuclei. PMID:29181313

Results of endocapsular phacofracture debulking of hard cataracts

PubMed Central

Davison, James A

2015-01-01

Purpose/aim of the study To present a phacoemulsification technique for hard cataracts and compare postoperative results using two different ultrasonic tip motions during quadrant removal. Materials and methods A phacoemulsification technique which employs in situ fracture and endocapsular debulking for hard cataracts is presented. The prospective study included 56 consecutive cases of hard cataract (LOCS III NC [Lens Opacification Classification System III, nuclear color], average 4.26), which were operated using the Infiniti machine and the Partial Kelman tip. Longitudinal tip movement was used for sculpting for all cases which were randomized to receive longitudinal or torsional/interjected longitudinal (Intelligent Phaco [IP]) strategies for quadrant removal. Measurements included cumulative dissipated energy (CDE), 3 months postoperative surgically induced astigmatism (SIA), and corneal endothelial cell density (ECD) losses. Results No complications were recorded in any of the cases. Respective overall and longitudinal vs IP means were as follows: CDE, 51.6±15.6 and 55.7±15.5 vs 48.6±15.1; SIA, 0.36±0.2 D and 0.4±0.2 D vs 0.3±0.2 D; and mean ECD loss, 4.1%±10.8% and 5.9%±13.4% vs 2.7%±7.8%. The differences between longitudinal and IP were not significant for any of the three categories. Conclusion The endocapsular phacofracture debulking technique is safe and effective for phacoemulsification of hard cataracts using longitudinal or torsional IP strategies for quadrant removal with the Infiniti machine and Partial Kelman tip. PMID:26203213

Ozil IP torsional mode versus combined torsional/longitudinal microcoaxial phacoemulsification.

PubMed

Helvacioglu, Firat; Tunc, Zeki; Yeter, Celal; Oguzhan, Hasan; Sencan, Sadik

2012-01-01

To compare the safety and efficacy of microcoaxial phacoemulsification surgeries performed with the Ozil Intelligent Phaco (IP) torsional mode and combined torsional/longitudinal ultrasound (US) mode using the Infiniti Vision System (Alcon Laboratories). In this prospective randomized comparative study, 60 eyes were assigned to 2.2-mm microcoaxial phacoemulsification using the Ozil IP torsional mode (group 1) or combined torsional/longitudinal US mode (group 2). The primary outcome measures were US time (UST), cumulative dissipated energy (CDE), longitudinal and torsional ultrasound amplitudes, mean operation time, mean volume of balanced salt solution (BSS) used, and surgical complications. Both groups included 30 eyes. Mean UST, CDE, and longitudinal and torsional ultrasound amplitudes in group 1 were 1 minute 15±34.33 seconds, 8.74±5.64, 0.43±0.74, and 25.56±8.56, respectively, and these parameters in group 2 were 1 minute 40±51.44 seconds, 9.28±5.99, 3.64±1.55, and 3.71±1.34, respectively. UST and longitudinal amplitudes were found to be significantly low in group 1 (p<0.001, p<0.001), whereas torsional amplitude was found to be significantly high in this group (p=0.001). Mean volumes of BSS used in groups 1 and 2 were 63.30±18.00 cc and 84.50±28.65 cc, respectively (p=0.001). The Ozil IP torsional mode may provide more effective lens removal than the combined torsional/longitudinal US mode with a lower UST and volume of BSS used.

Evaluation of endothelial mucin layer thickness after phacoemulsification with next generation ophthalmic irrigating solution.

PubMed

Ghate, Deepta A; Holley, Glenn; Dollinger, Harli; Bullock, Joseph P; Markwardt, Kerry; Edelhauser, Henry F

2008-10-01

To evaluate human corneal endothelial mucin layer thickness and ultrastructure after phacoemulsification and irrigation-aspiration with either next generation ophthalmic irrigating solution (NGOIS) or BSS PLUS. Paired human corneas were mounted in an artificial anterior chamber, exposed to 3 minutes of continuous ultrasound (US) at 80% power using the Alcon SERIES 20000 LEGACY surgical system (n = 9) or to 2 minutes of pulsed US at 50% power, 50% of the time at 20 pps using the Alcon INFINITI Vision System (n = 5), and irrigated with 250 mL of either NGOIS or BSS PLUS. A control group of paired corneas did not undergo phacoemulsification or irrigation-aspiration (n = 5). Corneas were divided and fixed for mucin staining or transmission electron microscopy. Mucin layer thickness was measured on the transmission electron microscopy prints. The mucin layer thickness in the continuous phaco group was 0.77 +/- 0.02 microm (mean +/- SE) with NGOIS and 0.51 +/- 0.01 microm with BSS PLUS (t test, P < 0.001). The mucin layer thickness in the pulsed phaco group was 0.79 +/- 0.02 microm with NGOIS and 0.54 +/- 0.01 microm with BSS PLUS (P < 0.001). The mucin layer thickness in the untreated control group was 0.72 +/- 0.02 microm. The endothelial ultrastructure was normal in all corneas. In this in vitro corneal model, NGOIS, due to its lower surface tension and higher viscosity, preserved endothelial mucin layer thickness better than BSS PLUS with both the INFINITI Vision System (pulsed US) and the LEGACY surgical system (continuous US).

Factors Associated with Complications and Postoperative Visual Outcomes of Cataract Surgery; a Study of 1,632 Cases

PubMed Central

Thanigasalam, Thevi; Reddy, Sagili Chandrashekara; Zaki, Rafdzah Ahmad

2015-01-01

Purpose: Cataract surgery is the most common intraocular surgery performed all over the world and has advanced technically in recent years. As in all surgeries, complications are unavoidable. Herein we report factors associated with complications and visual outcomes of cataract surgery. Methods: This retrospective cohort study included data of 1,632 cataract surgeries performed from 2007 to 2010 which was obtained from the cataract registry of the Malaysian National Eye Database. Demographic features, ocular and systemic comorbidites, grade of surgeon expertise and duration of surgery, type of anesthesia, intraoperative and postoperative complications, and the type of intraocular lens were recorded. Best corrected visual acuities were compared before and after the operation. Results: Mean patient age was 66.9 years with equal gender distribution. The majority of subjects had age related cataracts. Phacoemulsification was done faster than other surgeries, especially by specialist surgeons. History of prior ocular surgery and operations performed under general anesthesia were associated with greater complications. Phacoemulsification was associated with less complications and better visual outcomes. The age and etiology of cataract did not affect complications. Malays, absence of ocular comorbidities, left eyes and eyes operated under local anesthesia were more likely to experience more visual improvement. Gender, age, cause of cataract, systemic comorbidities and surgeon expertise as well as intra-and postoperative complications did not affect the visual outcomes. Conclusion: Phacoemulsification had good visual outcomes in cataract surgery. Duration of surgery, expertise of the surgeon and complications did not affect the visual outcomes. PMID:27051481

Influence of cataract surgery on optical coherence tomography and neurophysiology measurements in patients with retinitis pigmentosa.

PubMed

Garcia-Martin, Elena; Rodriguez-Mena, Diego; Dolz, Isabel; Almarcegui, Carmen; Gil-Arribas, Laura; Bambo, Maria P; Larrosa, Jose M; Polo, Vicente; Pablo, Luis E

2013-08-01

To evaluate the effect of uncomplicated cataract phacoemulsification on the measurements of visual evoked potentials (VEP), pattern electroretinogram (PERG), and macular and retinal nerve fiber layer (RNFL) using 2 spectral-domain optical coherence tomography (OCT) instruments, the Cirrus OCT (Carl Zeiss Meditech) and Spectralis OCT (Heidelberg Engineering), in patients with retinitis pigmentosa (RP), and to assess the reliability of the OCT measurements before and after cataract surgery. Observational cross-sectional study. Thirty-five eyes of 35 patients with RP (20 men and 15 women, 45-66 years) who underwent cataract phacoemulsification were studied. At 1 month before and 1 month after surgery, visual acuity, VEP, PERG, and 3 repetitions of scans using the RNFL and macular analysis protocols of the Cirrus and Spectralis OCT instruments were performed. The differences in measurements between the 2 visits were analyzed. Repeatability of OCT measurements was evaluated by calculating the coefficients of variation. VEP amplitude, RNFL thicknesses provided by Cirrus and Spectralis, and macular measurements provided by Cirrus OCT differed between the 2 visits. VEP latency, PERG measurements, and macular thicknesses provided by the Spectralis OCT before surgery did not differ significantly from those after surgery. The OCT repeatability was better after surgery, with lower coefficients of variation for scans performed after surgical removal of the cataract. The nuclear, cortical, and posterior subcapsular types of cataracts did not show different repeatability. The presence of cataracts affects VEP amplitude, RNFL, and macular measurements performed with OCT in eyes with RP. Image repeatability significantly improves after cataract phacoemulsification. Copyright © 2013 Elsevier Inc. All rights reserved.

A 5-year audit of cataract surgery outcomes after posterior capsule rupture and risk factors affecting visual acuity.

PubMed

Ti, Seng-Ei; Yang, You-Nian; Lang, Stephanie S; Chee, Soon Phaik

2014-01-01

To describe the posterior capsule rupture rates and visual outcomes after phacoemulsification, analyze risk factors for poor vision, and compare results of faculty (F) and residents (R). Retrospective audit study. Visual success of all capsule ruptures (2006-2010) was analyzed and compared to uneventful cases. Rupture rates of faculty and residents were compared (χ², P < .05). Success was defined as % best-corrected visual acuity (BCVA) ≥20/40 at 3 months (excluding poor-prognosis eyes) and studied in relation to age, sex, surgeon type, stage of surgery, vitreous loss, dropped nucleus, and other complications (eg, retinal detachment, corneal decompensation, dislocated intraocular lens [IOL]). Final risk factors were identified using multivariate logistic regression analysis. From 2006 to 2010, there were 887 capsule ruptures in 48 377 phacoemulsification cases (rate 1.8%). Uneventful cases had significantly better visual outcomes than capsule ruptures (98.5% vs 93.9%; P < .01). Faculty rupture rates were lower (F = 1.4%) than residents' (R = 3.4%; P < .01), but visual outcomes were similar (F = 93.8%, R = 93.7%; P > .05). Ruptures most frequently occurred during phacoemulsification (59.6%) and irrigation and aspiration (24.8%) stages. Risk factors for poor outcomes included age >65 years, dropped nuclei, and other complications. The overall capsule rupture rate was 1.8%. Although residents had higher rates, visual success matched faculty's, possibly attributable to case mix and close supervision. Associated risk factors for poor vision included age >65 years, dropped nuclei, and postoperative retinal, corneal, and IOL complications. Copyright © 2014 Elsevier Inc. All rights reserved.

The Auckland Cataract Study: Assessing Preoperative Risk Stratification Systems for Phacoemulsification Surgery in a Teaching Hospital.

PubMed

Kim, Bia Z; Patel, Dipika V; Sherwin, Trevor; McGhee, Charles N J

2016-11-01

To evaluate 2 preoperative risk stratification systems for assessing the risk of complications in phacoemulsification cataract surgery, performed by residents, fellows, and attending physicians in a public teaching hospital. Cohort study. One observer assessed the clinical data of 500 consecutive cases, prior to phacoemulsification cataract surgery performed between April and June 2015 at Greenlane Clinical Centre, Auckland, New Zealand. Preoperatively 2 risk scores were calculated for each case using the Muhtaseb and Buckinghamshire risk stratification systems. Complications, intraoperative and postoperative, and visual outcomes were analyzed in relation to these risk scores. Intraoperative complication rates increased with higher risk scores using the Muhtaseb or Buckinghamshire stratification system (P = .001 and P = .003, respectively, n = 500). The odds ratios for residents and fellows were not significantly different from attending physicians after case-mix adjustment according to risk scores (P > .05). Postoperative complication rates increased with higher Buckinghamshire risk scores but not with Muhtaseb scores (P = .014 and P = .094, respectively, n = 476). Postoperative corrected-distance visual acuity was poorer with higher risk scores (P < .001 for both, n = 476). This study confirms that the risk of intraoperative complications increases with higher preoperative risk scores. Furthermore, higher risk scores correlate with poorer postoperative visual acuity and the Buckinghamshire risk score also correlates with postoperative complications. Therefore, preoperative assessment using such risk stratification systems could assist individual informed consent, preoperative surgical planning, safe allocation of cases to trainees, and more meaningful analyses of outcomes for individual surgeons and institutions. Copyright © 2016 Elsevier Inc. All rights reserved.

Corneal endothelial morphology and function after torsional and longitudinal ultrasound mode phacoemulsification

PubMed Central

Módis, László Jr.; Szalai, Eszter; Flaskó, Zsuzsa; Németh, Gábor

2016-01-01

Purpose. To study the endothelial cell morphology and corneal thickness changes after phacoemulsification by using the OZil torsional and longitudinal ultrasound techniques (Infiniti Vision System, Alcon Laboratories). Setting. Department of Ophthalmology, Clinical Center, University of Debrecen, Debrecen, Hungary. Methods. 52 patients with cataract were randomly assigned to longitudinal ultrasound and torsional mode group. All surgeries were performed through a 2.2 mm clear corneal incision, the method employed being divide and conquer. The endothelial morphometry such as cell density (ECD), mean cell area, coefficient of variation of cell area, and central corneal thickness were examined with specular microscopy (EM-1000, Tomey) preoperatively and 4, 8 weeks postoperatively. Results. ECD values decreased significantly in both surgical groups (P < .001, repeated- mesures ANOVA), the postoperative endothelial cell loss was higher in the longitudinal ultrasound mode group (3.5% and 6.5%, at 4 and 8 weeks after surgery) than in the torsional group (3.3% and 5.5%, at 4 and 8 weeks after surgery), the difference not being significant between the two groups (P = .164 and P = .479, at 4 and 8 weeks after surgery, Mann-Whitney test). There was no statistically significant difference in any of the assessed parameters between the two surgical groups (P > .05). No significant correlation was found between the endothelial cell loss and the nucleus density. Conclusions. Both phacoemulsification techniques were safe and effective. The torsional handpiece performs oscillatory movements and delivers less energy into the eye than the longitudinal ultrasound technique, therefore providing more favorable energy and thermal safety profile. PMID:29450332

Safety and Effectiveness of Cataract Surgery with Simultaneous Intravitreal Anti-VEGF in Patients with Previously Treated Exudative Age-Related Macular Degeneration.

PubMed

Falcão, Manuel Sousa; Freitas-Costa, Paulo; Beato, João Nuno; Pinheiro-Costa, João; Rocha-Sousa, Amândio; Carneiro, Ângela; Brandão, Elisete Maria; Falcão-Reis, Fernando

2017-02-27

To evaluate the safety and impact on visual acuity, retinal and choroidal morphology of simultaneous cataract surgery and intravitreal anti-vascular endothelial growth factor on patients with visually significant cataracts and previously treated exudative age-related macular degeneration. Prospective study, which included 21 eyes of 20 patients with exudative age-related macular degeneration submitted to simultaneous phacoemulsification and intravitreal ranibizumab or bevacizumab. The patients were followed for 12 months after surgery using a pro re nata strategy. Visual acuity, foveal and choroidal thickness changes were evaluated 1, 6 and 12 months post-operatively. There was a statistically significant increase in mean visual acuity at one (13.4 letters, p < 0.05), six (11.5 letters, p < 0.05) and twelve months (11.3 letters, p < 0.05) without significant changes in retinal or choroidal morphology. At 12 months, 86% of eyes were able to maintain visual acuity improvement. There were no significant differences between the two anti-vascular endothelial growth factor drugs and no complications developed during follow-up. Simultaneous phacoemulsification and intravitreal anti- vascular endothelial growth factor is safe and allows improvement in visual acuity in patients with visually significant cataracts and exudative age-related macular degeneration. Visual acuity gains were maintained with a pro re nata strategy showing that in this subset of patients, phacoemulsification may be beneficial. Cataract surgery and simultaneous anti-vascular endothelial growth factor therapy improves visual acuity in patients with exudative age-related macular degeneration.

Effect of IOP based infusion system with and without balanced phaco tip on cumulative dissipated energy and estimated fluid usage in comparison to gravity fed infusion in torsional phacoemulsification.

PubMed

Malik, Praveen K; Dewan, Taru; Patidar, Arun Kr; Sain, Ekta

2017-01-01

To evaluate the effect of three different combinations of tip designs and infusion systems in torsional phacoemulsification (INFINITI and CENTURION) in patients with cataract. According to the manufacturer, two unique improvements in the Centurion are: active fluid dynamic management system and use of an intrepid balanced tip. The study specifically aimed to evaluate the beneficial effects, if any, of change in tip design and infusion system individually and in combination on both per-operative parameters as well as endothelial health over 6 months. One hundred and twenty six consenting patients of grade 4.0-6.9 senile cataract were randomized into three groups for phacoemulsification: Group A ( n  = 42): Gravity fed infusion system and 45 0 Kelman miniflared ABS phaco tip; Group B ( n  = 42): intraocular pressure (IOP) based infusion system and 45 0 Kelman miniflared ABS phaco tip; Group C ( n  = 42): IOP based infusion system and 45 0 Intrepid balanced phaco tip. The cumulative dissipated energy (CDE), estimated fluid usage (EFU) and total aspiration time (TAT) were compared peroperatively. The endothelial parameters were followed up postoperatively for six months. The three arms were matched for age ( p  = 0.525), gender ( p  = 0.96) and grade of cataract ( p  = 0.177). Group C was associated with significant reductions in CDE ( p  = 0.001), EFU ( p  < 0.0005) as well as TAT ( p  = 0.001) in comparison to the other groups. All three groups had comparable baseline endothelial cell density ( p  = 0.876) and central corneal thickness ( p  = 0.561). On post-operative evaluation, although all groups were comparable till 3 months, by 6 months, the percentage losses in endothelial cell density were significantly lower in group C as compared to the other groups. Use of an IOP based phacoemulsification system in association with use of the Intrepid balanced tip reduces the CDE, EFU and TAT in comparison to a gravity fed system with a mini flared tip or IOP based system with a mini flared tip while also providing better endothelial preservation thus favouring the use of an IOP fed system with a balanced tip. Trial registration No.: CTRI/2016/06/007022.

Measuring rectilinear flow within the anterior chamber in phacoemulsification procedures.

PubMed

Oki, Kotaro

2004-08-01

To measure and photograph rectilinear flow generated in an anterior chamber model during different power phases of phacoemulsification. Oki Eye Surgery Center, Tokyo, Japan. An ultrasound (US) needle was fitted to a Sovereign WhiteStar (AMO) phacoemulsification unit. The sleeved needle was inserted into a silicone test chamber filled with balanced salt solution with glutation (BSS Plus). An LV-1610 laser Doppler vibrometer (Ono-Sokki) captured and processed the velocity and displacement of vibrations on the surface of the test chamber. Measurements were processed in a CF-520 Fast Fourier Transform (FFT) analyzer with the results shown in real time on the FFT analyzer and displayed on a computer monitor using 3-dimensional software. Four US delivery modes were measured: WhiteStar DB, WhiteStar CF, continuous mode, and short-pulse mode at 6 pulses per second (pps). Flow and vacuum were set at 20 cc/min and 200 mm Hg, respectively, and US power was 20% and 50%. Schlieren photography of the fluid flow was performed with an ultra-high-speed Memrecam fx 6000 camera (NAC Image Technology). The peak vibration velocity (m/s) and displacement at the distal end of the test chamber were greatest for continuous mode, followed by short pulse (6 pps), WhiteStar DB, and WhiteStar CF, in descending order. At 20% power, the US needle generated a peak velocity of 8.64 x 10(-3) m/s in continuous mode, 7.30 x 10(-3) m/s in short-pulse mode, 5.03 x 10(-3) m/s in DB mode, and 3.74 x 10(-3) m/s in CF mode. At 50% power, the US needle generated a peak velocity of 12.8 x 10(-3) m/s in continuous mode, 10.9 x 10(-3) m/s in short-pulse mode, 8.52 x 10(-3) m/s in DB mode, and 6.37 x 10(-3) m/s in CF mode. Schlieren photography showed the greatest wave speed, intensity, and turbulence in continuous mode and the least with the WhiteStar modes. Peak vibration velocity and amplitude of displacement were less with the WhiteStar delivery modes than with continuous power or short-pulse modes. A similar reduction was seen in the rectilinear flow under Schlieren photography. Attenuation of rectilinear flow and turbulence patterns may have clinical implications for the corneal endothelium during phacoemulsification.

Corneal Astigmatism and Aberrations After Combined Femtosecond-Assisted Phacoemulsification and Arcuate Keratotomy: Two-Year Results.

PubMed

Chan, Tommy C Y; Ng, Alex L K; Cheng, George P M; Wang, Zheng; Woo, Victor C P; Jhanji, Vishal

2016-10-01

To investigate the stability of corneal astigmatism and higher-order aberrations after combined femtosecond-assisted phacoemulsification and arcuate keratotomy. Retrospective, interventional case series. Surgery was performed using a VICTUS (Bausch & Lomb Inc, Dornach, Germany) platform. A single, 450-μm deep, arcuate keratotomy was paired at the 8-mm zone with the main phacoemulsification incision in the opposite meridian. The keratotomy incisions were not opened. Corneal astigmatism and higher-order aberration measurements obtained preoperatively and at 2 months and 2 years postoperatively were analyzed. Fifty eyes of 50 patients (mean age 66.2 ± 10.5 years) were included. The mean preoperative corneal astigmatism was 1.35 ± 0.48 diopters (D). This was reduced to 0.67 ± 0.54 D at 2 months and 0.74 ± 0.53 D at 2 years postoperatively (P < .001). There was no statistically significant difference between postoperative corneal astigmatism over 2 years (P = .392). Both magnitude of error and absolute angle of error were comparable between the 2 postoperative time points (P > .283). At postoperative 2 months and 2 years, 72% and 70% of eyes were within 15 degrees of preoperative meridian of astigmatism, respectively. All wavefront measurements increased significantly at 2 months and 2 years (P < .007), except spherical aberration (P > .150). There was no significant difference in higher-order aberrations between 2 months and 2 years postoperatively (P > .486). Our study showed the stability of femtosecond-assisted arcuate keratotomy. Further studies using other platforms and nomograms are needed to corroborate the findings of this study. Copyright © 2016 Elsevier Inc. All rights reserved.

Femtosecond laser-assisted compared with standard cataract surgery for removal of advanced cataracts.

PubMed

Hatch, Kathryn M; Schultz, Tim; Talamo, Jonathan H; Dick, H Burkhard

2015-09-01

To compare effective phacoemulsification time (EPT) for the removal of brunescent cataracts treated with femtosecond laser-assisted cataract surgery with standard cataract phacoemulsification techniques. Ruhr University Eye Hospital, Bochum, Germany. Comparative prospective case study. The Lens Opacities Classification System III (LOCS III) grading system was used to measure eyes divided into 4 groups having cataract surgery. Groups 1 and 2 contained eyes with LOCS III grade nuclear opalescence (NO) 3 cataracts treated with standard cataract surgery and femtosecond laser-assisted cataract surgery, respectively. Groups 3 and 4 contained brunescent cataracts, LOCS III grades NO5, treated with standard cataract surgery and femtosecond laser-assisted cataract surgery, respectively. There were 240 eyes, with 60 eyes in each group. The EPT in Group 1 ranged from 0.46 to 3.10 (mean 1.38); the EPT in all eyes in Group 2 was 0 (P < .001). The EPT in Groups 3 and 4 was 2.12 to 19.29 (mean 6.85) and 0 to 6.75 (mean 1.35), respectively (P < .001). A comparison between EPT in Groups 1 and 4 showed that EPT in Group 4 was also lower than in Group 1 (P = .013). Groups 4 and 1 were the most statistically similar of all groups compared, suggesting that EPT for a femtosecond laser-treated grade 5 cataract was most similar to that of a standard-treated grade 3 cataract. Femtosecond laser pretreatment for brunescent cataracts allowed for a significant reduction in EPT compared with manual standard phacoemulsification techniques. Drs. Hatch, Talamo, and Dick are consultants to Abbott Medical Optics, Inc. Dr. Schultz has no financial or proprietary interest in any material or method mentioned. Copyright © 2015 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Automated refraction is stable 1 week after uncomplicated cataract surgery.

PubMed

Ostri, Christoffer; Holfort, Stig K; Fich, Marianne S; Riise, Per

2018-03-01

To compare automated refraction 1 week and 1 month after uncomplicated cataract surgery. In this prospective cohort study, we recruited patients in a 2-month period and included consecutive patients scheduled for bilateral small-incision phacoemulsification cataract surgery. The exclusion criteria were (i) corneal and/or retinal pathology that could lead to automated refraction miscalculation and (ii) surgery complications. Automated refraction was measured 1 week and 1 month after surgery. Ninety-five patients met the in- and exclusion criteria and completed follow-up. The mean refractive shift in spherical equivalent was -0.02 dioptre (D) between 1 week and 1 month after surgery and not statistical significant (p = 0.78, paired t-test). The magnitude of refractive shift in either myopic or hyperopic direction was neither correlated to age, preoperative corneal astigmatism, axial length nor phacoemulsification energy used during surgery (p > 0.05 for all variables, regression analysis). The refractive target was missed with 1.0 D or more in 11 (12%) patients. In this subgroup, the mean refractive shift in spherical equivalent was 0.49 D between 1 week and 1 month after surgery with a trend towards statistical significance (p = 0.07, paired t-test). There was no difference in age, preoperative corneal astigmatism, axial length or phacoemulsification energy used during surgery compared to the remainder of the patients (p > 0.05 for all variables, unpaired t-test). Automated refraction is stabile 1 week after uncomplicated cataract surgery, but there is a trend towards instability, if the refractive target is missed with 1.0 D or more. © 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Thermal characterization of phacoemulsification probes operated in axial and torsional modes.

PubMed

Zacharias, Jaime

2015-01-01

To analyze temperature increases and identify potential sources of heat generated when sleeved and sleeveless phacoemulsification probes were operated in axial and torsional modes using the Infiniti Vision System with the Ozil torsional handpiece. Phacodynamics Laboratory, Pasteur Ophthalmic Clinic, Santiago, Chile. Experimental study. Two computer-controlled thermal transfer systems were developed to evaluate the contribution of internal metal stress and tip-to-sleeve friction on heat generation during phacoemulsification using axial and torsional ultrasound modalities. Both systems incorporated infrared thermal imaging and used a black-body film to accurately capture temperature measurements. Axial mode was consistently associated with greater temperature increases than torsional mode whether tips were operated with or without sleeves. In tests involving bare tips, axial mode and torsional mode peaked at 51.7°C and 34.2°C, respectively. In an example using sleeved tips in which a 30.0 g load was applied for 1 second, temperatures for axial mode reached 45°C and for torsional mode, 38°C. Friction between the sleeved probe and the incisional wall contributed more significantly to the temperature increase than internal metal stress regardless of the mode used. In all experiments, the temperature increase observed with axial mode was greater than that observed with torsional mode, even when conditions such as power or amplitude and flow rate were varied. Tip-to-sleeve friction was a more dominant source of phaco probe heating than internal metal stress. The temperature increase due to internal metal stress was greater with axial mode than with torsional mode. Dr. Zacharias received research funding from Alcon Laboratories, Inc., to conduct this study. He has no financial or proprietary interest in any material or method mentioned. Copyright © 2015 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

The risk of capsular breakage from phacoemulsification needle contact with the lens capsule: a laboratory study.

PubMed

Meyer, Jay J; Kuo, Annie F; Olson, Randall J

2010-06-01

To determine capsular breakage risk from contact by phacoemulsification needles by machine and tip type. Experimental laboratory investigation. Infiniti (Alcon, Inc.) with Intrepid cartridges and Signature (Abbott Medical Optics, Inc.) phacoemulsification machines were tested using 19- and 20-gauge sharp and rounded tips. Actual and unoccluded flow vacuum were determined at 550 mm Hg, bottle height of 75 cm, and machine-indicated flow rate of 60 mL/minute. Breakage from brief tip contact with a capsular surrogate and human cadaveric lenses was calculated. Nineteen-gauge tips had more flow and less unoccluded flow vacuum than 20-gauge tips for both machines, with highest unoccluded flow vacuum in the Infiniti. The 19-gauge sharp tip was more likely than the 20-gauge sharp tip to cause surrogate breakage for Signature with micropulse and Ellips (Abbott Medical Optics, Inc.) ultrasound at 100% power. For Infiniti using OZil (Alcon, Inc.) ultrasound, 20-gauge sharp tips were more likely than 19-gauge sharp tips to break the membrane. For cadaveric lenses, using rounded 20-gauge tips at 100% power, breakage rates were micropulse (2.3%), Ellips (2.3%), OZil (5.3%). Breakage rates for sharp 20-gauge Ellips tips were higher than for rounded tips. Factors influencing capsular breakage may include active vacuum at the tip, flow rate, needle gauge, and sharpness. Nineteen-gauge sharp tips were more likely than 20-gauge tips to cause breakage in lower vacuum methods. For higher-vacuum methods, breakage is more likely with 20-gauge than with 19-gauge tips. Rounded-edge tips are less likely than sharp-edged tips to cause breakage. Copyright 2010 Elsevier Inc. All rights reserved.

Impact of the Femtosecond Laser in Line with the Femtosecond Laser-Assisted Cataract Surgery (FLACS) on the Anterior Chamber Characteristics in Comparison to the Manual Phacoemulsification.

PubMed

Pahlitzsch, Milena; Torun, Necip; Pahlitzsch, Marie Luise; Klamann, Matthias K J; Gonnermann, Johannes; Bertelmann, Eckart; Pahlitzsch, Thomas

2017-01-01

To assess the alterations of the anterior chamber conditions including laser flare photometry after femtosecond laser-assisted cataract surgery (FLACS) compared to the manual phacoemulsification. Data of n=70 FLACS (mean age 67.2 ± 8.9 years) and n=40 manual phacoemulsification (mean age 69.5 ± 9.6 years) were analyzed. The procedures were performed by LenSx Alcon, USA, and Alcon Infiniti Vision System, USA. The following parameters were recorded: laser flare photometry (Kowa FM 700, Japan), anterior chamber (AC) depth, AC volume, AC angle (Pentacam, Oculus Inc., Germany), lens density, pupil diameter, endothelial cell count and pachymetry. The analysis was performed preoperatively, immediately after femtosecond laser procedure and one day postoperatively. Between FLACS and the phaco control group, there was a significant difference in the AC depth (p=0.023, 3.77 mm vs. 4.05 mm) one day postoperatively. The AC angle (p=0.016) showed a significant difference immediately after the femto laser treatment. The central and thinnest pachymetry and endothelial cell count did not show a significant difference between the two study cohorts (p=0.165, p=0.291, p=0.979). The phaco cohort (n=40) demonstrated a non-statistically significant difference in the flare photometry of 15.80 photons/ms one postoperative day compared to the FLACS group 26.62 photons/ms (p=0.322). In this study population, no evidence for an additive damage caused by the use of the femtosecond laser was demonstrated. Furthermore, no increase in the central and thinnest corneal thickness and no increased endothelial cell loss was demonstrated by the laser energy.

Fluid dynamics, cavitation, and tip-to-tissue interaction of longitudinal and torsional ultrasound modes during phacoemulsification.

PubMed

Zacharias, Jaime; Ohl, Claus-Dieter

2013-04-01

To describe the fluidic events that occur in a test chamber during phacoemulsification with longitudinal and torsional ultrasound (US) modalities. Pasteur Ophthalmic Clinic Phacodynamics Laboratory, Santiago, Chile, and Nanyang Technological University, Singapore. Experimental study. Ultra-high-speed videos of a phacoemulsifying tip were recorded while the tip operated in longitudinal and torsional US modalities using variable US power. Two high-speed video cameras were used to record videos up to 625,000 frames per second. A high-intensity spotlight source was used for illumination to engage shadowgraphy techniques. Particle image velocimetry was used to evaluate fluidic patterns while a hyperbaric environmental system allowed the evaluation of cavitation effects. Tip-to-tissue interaction at high speed was evaluated using human cataract fragments. Particle imaging velocimetry showed the following flow patterns for longitudinal and torsional modes at high US powers: forward-directed streaming with longitudinal mode and backward-directed streaming with torsional mode. The ultrasound power threshold for the appearance of cavitation was 60% for longitudinal mode and 80% for torsional mode. Cavitation was suppressed with pressure of 1.0 bar for longitudinal mode and 0.3 bar for torsional mode. Generation of previously unseen stable gaseous microbubbles was noted. Tip-to-tissue interaction analysis showed the presence of cavitation bubbles close to the site of fragmentation with no apparent effect on cutting. High-speed imaging and particle image velocimetry yielded a better understanding and differentiated the fluidic pattern behavior between longitudinal and torsional US during phacoemulsification. These recordings also showed more detailed aspects of cavitation that clarified its role in lens material cutting for both modalities. Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Cumulative probability of neodymium: YAG laser posterior capsulotomy after phacoemulsification.

PubMed

Ando, Hiroshi; Ando, Nobuyo; Oshika, Tetsuro

2003-11-01

To retrospectively analyze the cumulative probability of neodymium:YAG (Nd:YAG) laser posterior capsulotomy after phacoemulsification and to evaluate the risk factors. Ando Eye Clinic, Kanagawa, Japan. In 3997 eyes that had phacoemulsification with an intact continuous curvilinear capsulorhexis, the cumulative probability of posterior capsulotomy was computed by Kaplan-Meier survival analysis and risk factors were analyzed using the Cox proportional hazards regression model. The variables tested were sex; age; type of cataract; preoperative best corrected visual acuity (BCVA); presence of diabetes mellitus, diabetic retinopathy, or retinitis pigmentosa; type of intraocular lens (IOL); and the year the operation was performed. The IOLs were categorized as 3-piece poly(methyl methacrylate) (PMMA), 1-piece PMMA, 3-piece silicone, and acrylic foldable. The cumulative probability of capsulotomy after cataract surgery was 1.95%, 18.50%, and 32.70% at 1, 3, and 5 years, respectively. Positive risk factors included a better preoperative BCVA (P =.0005; risk ratio [RR], 1.7; 95% confidence interval [CI], 1.3-2.5) and the presence of retinitis pigmentosa (P<.0001; RR, 6.6; 95% CI, 3.7-11.6). Women had a significantly greater probability of Nd:YAG laser posterior capsulotomy (P =.016; RR, 1.4; 95% CI, 1.1-1.8). The type of IOL was significantly related to the probability of Nd:YAG laser capsulotomy, with the foldable acrylic IOL having a significantly lower probability of capsulotomy. The 1-piece PMMA IOL had a significantly higher risk than 3-piece PMMA and 3-piece silicone IOLs. The probability of Nd:YAG laser capsulotomy was higher in women, in eyes with a better preoperative BCVA, and in patients with retinitis pigmentosa. The foldable acrylic IOL had a significantly lower probability of capsulotomy.

Association of biometric factors with anterior chamber angle widening and intraocular pressure reduction after uneventful phacoemulsification for cataract.

PubMed

Huang, Guofu; Gonzalez, Eduardo; Lee, Roland; Chen, Yi-Chun; He, Mingguang; Lin, Shan C

2012-01-01

To evaluate anterior chamber biometric factors associated with the degree of angle widening and intraocular pressure (IOP) reduction after phacoemulsification. University of California, San Francisco, California, USA. Case series. Anterior chamber parameters obtained by anterior segment coherence tomography were compared preoperatively and 3 months postoperatively. Measurements included the angle opening distance 500 μm anterior to the scleral spur (AOD500), trabecular-iris space area 500 μm from the scleral spur (TISA500), iris curvature (I-Curv), anterior chamber angle (ACA), trabecular-iris space area, anterior chamber volume, anterior chamber width, and lens vault (LV). The study enrolled 73 eyes. The mean patient age was 77.45 years ± 7.84 (SD); 65.75% of patients were women. From preoperatively to 3 months postoperatively, the mean AOD500 increased significantly (0.254 ± 0.105 to 0.433 ± 0.108 mm) and the mean IOP decreased significantly (14.97 ± 3.35 to 12.62 ± 3.37 mm Hg) (P<.001). The reduction in IOP was correlated with the increase in AOD500 (r = 0.240, P=.041) and preoperative LV (r = 0.235, P=.045). After adjusting for related factors, AOD500 widening was positively correlated with LV (β = 0.458, P=.044) and I-Curv (β = 0.235, P=.043) and negatively correlated with preoperative TISA500 (β = -0.269, P=.025) and ACA (β = -0.919, P=.027). Surgically induced AOD widening was significantly correlated with anterior chamber biometric factors. Preoperative LV appears to be a significant factor in angle widening and IOP reduction after phacoemulsification. Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Entropic Imaging of Cataract Lens: An In Vitro Study

PubMed Central

Shung, K. Kirk; Tsui, Po-Hsiang; Fang, Jui; Ma, Hsiang-Yang; Wu, Shuicai; Lin, Chung-Chih

2014-01-01

Phacoemulsification is a common surgical method for treating advanced cataracts. Determining the optimal phacoemulsification energy depends on the hardness of the lens involved. Previous studies have shown that it is possible to evaluate lens hardness via ultrasound parametric imaging based on statistical models that require data to follow a specific distribution. To make the method more system-adaptive, nonmodel-based imaging approach may be necessary in the visualization of lens hardness. This study investigated the feasibility of applying an information theory derived parameter – Shannon entropy from ultrasound backscatter to quantify lens hardness. To determine the physical significance of entropy, we performed computer simulations to investigate the relationship between the signal-to-noise ratio (SNR) based on the Rayleigh distribution and Shannon entropy. Young's modulus was measured in porcine lenses, in which cataracts had been artificially induced by the immersion in formalin solution in vitro. A 35-MHz ultrasound transducer was used to scan the cataract lenses for entropy imaging. The results showed that the entropy is 4.8 when the backscatter data form a Rayleigh distribution corresponding to an SNR of 1.91. The Young's modulus of the lens increased from approximately 8 to 100 kPa when we increased the immersion time from 40 to 160 min (correlation coefficient r = 0.99). Furthermore, the results indicated that entropy imaging seemed to facilitate visualizing different degrees of lens hardening. The mean entropy value increased from 2.7 to 4.0 as the Young's modulus increased from 8 to 100 kPa (r = 0.85), suggesting that entropy imaging may have greater potential than that of conventional statistical parametric imaging in determining the optimal energy to apply during phacoemulsification. PMID:24760103

Combined glaucoma and cataract surgery: Comparison of viscocanalostomy, endocyclophotocoagulation, and ab interno trabeculectomy.

PubMed

Moghimi, Sasan; Hamzeh, Nikoo; Mohammadi, Massood; Khatibi, Nassim; Bowd, Christopher; Weinreb, Robert N

2018-05-01

To compare outcomes of phacoemulsification combined with viscocanalostomy, endocyclophotocoagulation (ECP), or ab interno trabulectomy for intraocular pressure (IOP) control and safety in eyes with open-angle glaucoma and visually significant cataract. Farabi Eye Hospital, Tehran, Iran. Retrospective case series. Medical records of patients who had combined surgery and were followed for at least 1 year were reviewed. Complete success, postoperative IOP, number of medications at each visit, and complications were evaluated and compared before and after adjustments for confounders. Forty-six eyes had combined phacoviscocanalostomy, 35 had phaco-ECP, and 28 eyes phaco-ab interno trabulectomy. The groups were matched for baseline IOP (P = .24). At the final follow-up (mean 17.2 months ± 5.5 [SD]), the phacoviscocanalostomy group had the lowest mean IOP (13.5 ± 4.7 mm Hg, 29% decrease) (P = .01). There was no significant difference in the final IOP between phaco-ECP and phaco-ab interno trabulectomy (16.4 ± 3.9 mm Hg, 20% decrease versus 15.8 ± 4.2 mm Hg, 15% decrease) (P = .88). The reduction in the number of medications was greater with phacoviscocanalostomy (77%) than with phaco-ECP (40%) and phaco-ab interno trabulectomy (44%) (P = .01). Phacoemulsification-ab interno trabulectomy had the fewest complications. Intraocular pressure spikes were more frequent in the phaco-ECP group (20%) than in the other groups (4%) (P = .05). All procedures significantly lowered IOP. Phacoemulsification-ab interno trabulectomy resulted in fewest complications and phacoviscocanalostomy led to the largest IOP drop and largest reduction of medications. Copyright © 2018 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

A comparison between internal and surface temperature measurement techniques during phacoemulsification cataract surgery: thermocamera versus thermocouple.

PubMed

Innocenti, B; Diciotti, S; Bocchi, L; Mencucci, R; Corvi, A

2008-01-01

Corneal and scleral burns, one of the main complications that can occur during a cataract operation, are produced by overheating due to the use of the phacoemulsifier. The temperature of the anterior chamber of the eye can be measured both invasively using thermocouples and non-invasively, but only superficially, using a thermocamera. To compare the measures obtained from both techniques an in vitro experimental analysis was conducted on pigs' eyes. During a simulated phacoemulsification cataract operation both the surface temperature with a thermocamera and the temperature inside the anterior chamber with a thermocouple were recorded. For each procedure, the maximum temperature values measured by each technique were compared. The results of this research show that the difference between the maximum values measured with the two techniques is on average 0.5 degrees C. It is possible to employ a thermocamera technique instead of a thermocouple technique to provide an indication of the temperature inside the anterior chamber.

Use of Scheimpflug imaging in the management of intra-lenticular foreign body.

PubMed

Singh, R; Ram, J; Gupta, R

2015-01-01

Asymptomatic traumatic intra-lenticular foreign body is very uncommon and few case reports have been published. To report a case of post-traumatic intra-lenticular foreign body and use of Scheimpflug imaging in its management. A 41-year-old male with history of injury to right eye during hammering a chisel 1 year back presented with decreased vision since 6 months. An intra-lenticular foreign body was found on slit lamp bio-microscopy and was confrmed by Scheimpflug imaging. Posterior capsule was intact on Scheimpflug imaging. Thus, Scheimpflug imaging helps in exact localization of the foreign body in the intralenticular space or behind the iris. We ruled out other foreign bodies by x-ray and ultrasonography of the orbit. The foreign body with post-traumatic cataract was removed using phacoemulsification and three piece foldable intraocular lens was implanted in the bag. An intra- lenticular foreign body may remain asymptomatic for months. Scheimpflug imaging can be useful in its localization. It can be removed during phacoemulsification. © NEPjOPH.

Laser-assisted cataract surgery: benefits and barriers.

PubMed

Hatch, Kathryn M; Talamo, Jonathan H

2014-01-01

The use of the femtosecond laser (FSL) in cataract surgery may represent the largest advancement in the field since the inception of phacoemulsification. The goal of this review is to outline the benefits of and barriers to this technology. There are several significant potential benefits of the FSL in cataract surgery over conventional manual cataract surgery: precise capsulotomy formation, clear corneal and limbal relaxing incision construction, lens fragmentation, and lens softening. Evidence suggests that refractive benefits include more precise effective lens position as well as reduced effective phacoemulsification time with the use of FSL compared with manual surgery. Patients with conditions such as Fuchs' endothelial dystrophy, pseudoexfoliation, history of trauma, or brunescent cataracts may particularly benefit from this technology. There are significant financial and logistical issues to consider prior to the purchase of a FSL, including the cost of the laser, and charges to patients, and how the laser affects the patient flow in the operating room. The FSL may significantly change the current approach to cataract surgery.

Serial corneal endothelial cell loss with lathe-cut and injection-molded posterior chamber intraocular lenses.

PubMed

Kraff, M C; Sanders, D R; Lieberman, H L

1983-01-01

We compared endothelial cell loss of patients implanted with lathe-cut posterior chamber lenses and those implanted with injection-molded lenses over a three-year postoperative period. Results were based on more than 2,500 measurements of corneal endothelial density. Although the technique of cataract extraction (anterior chamber phacoemulsification, posterior chamber phacoemulsification, or planned extracapsular extraction) significantly affected cell loss (P less than .01), the type of implant (lathe-cut or injection-molded) did not. Significant continuing endothelial cell loss did not occur during the first three postoperative years with injection-molded lenses. There was, however, a statistically significant 7% to 15% additional cell loss after surgery over the first two to three postoperative years with lathe-cut implants. There have been no cases of corneal endothelial decompensation developing after implantation of injection-molded or lathe-cut lenses. Because a standard field clinical specular microscope was used in this study, cell counting errors cannot be ruled out as a cause of these findings.

Ab interno trabeculectomy: patient selection and perspectives

PubMed Central

Vinod, Kateki; Gedde, Steven J

2016-01-01

Ab interno trabeculectomy is one among several recently introduced minimally invasive glaucoma surgeries that avoid a conjunctival incision and full-thickness sclerostomy involved in traditional glaucoma surgery. Ablation of the trabecular meshwork and inner wall of Schlemm’s canal is performed in an arcuate fashion via a clear corneal incision, alone or in combination with phacoemulsification cataract surgery. Intraocular pressure reduction following ab interno trabeculectomy is limited by resistance in distal outflow pathways and generally stabilizes in the mid-to-high teens. Relief of medication burden has been demonstrated by some studies. A very low rate of complications, most commonly transient hyphema and intraocular pressure elevations in the immediate postoperative period, have been reported. However, available data are derived from small retrospective and prospective case series. Randomized, controlled trials are needed to better elucidate the potential merits of ab interno trabeculectomy in the combined setting versus phacoemulsification cataract surgery alone and to compare it with other minimally invasive glaucoma surgeries. PMID:27574396

iStent trabecular micro-bypass stent for open-angle glaucoma

PubMed Central

Le, Kim; Saheb, Hady

2014-01-01

Trabecular micro-bypass stents, commonly known as iStents, are micro-invasive glaucoma surgery (MIGS) devices used to treat open-angle glaucoma. Like other MIGS procedures that enhance trabecular outflow, the iStent lowers intraocular pressure (IOP) by creating a direct channel between the anterior chamber and Schlemm’s canal. iStents are typically implanted at the time of phacoemulsification for patients with open-angle glaucoma and visually significant cataracts. This review summarizes the published data regarding the efficacy, safety, and cost considerations of trabecular micro-bypass stents. Most studies found statistically significant reductions in mean IOP and ocular medication use after combined phacoemulsification with single or double iStent implantation. The devices were found to be very safe, with a safety profile similar to that of cataract surgery. Complications were infrequent, with the most common complications being temporary stent obstruction or malposition, which resolved with observation or secondary procedures. Future studies are needed to evaluate long-term outcomes, patient satisfaction, cost effectiveness, and expanded indications. PMID:25284980

Learning micro incision surgery without the learning curve

PubMed Central

Navin, Shoba; Parikh, Rajul

2008-01-01

We describe a method of learning micro incision cataract surgery painlessly with the minimum of learning curves. A large-bore or standard anterior chamber maintainer (ACM) facilitates learning without change of machine or preferred surgical technique. Experience with the use of an ACM during phacoemulsification is desirable. PMID:18292624

A computer system for the collection and analysis of information for cataract

NASA Astrophysics Data System (ADS)

Kirillovykh, K. D.; Nikitaev, V. G.; Ulin, S. E.; Polyakov, E. V.; Trubilin, V. N.; Orlova, O. M.

2017-01-01

Automation system for ophthalmologist proposed. The system allows to collect anamnesis(pre-history) using a questionnaire. Its use contributes to the early detection of cataracts. This system will allow the doctor to choose the possible types of intraocular lenses for phacoemulsification. Results of system work are shown.

An evaluation of intraoperative and postoperative outcomes of torsional mode versus longitudinal ultrasound mode phacoemulsification: a Meta-analysis.

PubMed

Leon, Pia; Umari, Ingrid; Mangogna, Alessandro; Zanei, Andrea; Tognetto, Daniele

2016-01-01

To evaluate and compare the intraoperative parameters and postoperative outcomes of torsional mode and longitudinal mode of phacoemulsification. Pertinent studies were identified by a computerized MEDLINE search from January 2002 to September 2013. The Meta-analysis is composed of two parts. In the first part the intraoperative parameters were considered: ultrasound time (UST) and cumulative dissipated energy (CDE). The intraoperative values were also distinctly considered for two categories (moderate and hard cataract group) depending on the nuclear opacity grade. In the second part of the study the postoperative outcomes as the best corrected visual acuity (BCVA) and the endothelial cell loss (ECL) were taken in consideration. The UST and CDE values proved statistically significant in support of torsional mode for both moderate and hard cataract group. The analysis of BCVA did not present statistically significant difference between the two surgical modalities. The ECL count was statistically significant in support of torsional mode (P<0.001). The Meta-analysis shows the superiority of the torsional mode for intraoperative parameters (UST, CDE) and postoperative ECL outcomes.

An evaluation of intraoperative and postoperative outcomes of torsional mode versus longitudinal ultrasound mode phacoemulsification: a Meta-analysis

PubMed Central

Leon, Pia; Umari, Ingrid; Mangogna, Alessandro; Zanei, Andrea; Tognetto, Daniele

2016-01-01

AIM To evaluate and compare the intraoperative parameters and postoperative outcomes of torsional mode and longitudinal mode of phacoemulsification. METHODS Pertinent studies were identified by a computerized MEDLINE search from January 2002 to September 2013. The Meta-analysis is composed of two parts. In the first part the intraoperative parameters were considered: ultrasound time (UST) and cumulative dissipated energy (CDE). The intraoperative values were also distinctly considered for two categories (moderate and hard cataract group) depending on the nuclear opacity grade. In the second part of the study the postoperative outcomes as the best corrected visual acuity (BCVA) and the endothelial cell loss (ECL) were taken in consideration. RESULTS The UST and CDE values proved statistically significant in support of torsional mode for both moderate and hard cataract group. The analysis of BCVA did not present statistically significant difference between the two surgical modalities. The ECL count was statistically significant in support of torsional mode (P<0.001). CONCLUSION The Meta-analysis shows the superiority of the torsional mode for intraoperative parameters (UST, CDE) and postoperative ECL outcomes. PMID:27366694

Relationship between preoperative axis of astigmatism and postoperative astigmatic change after superior scleral incision phacoemulsification.

PubMed

Lyhne, N; Hansen, T E; Corydon, L

1998-07-01

To evaluate the effect of the preoperative axis of astigmatism on the outcome of corneal astigmatism after sutured 5.2 to 5.7 mm superior incision phacoemulsification. Departments of Opthalmology, Odense and Vejle Hospitals, Denmark. Seventy-three consecutive patients with preoperative corneal astigmatism of 2.0 diopters (D) or less, axial length between 20.0 and 25.5 mm, and no eye disease except cataract were grouped according to preoperative with-the-rule (WTR) or against-the-rule (ATR) astigmatism. The keratometric cylinder, induced keratometric cylinder (subtraction), and induced cylinder (Jaffe) were measured and calculated 10 to 12 months postoperatively. The postoperative keratometric cylinder and induced keratometric cylinder were significantly higher in the ATR group (P < .00001; mean difference [95% confidence limits]: 0.76 D [0.54; 0.98] and 0.69 D [0.46; 0.92], respectively). There was no significant difference between groups in induced cylinder (Jaffe). The estimated differences were significantly in favor of patients with preoperative WTR astigmatism. The findings support using temporal incision in cases with a preoperative ATR axis of astigmatism.

Effect of prophylactic topical hypotensive medications in reducing the incidence of postoperative ocular hypertension after phacoemulsification in dogs.

PubMed

Dees, D Dustin; Spahn, Kate J; Wagner, Lynsey Smith; Greller, Andrew; Paglia, Danielle; Armour, Micki D; Madsen, Richard

2017-11-01

To determine whether topical hypotensive medications prevent postoperative ocular hypertension (POH) after phacoemulsification. 52 client-owned dogs (88 eyes). Diabetic and nondiabetic dogs having undergone phacoemulsification were included in this retrospective study. The control group received no ocular hypotensive medications. The treatment groups received latanoprost, dorzolamide, or dorzolamide/timolol, beginning immediately after surgery, for 2-week duration. IOPs were obtained at initial examination followed by 4 h, 24 h, 7 days, and 14 days postoperatively. POH was defined as an IOP above 20 mmHg (POH20) or 25 mmHg (POH25). POH20 occurred in 33 of 87 eyes (37.93%), including 11 of 21 eyes (52.38%) in the control group, three of 23 eyes (13.04%) in the latanoprost group, eight of 15 eyes (53.33%) in the dorzolamide group, and 11 of 28 eyes (39.29%) in the dorzolamide/timolol group. Active treatment groups were compared to the control group, and the overall group effect was not significant (P = 0.11). POH25 occurred in 22 of 86 eyes (25.58%), including seven of 21 eyes (33.33%) in the control group, two of 23 eyes (8.70%) in the latanoprost group, five of 15 eyes (33.33%) in the dorzolamide group, and eight of 27 eyes (29.63%) in the dorzolamide/timolol group. Active treatment groups were compared to the control group, and the overall group effect was not significant (P = 0.31). Intraoperative use of intracameral tissue plasminogen activator significantly decreased the chances of POH25 (P = 0.0063). The latanoprost group had a substantially lower percentage of POH 20 and POH25 compared to the control and other active treatment groups, although statistical significance was not achieved. Intraoperative intracameral tissue plasminogen activator decreased the incidence of POH25. © 2017 American College of Veterinary Ophthalmologists.

Bromfenac 0.09% bioavailability in aqueous humor, prophylactic effect on cystoid macular edema, and clinical signs of ocular inflammation after phacoemulsification in a Mexican population

PubMed Central

Palacio, Claudia; Fernández De Ortega, Lourdes; Bustos, Francisco R; Chávez, Eduardo; Oregon-Miranda, Aldo A; Mercado-Sesma, Arieh R

2016-01-01

Purpose The purpose of this study was to evaluate the aqueous humor bioavailability and clinical efficacy of bromfenac 0.09% vs nepafenac on the presence of cystoid macular edema (CME) after phacoemulsification. Material and methods A Phase II, double-blind, masked, active-controlled, multicenter, clinical trial of 139 subjects, randomized to either a bromfenac 0.09% ophthalmic solution (n=69) or nepafenac 0.1% (n=70). Subjects instilled a drop three times a day for a period of 30 days. Follow-up visits were on days 2, 7, 15, 30, and 60. Biomicroscopy, clinical ocular signs, and assessment of posterior segment were performed. The primary efficacy endpoints included the presence of CME evaluated by optical coherence tomography. Safety evaluation included intraocular pressure, transaminase enzymes, lissamine green, and fluorescein stain. Results The demographic and efficacy variables were similar between groups at baseline. The presence of pain, photophobia, conjunctival hyperemia, chemosis, cellularity, and corneal edema disappeared by day 30 in both groups. The central retinal thickness did not show significant changes after treatment when compared to baseline as follows: in the bromfenac group (247.2±32.9 vs 252.0±24.9 μm; P=0.958) and in nepafenac group (250.8±34 vs 264.0±34.1 μm; P=0.137), respectively. A statistically significant difference was observed between bromfenac and nepafenac group: (252.0±24.9 vs 264.0±34.1 μm; P=0.022), at day 30, respectively; even though there was no clinical relevance in the presentation of CME. There were no significant alterations in intraocular pressure, either lissamine green or fluorescein stains. The adverse events were not related to the interventions. Conclusion Bromfenac 0.09% ophthalmic solution showed similar clinical efficacy to reduce the presentation of CME after phacoemulsification compared to nepafenac 0.01%. PMID:26869758

Bromfenac 0.09% bioavailability in aqueous humor, prophylactic effect on cystoid macular edema, and clinical signs of ocular inflammation after phacoemulsification in a Mexican population.

PubMed

Palacio, Claudia; Fernández De Ortega, Lourdes; Bustos, Francisco R; Chávez, Eduardo; Oregon-Miranda, Aldo A; Mercado-Sesma, Arieh R

2016-01-01

The purpose of this study was to evaluate the aqueous humor bioavailability and clinical efficacy of bromfenac 0.09% vs nepafenac on the presence of cystoid macular edema (CME) after phacoemulsification. A Phase II, double-blind, masked, active-controlled, multicenter, clinical trial of 139 subjects, randomized to either a bromfenac 0.09% ophthalmic solution (n=69) or nepafenac 0.1% (n=70). Subjects instilled a drop three times a day for a period of 30 days. Follow-up visits were on days 2, 7, 15, 30, and 60. Biomicroscopy, clinical ocular signs, and assessment of posterior segment were performed. The primary efficacy endpoints included the presence of CME evaluated by optical coherence tomography. Safety evaluation included intraocular pressure, transaminase enzymes, lissamine green, and fluorescein stain. The demographic and efficacy variables were similar between groups at baseline. The presence of pain, photophobia, conjunctival hyperemia, chemosis, cellularity, and corneal edema disappeared by day 30 in both groups. The central retinal thickness did not show significant changes after treatment when compared to baseline as follows: in the bromfenac group (247.2±32.9 vs 252.0±24.9 μm; P=0.958) and in nepafenac group (250.8±34 vs 264.0±34.1 μm; P=0.137), respectively. A statistically significant difference was observed between bromfenac and nepafenac group: (252.0±24.9 vs 264.0±34.1 μm; P=0.022), at day 30, respectively; even though there was no clinical relevance in the presentation of CME. There were no significant alterations in intraocular pressure, either lissamine green or fluorescein stains. The adverse events were not related to the interventions. Bromfenac 0.09% ophthalmic solution showed similar clinical efficacy to reduce the presentation of CME after phacoemulsification compared to nepafenac 0.01%.

Torsional ultrasound mode versus combined torsional and conventional ultrasound mode phacoemulsification for eyes with hard cataract.

PubMed

Fakhry, Mohamed A; El Shazly, Malak I

2011-01-01

To compare torsional versus combined torsional and conventional ultrasound modes in hard cataract surgery regarding ultrasound energy and time and effect on corneal endothelium. Kasr El Aini hospital, Cairo University, and International Eye Hospital, Cairo, Egypt. Ninety-eight eyes of 63 patients were enrolled in this prospective comparative randomized masked clinical study. All eyes had nuclear cataracts of grades III and IV using the Lens Opacities Classification System III (LOCS III). Two groups were included, each having an equal number of eyes (49). The treatment for group A was combined torsional and conventional US mode phacoemulsification, and for group B torsional US mode phacoemulsification only. Pre- and post-operative assessments included best corrected visual acuity (BCVA), intraocular pressure (IOP), slit-lamp evaluation, and fundoscopic evaluation. Endothelial cell density (ECD) and central corneal thickness (CCT) were measured preoperatively, 1 day, 7 days, and 1 month postoperatively. All eyes were operated on using the Alcon Infiniti System (Alcon, Fort Worth, TX) with the quick chop technique. All eyes were implanted with AcrySof SA60AT (Alcon) intraocular lens (IOL). The main phaco outcome parameters included the mean ultrasound time (UST), the mean cumulative dissipated energy (CDE), and the percent of average torsional amplitude in position 3 (%TUSiP3). Improvement in BCVA was statistically significant in both groups (P < 0.001). Comparing UST and CDE for both groups revealed results favoring the pure torsional group (P = 0.002 and P < 0.001 for UST; P = 0.058 and P = 0.009 for CDE). As for %TUSiP3, readings were higher for the pure torsional group (P = 0.03 and P = 0.01). All changes of CCT, and ECD over time were found statistically significant using one-way ANOVA testing (P < 0.001). Both modes are safe in hard cataract surgery, however the pure torsional mode showed less US energy used.

Torsional ultrasound mode versus combined torsional and conventional ultrasound mode phacoemulsification for eyes with hard cataract

PubMed Central

Fakhry, Mohamed A; Shazly, Malak I El

2011-01-01

Purpose To compare torsional versus combined torsional and conventional ultrasound modes in hard cataract surgery regarding ultrasound energy and time and effect on corneal endothelium. Settings Kasr El Aini hospital, Cairo University, and International Eye Hospital, Cairo, Egypt. Methodology Ninety-eight eyes of 63 patients were enrolled in this prospective comparative randomized masked clinical study. All eyes had nuclear cataracts of grades III and IV using the Lens Opacities Classification System III (LOCS III). Two groups were included, each having an equal number of eyes (49). The treatment for group A was combined torsional and conventional US mode phacoemulsification, and for group B torsional US mode phacoemulsification only. Pre- and post-operative assessments included best corrected visual acuity (BCVA), intraocular pressure (IOP), slit-lamp evaluation, and fundoscopic evaluation. Endothelial cell density (ECD) and central corneal thickness (CCT) were measured preoperatively, 1 day, 7 days, and 1 month postoperatively. All eyes were operated on using the Alcon Infiniti System (Alcon, Fort Worth, TX) with the quick chop technique. All eyes were implanted with AcrySof SA60AT (Alcon) intraocular lens (IOL). The main phaco outcome parameters included the mean ultrasound time (UST), the mean cumulative dissipated energy (CDE), and the percent of average torsional amplitude in position 3 (%TUSiP3). Results Improvement in BCVA was statistically significant in both groups (P < 0.001). Comparing UST and CDE for both groups revealed results favoring the pure torsional group (P = 0.002 and P < 0.001 for UST; P = 0.058 and P = 0.009 for CDE). As for %TUSiP3, readings were higher for the pure torsional group (P = 0.03 and P = 0.01). All changes of CCT, and ECD over time were found statistically significant using one-way ANOVA testing (P < 0.001). Conclusion Both modes are safe in hard cataract surgery, however the pure torsional mode showed less US energy used. PMID:21792288

Two-Year COMPASS Trial Results: Supraciliary Microstenting with Phacoemulsification in Patients with Open-Angle Glaucoma and Cataracts.

PubMed

Vold, Steven; Ahmed, Iqbal Ike K; Craven, E Randy; Mattox, Cynthia; Stamper, Robert; Packer, Mark; Brown, Reay H; Ianchulev, Tsontcho

2016-10-01

We evaluated 2-year safety and efficacy of supraciliary microstenting (CyPass Micro-Stent; Transcend Medical, Inc., Menlo Park, CA) for treating mild-to-moderate primary open-angle glaucoma (POAG) in patients undergoing cataract surgery. Multicenter (24 US sites), interventional randomized clinical trial (RCT) (ClinicalTrials.gov identifier, NCT01085357). Subjects were enrolled beginning July 2011, with study completion in March 2015. Subjects had POAG with mean diurnal unmedicated intraocular pressure (IOP) 21-33 mmHg and were undergoing phacoemulsification cataract surgery. After completing cataract surgery, subjects were intraoperatively randomized to phacoemulsification only (control) or supraciliary microstenting with phacoemulsification (microstent) groups (1:3 ratio). Microstent implantation via an ab interno approach to the supraciliary space allowed concomitant cataract and glaucoma surgery. Outcome measures included percentage of subjects achieving ≥20% unmedicated diurnal IOP lowering versus baseline, mean IOP change and glaucoma medication use, and ocular adverse event (AE) incidence through 24 months. Of 505 subjects, 131 were randomized to the control group and 374 were randomized to the microstent group. Baseline mean IOPs in the control and microstent groups were similar: 24.5±3.0 and 24.4±2.8 mmHg, respectively (P > 0.05); mean medications were 1.3±1.0 and 1.4±0.9, respectively (P > 0.05). There was early and sustained IOP reduction, with 60% of controls versus 77% of microstent subjects achieving ≥20% unmedicated IOP lowering versus baseline at 24 months (P = 0.001; per-protocol analysis). Mean IOP reduction was ↓7.4 mmHg for the microstent group versus ↓5.4 mmHg in controls (P < 0.001), with 85% of microstent subjects not requiring IOP medications at 24 months. Mean 24-month medication use was 67% lower in microstent subjects (P < 0.001); 59% of control versus 85% of microstent subjects were medication free. Mean medication use in controls decreased from 1.3±1.0 drugs at baseline to 0.7±0.9 and 0.6±0.8 drugs at 12 and 24 months, respectively, and in the microstent group from 1.4±0.9 to 0.2±0.6 drugs at both 12 and 24 months (P < 0.001 for reductions in both groups at both follow-ups vs. baseline). No vision-threatening microstent-related AEs occurred. Visual acuity was high in both groups through 24 months; >98% of all subjects achieved 20/40 best-corrected visual acuity or better. This RCT demonstrated safe and sustained 2-year reduction in IOP and glaucoma medication use after microinterventional surgical treatment for mild-to-moderate POAG. Copyright © 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

INTRAOCULAR LENS POSITION IN COMBINED PHACOEMULSIFICATION AND VITREORETINAL SURGERY.

PubMed

Ozates, Serdar; Kiziltoprak, Hasan; Koc, Mustafa; Uzel, Mehmet Murat; Teke, Mehmet Yasin

2017-10-09

To assess the decentration and angle of tilt of the intraocular lens (IOL) according to the intravitreal tamponade types used in combined phacoemulsification and vitreoretinal surgery. This prospective and randomized clinical study involved 73 eyes of 69 patients who underwent combined vitreoretinal surgery. Eyes with intravitreal tamponades formed the study group and eyes without intravitreal tamponades formed the control group. The study group was further divided into silicone oil and gas tamponade subgroups. Cross-sectional IOL images were captured using a Pentacam HR (Oculus, Germany) and tilt and decentration were calculated with Adobe Photoshop software (Adobe, San Jose, CA). The mean angle of tilt and decentration at the vertical meridian were significantly higher in both tamponade groups than in the control group (P < 0.05 for all). No significant difference was observed among the groups regarding IOL position parameters at the horizontal meridian (P > 0.05). When comparing the silicone oil and gas tamponade subgroups, no significant differences were noted on the position of IOL at both meridians (P > 0.05 for all). Intravitreal tamponades have an important effect on the position of IOL in combined vitreoretinal surgery. Silicone oil and gas tamponades may induce postoperative tilt and decentration of one-piece acrylic IOLs.

A systematic review of phacoemulsification cataract surgery in virtual reality simulators.

PubMed

Lam, Chee Kiang; Sundaraj, Kenneth; Sulaiman, Mohd Nazri

2013-01-01

The aim of this study was to review the capability of virtual reality simulators in the application of phacoemulsification cataract surgery training. Our review included the scientific publications on cataract surgery simulators that had been developed by different groups of researchers along with commercialized surgical training products, such as EYESI® and PhacoVision®. The review covers the simulation of the main cataract surgery procedures, i.e., corneal incision, capsulorrhexis, phacosculpting, and intraocular lens implantation in various virtual reality surgery simulators. Haptics realism and visual realism of the procedures are the main elements in imitating the actual surgical environment. The involvement of ophthalmology in research on virtual reality since the early 1990s has made a great impact on the development of surgical simulators. Most of the latest cataract surgery training systems are able to offer high fidelity in visual feedback and haptics feedback, but visual realism, such as the rotational movements of an eyeball with response to the force applied by surgical instruments, is still lacking in some of them. The assessment of the surgical tasks carried out on the simulators showed a significant difference in the performance before and after the training.

Manual small incision extracapsular cataract surgery in Australia.

PubMed

van Zyl, Lourens; Kahawita, Shyalle; Goggin, Michael

2014-11-01

Examination of the results and describing the technique of manual small incision extracapsular cataract extraction on patients with advanced cataracts in urban Australia. A descriptive case series. Thirty-eight patients at three public hospitals, one tertiary and two secondary ophthalmic units in urban Australia. Forty eyes with dense mature cataracts with hand movement vision or worse underwent a planned manual small incision extracapsular cataract extraction instead of traditional phaco-emulsification. Postoperative visual aquity, surgically induced astigmatism and complications. Seventy-eight per cent of patients had an uncorrected visual acuity of 6/12 or better on the first postoperative day. Eighty-three per cent of patients had a distance corrected visual acuity of 6/9 or better 3 months postoperatively. One case was complicated by a posterior capsule rupture. No cases of endophthalmitis were reported. The summated vector mean of the surgically induced astigmatism was 0.089D at 93°. Manual small incision extracapsular cataract extraction is an efficacious cataract surgery technique with good visual outcome and is a safe alternative to phaco-emulsification in suitable cases in a first-world setting. © 2014 Royal Australian and New Zealand College of Ophthalmologists.

[Comparison of two kinds of artificial tears on the dry eye after phacoemulsification].

PubMed

You, R; Wang, J; Han, Y; Liu, L J; Wang, W Y

2017-06-11

Objective: To compare the curative effect of two different artificial tears on dry eye after phacoemulsification. Methods: Prospective randomized controlled clinical trial. From March to June in 2012, 102 patients (102 eyes) with age-related cataract were treated with phacoemulsification at Beijing Tongren Hospital, Capital University of Medical Sciences, and these eyes were randomly divided into blank group (group A ) 32 cases, treatment group 1 (group B) 35 cases and treatment group 2 (group C) 35 cases. Group A was treated with conventional antibiotics. Group B was sodium hyaluronate eye drop, group C was lipid-containing carbomer gel respectively. All patients finished a dry eye questionnaire called Ocular Surface Disease Index (OSDI), and Schimmer's test (SIt), break up time (BUT) and fluorescein staining (FL) tests were performed before surgery and at 7, 30 and 90 days after surgery respectively. Optometry were performed at 90 days after surgery. The χ(2) test was used to analyze the sex of the patients, and the age of the patients was analyzed by one-way ANOVA. Partial data in eye tests and in OSDI does not meet the normal distribution. Therefore, they were analyzed by Kruskal-Wallis H test. If significant difference existed, these data were then analyzed by independent sample Wilcoxon rank sum test. Results: Twelve patients were lost to visit within 3 months. A total of 90 patients were followed up for 90 days. The mean age of all patients was (69.5±9.5) years (46.0-89.0 years), 38 males and 64 females. There were 30 patients in Group A, group B and group C respectively. The prevalence of dry eye was 56. 7% (60/102). There was no significant difference among the three groups ( P> 0.05). OSDI questionnaire showed that OSDI score was significantly different among the three groups at 7, 30 and 90 days after operation ( H =9.89, 55.53, 45.43, P< 0.05). At 30 and 90 days after operation, the median OSDI scores were 12.50 and 10.42 in group C, respectively, which were better than those of group A scores 27.09 and 20. 8 ( Z=- 6.30, -5.94, P< 0.05), and were better than those of group B scores 17.71 and 13. 54 ( Z=- 3.40, -3.52, P< 0.05). At 90 days after operation, the median BUT of B and C treatment groups was 9. 00, which was better than that of group A (4.00). The difference was statistically significant ( H =21.51, P< 0.05), There was no significant difference between group B and group C ( Z=- 0.34, P> 0.05). Conclusion: The treatment of artificial tears with lipid composition in the early stage after phacoemulsification is beneficial to the improvement of postoperative symptoms and signs of dry eye. (Chin J Ophthalmol, 2017, 53: 445-450) .

[Optimizing the financial impact of transitioning to transconjunctival vitrectomy and microincisional phacoemulsification].

PubMed

Cornut, P-L; Soldermann, Y; Robin, C; Barranco, R; Kerhoas, A; Burillon, C

2013-12-01

To report the financial impact of using modern lens and vitreoretinal surgical techniques. Bottom-up sterilization and consumables costs for new surgical techniques (microincisional coaxial phacoemulsification and transconjunctival sutureless vitrectomy) and the corresponding former techniques (phacoemulsification with 3.2-mm incision and 20G vitrectomy) were determined. These costs were compared to each other and to the target costs of the Diagnosis Related Groups for public hospitals (Groupes Homogènes de Séjours [GHS]) concerned, extracted from the analytic accounting data of the French National Cost Study (Étude Nationale des Coûts [ENC]) for 2009 (target=sum of sterilization costs posted under medical logistics, consumables, implantable medical devices, and special pharmaceuticals posted as direct expenses). For outpatient lens surgery with or without vitrectomy (GHS code: 02C05J): the ENC's target cost for 2009 was 339€ out of a total of 1432€. The cost detailed in this study was 4 % higher than the target cost when the procedure was performed using the former technique (3.2mm sutured incision) and 12 % lower when the procedure was performed using the new technique (1.8mm sutureless) after removing now unnecessary consumables and optimization of the technique. For level I retinal detachment surgeries (GHS code: 02C021): the ENC's 2009 target cost was 641€ out of a total of 3091€. The cost specified in this study was 1 % lower than the target cost when the procedure was done using the former technique (20-G vitrectomy) and 16 % less when the procedure was performed using the new technique (transconjunctival vitrectomy) after removal of now unnecessary consumables and optimization of the technique. Contrary to generally accepted ideas, implementing modern techniques in ocular surgery can result in direct cost and sterilization savings when the operator takes advantage of the possibilities these techniques offer in terms of simplification of the procedures to do away with consumables that are no longer necessary. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Comparative Effectiveness of Three Prophylactic Strategies to Prevent Clinical Macular Edema after Phacoemulsification Surgery.

PubMed

Shorstein, Neal H; Liu, Liyan; Waxman, Michael D; Herrinton, Lisa J

2015-12-01

To study the relationship of chemoprophylaxis and other factors with the occurrence of acute, clinical, postoperative macular edema. Retrospective cohort study. The drug regimens consisted of postoperative topical prednisolone acetate (PA) alone or with a nonsteroidal anti-inflammatory drug (NSAID) or intraoperative subconjunctival injection of 2 mg triamcinolone acetonide (TA) alone. Patients undergoing phacoemulsification at Kaiser Permanente, Diablo Service Area, Northern California, from 2007 through 2013. We identified incident macular edema diagnoses that had been recorded 5 to 120 days after phacoemulsification with visual acuity 20/40 or worse and evidence of macular thickening by optical coherence tomography. Odds ratios (ORs) and 95% confidence intervals (CIs) were obtained from logistic regression analysis, conditioned on the surgeon and adjusted for year, patient age and race, diabetic retinopathy status, other ocular comorbidities, systemic comorbidities, and posterior capsular rupture status. Incident rates of acute, clinical, postoperative macular edema. We confirmed 118 cases among 16 070 cataract surgeries (incidence, 0.73%). Compared with PA alone, the OR for the relationship of macular edema with PA+NSAID was 0.45 (95% CI, 0.21-0.95) and that for TA injection was 1.21 (95% CI, 0.48-3.06). The frequency of intraocular pressure spikes of 30 mmHg or more between postoperative days 16 and 45 was 0.6% in the topical PA group, 0.3% in the topical PA+NSAID group (P = 0.13), and 0.8% for the TA group (P = 0.52). Black race was associated with a risk of macular edema (OR, 2.86; 95% CI, 1.41-5.79). Adding a prophylactic NSAID to PA treatment was associated with a reduced risk of macular edema with visual acuity of 20/40 or worse. The risk and safety of TA injection were similar to those of PA alone. Further research is needed on the prognostic significance of postoperative macular edema, the role of prophylaxis, the risk among black people, and the effectiveness of depot medications. Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Rapidly progressive idiopathic lenticular astigmatism.

PubMed

Tint, Naing L; Jayaswal, Rakesh; Masood, Imran; Maharajan, V Senthil

2007-02-01

A myopic 43-year-old woman with early nuclear sclerotic cataract developed more than 11.0 diopters (D) of astigmatism over a 6-month period. This was found to be lenticular in origin. Phacoemulsification with intraocular lens implantation was performed, resulting in residual astigmatism of 0.75 D. To our knowledge, this is the first case of rapidly progressive lenticular astigmatism in an otherwise healthy eye with early nuclear sclerotic cataract.

Laser-assisted corneal welding in cataract surgery: retrospective study.

PubMed

Menabuoni, Luca; Pini, Roberto; Rossi, Francesca; Lenzetti, Ivo; Yoo, Sonia H; Parel, Jean-Marie

2007-09-01

To evaluate the efficacy of laser welding to close corneal wounds in cataract surgery. Department of Ophthalmology, Hospital of Misericordia e Dolce, Prato, Italy. This retrospective nonrandomized interventional case series included 20 eyes of 20 patients. All eyes had cataract with visual acuity worse than 20/200. Ten patients had phacoemulsification surgery, and 10 had extracapsular cataract extraction (ECCE). Surgeries were followed by laser-assisted closure of the corneal wounds by diode laser welding of the stroma using a technique established in animal models. Preoperative and postoperative (1, 3, 7, 30, and 90 days) astigmatism, level of inflammation, Seidel testing, and endothelial cell counts were obtained. There were minor differences in preoperative and postoperative astigmatism except in 1 eye in the ECCE group. The Seidel test showed no wound leakage during the follow-up examinations, and endothelial cell loss was similar to that published for standard surgical cataract procedures. No collateral effects of the laser welding were detected, nor was postoperative inflammation. Astigmatism was slightly affected by the use of laser welding for corneal wound closure after phacoemulsification and ECCE. The laser-assisted corneal sealing procedure was rapid and safe and could serve as an alternative to corneal suturing, with significant potential applications for the closure of longer incisions, such as those used in penetrating keratoplasty.

Inadvertent trypan blue posterior capsule staining during cataract surgery.

PubMed

Burkholder, Bryn M; Srikumaran, Divya; Nanji, Afshan; Lee, Bryan; Weinberg, Robert S

2013-04-01

To report 5 cases of inadvertent posterior capsule staining with trypan blue during phacoemulsification. Retrospective, observational case series. Five cases of posterior capsule staining with trypan blue were identified from cataract surgeries performed at an academic institution. All 5 eyes underwent phacoemulsification with use of iris retractors. The surgical videos from each case were reviewed to better understand the mechanisms and risk factors for posterior capsule staining with trypan blue and techniques to avoid this complication. No eyes had clinical evidence of zonular pathology during their preoperative examination. Only 1 patient reported a possible childhood history of trauma to both eyes. One eye had uveitis, requiring posterior synechialysis. All 5 cases involved the use of iris retractors. No other intraoperative complications occurred, and the intraocular lens was successfully placed in the capsular bag in all cases. All eyes had resolution of posterior capsule staining by postoperative day 8. Inadvertent posterior capsule staining with trypan blue can occur in eyes that appear structurally normal. The use of iris retractors may facilitate posterior capsule staining by allowing the posterior flow of trypan blue under the iris and through the zonules to the posterior capsule. Surgeons should consider techniques to minimize the risk of posterior capsule staining, particularly in cases involving the use of iris retractors. Copyright © 2013 Elsevier Inc. All rights reserved.

Topical anesthesia in phacoemulsification.

PubMed

Waheeb, Saad

2010-09-01

To evaluate the efficacy of topical anesthesia; topical Benoxinate 0.4% (Oxybuprocaine) and Xylocaine (Lidocaine) gel, in selected cataract patients as an alternative to peribulbar or retrobulbar block anesthesia during cataract surgery. Prospective non-comparative evaluation of patients' and surgeon's satisfaction at the end of the procedure. Three hundred patients (300 eyes) were included in the study. The procedure was explained to patients with details regarding what will happen and what to expect during surgery. All patients received topical anesthesia with Benoxinate 0.4% eye drops and Xylocaine gel 2%. All surgeries were done by the same surgeon using the same machine (updated LEGACY phacoemulsifier, Alcon) and approach (clear corneal incision) and followed by a foldable intraocular lens (IOL) implantation. None of the patients had severe pain during the procedure; only 2% (six of 300) required use of intravenous sedation (Propofol), both the surgeon's and the patients' satisfaction were high. Eye movements and blepharospasm were not significant problems, and no serious complications occurred. Rate of vitreous loss due to posterior capsule tear/rupture was within literature reported range and not different from our previous experience. Topical anesthesia is a satisfactory and safe alternative to retrobulbar and peribulbar anesthesia for clear corneal phacoemulsification and intraocular lens implantation in selected cataract patients in the hands of experienced cataract surgeon.

Topical anesthesia in phacoemulsification

PubMed Central

Waheeb, Saad

2010-01-01

Purpose: To evaluate the efficacy of topical anesthesia; topical Benoxinate 0.4% (Oxybuprocaine) and Xylocaine (Lidocaine) gel, in selected cataract patients as an alternative to peribulbar or retrobulbar block anesthesia during cataract surgery. Materials and Methods: Prospective non-comparative evaluation of patients’ and surgeon’s satisfaction at the end of the procedure. Three hundred patients (300 eyes) were included in the study. The procedure was explained to patients with details regarding what will happen and what to expect during surgery. All patients received topical anesthesia with Benoxinate 0.4% eye drops and Xylocaine gel 2%. All surgeries were done by the same surgeon using the same machine (updated LEGACY phacoemulsifier, Alcon) and approach (clear corneal incision) and followed by a foldable intraocular lens (IOL) implantation. Results: None of the patients had severe pain during the procedure; only 2% (six of 300) required use of intravenous sedation (Propofol), both the surgeon’s and the patients’ satisfaction were high. Eye movements and blepharospasm were not significant problems, and no serious complications occurred. Rate of vitreous loss due to posterior capsule tear/rupture was within literature reported range and not different from our previous experience. Conclusion: Topical anesthesia is a satisfactory and safe alternative to retrobulbar and peribulbar anesthesia for clear corneal phacoemulsification and intraocular lens implantation in selected cataract patients in the hands of experienced cataract surgeon. PMID:21120050

The treatment of malignant glaucoma in nanophthalmos: a case report.

PubMed

Wang, Jie; Du, Ergang; Tang, Jinfei

2018-02-23

The management of eyes with nanophthalmos is a dilemma for ophthalmologists due to various complications, especial the eye with malignant glaucoma. We report a case of effective treatment for malignant glaucoma in nanophthalmos. An 82-year-old man was performed phacoemulsification in the right eye with normal ocular pressure and nanophthalmos. The surgery was uneventful: an intraocular lens (IOL) was placed and centered in the capsular bag. 2 months later, the patient presented with malignant glaucoma, and the intraocular pressure fluctuated between 18.6 mmHg and 30.8 mmHg with antiglaucoma medications. The patient did not respond to surgical peripheral iridotomy and goniosynechialysis. Then a single treatment with laser peripheral lens posterior capsulotomy and vitreous anterior membranectomy was performed. The intraocular pressure normalized, and the anterior chamber deepened within 24 h. The patient's condition remained stable for 9 months with no further treatment, and his Snellen corrected distance visual acuity was 20/50. The left eye of this patient was treated by combined surgery including phacoemulsification, IOL implantation, anterior vitrectomy, surgical peripheral iridotomy (PI), and goniosynechialysis. No intraoperative or postoperative complications were observed. This case suggests that it is essential to choose a suitable treatment for nanophthalmos patients to deal with malignant glaucoma and to reduce the incidence of malignant glaucoma.

Comparison of posterior capsule opacification at 360-degree square edge hydrophilic and sharp edge hydrophobic acrylic intraocular lens in diabetic patients

PubMed Central

Bai, Ling; Zhang, Jin; Chen, Ling; Ma, Ting; Liang, Hou-Cheng

2015-01-01

AIM To compare posterior capsule opacification (PCO) degree and visual functions after phacoemulsification in eyes implanted with 360-degree square edge hydrophilic acrylic intraocular lens (IOL) (570C C-flex, Rayner) and sharp edge hydrophobic acrylic IOL (Sensar AR40e, AMO) in diabetic patients. METHODS Sixty diabetic patients underwent uneventful phacoemulsification and randomly implanted one of the two IOLs. The PCO value was measured by retroillumination photographs and Evaluation of Posterior Capsule Opacification (EPCO) 2000 image-analysis software at 1, 6, 12, and 24mo after surgery. Visual acuity, and contrast sensitivity in photopic and mesopic conditions were also examined at each follow up time point. The incidence of eye that required Nd:YAG laser posterior capsulotomy were also compared. RESULTS There was not any statistically significant difference in PCO scores between Rayner C-flex 570C group and Sensar AR40e group at each follow up time point. Visual acuity, Nd:YAG capsulotomy incidence and contrast sensitivity also had no significant difference during the 24mo follow-up. CONCLUSION For diabetic patients, Rayner 570C C-flex and Sensar AR40e IOLs are same effective for prevent PCO. The 360-degree square edge design maybe is a good alternative technique to improve PCO prevention. PMID:26309870

Effect of bottle height and aspiration rate on postocclusion surge in Infiniti and Millennium peristaltic phacoemulsification machines.

PubMed

Ward, Matthew S; Georgescu, Dan; Olson, Randall J

2008-08-01

To assess how flow and bottle height affect postocclusion surge in the Infiniti (Alcon, Inc.) and Millennium (Bausch & Lomb) peristaltic machines. John A. Moran Eye Center Clinical Laboratories, University of Utah, Salt Lake City, Utah. Postocclusion anterior chamber depth changes were measured in human eye-bank eyes using A-scan. Surge was simulated by clamping the aspiration tubing and releasing it at maximum vacuum. In both machines, surge was measured (1) with aspiration held constant at 12 mL/min and bottle heights at 60, 120, and 180 cm and (2) with bottle height held constant at 60 cm and aspiration rates at 12, 24, and 36 mL/min. Surge decreased approximately 40% with each 60 cm increase in bottle height in the Infiniti. It was constant at all bottle heights in the Millennium. At 12 and 24 mL/min aspiration rates, surge in the Millennium was less than half that in the Infiniti (P<.001). Postocclusion surge decreased linearly with increasing bottle height in the Infiniti system and was relatively constant with increasing bottle height in the Millennium system. The Millennium may offer a more stable phacoemulsification platform with respect to surge at a higher aspiration rate.

Comparison of posterior capsule opacification at 360-degree square edge hydrophilic and sharp edge hydrophobic acrylic intraocular lens in diabetic patients.

PubMed

Bai, Ling; Zhang, Jin; Chen, Ling; Ma, Ting; Liang, Hou-Cheng

2015-01-01

To compare posterior capsule opacification (PCO) degree and visual functions after phacoemulsification in eyes implanted with 360-degree square edge hydrophilic acrylic intraocular lens (IOL) (570C C-flex, Rayner) and sharp edge hydrophobic acrylic IOL (Sensar AR40e, AMO) in diabetic patients. Sixty diabetic patients underwent uneventful phacoemulsification and randomly implanted one of the two IOLs. The PCO value was measured by retroillumination photographs and Evaluation of Posterior Capsule Opacification (EPCO) 2000 image-analysis software at 1, 6, 12, and 24mo after surgery. Visual acuity, and contrast sensitivity in photopic and mesopic conditions were also examined at each follow up time point. The incidence of eye that required Nd:YAG laser posterior capsulotomy were also compared. There was not any statistically significant difference in PCO scores between Rayner C-flex 570C group and Sensar AR40e group at each follow up time point. Visual acuity, Nd:YAG capsulotomy incidence and contrast sensitivity also had no significant difference during the 24mo follow-up. For diabetic patients, Rayner 570C C-flex and Sensar AR40e IOLs are same effective for prevent PCO. The 360-degree square edge design maybe is a good alternative technique to improve PCO prevention.

Ketorolac-tobramycin combination vs fluorometholone-tobramycin combination in reducing inflammation following phacoemulsification cataract extraction with scleral tunnel incision.

PubMed

Guzey, M; Karadede, S; Dogan, Z; Satici, A

2000-01-01

The objective of this study was to compare the efficacy of ketorolac-tobramycin combination with fluorometholone-tobramycin combination in the control of ocular inflammation after endocapsular phacoemulsification cataract surgery with scleral tunnel incision. This was a prospective, randomized, investigator masked, 2-week, single-center study. Ocular examinations were carried out preoperatively and postoperatively on days 1 (baseline), 2, 3, 7, and 14. There were 60 patients (30 in each treatment group) undergoing uncomplicated cataract-lens implant surgery enrolled and randomized in the study. The baseline parameters were similar in the two study groups. At each visit comprehensive ocular examinations were performed and a 4-point (0 to 3) grading system was used to record findings of the burning/stinging sensation, blurred vision, ocular discomfort, conjunctival hyperemia, anterior chamber flare, and anterior chamber cells. There was no statistically significant difference between the treatment groups in the findings of the ocular inflammation at any of the postoperative visits. Both treatments were equally well tolerated. This study suggests that ketorolac may be an alternative to some corticosteroids (fluorometholone). It is generally accepted that fluorometholone is not as potent an anti-inflammatory as prednisolone the most commonly used steroid following cataract extraction.

[The pros and cons of femtosecond laser-assisted cataract surgery].

PubMed

Li, Z H; Ye, Z

2016-02-01

Femtosecond laser-assisted cataract surgery (FLACS) is known as an innovative new technology. Compared with traditional surgical approach, FLACS is more accurate, more predictable and less energy used. However, in the current stage of development, there still may be intraoperative and postoperative complications, or even serious complications. FLACS has obvious advantages in certain surgical steps, but there are still clear disadvantages, so it still cannot completely replace the traditional phacoemulsification surgery.

Cyclodialysis cleft with late hypotony maculopathy after inadvertent cannula detachment during cataract surgery.

PubMed

Kahawita, Shyalle; Cugati, Sudha; Casson, Robert

2015-05-01

We present the case of a 69-year-old woman who presented with hypotony several years after an inadvertent cannula detachment presumably formed a cyclodialysis cleft during phacoemulsification cataract extraction and posterior chamber intraocular lens implantation in her right eye. To our knowledge, this is the first report of late hypotony maculopathy as a result of inadvertent cannula release. Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.

Ab interno trabecular bypass surgery with iStent for open angle glaucoma

PubMed Central

Le, Jimmy T; Bicket, Amanda K; Li, Tianjing

2018-01-01

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: The primary objective is to assess the comparative effectiveness and safety of ab interno trabecular bypass surgery with iStent or iStent inject for OAG in comparison to conventional medical, laser, or surgical treatment. A secondary objective is to examine the effectiveness and safety of iStent or iStent Inject surgery in people who have concomitant phacoemulsification. PMID:27526051

Micro-Bypass Implantation for Primary Open-Angle Glaucoma Combined with Phacoemulsification: 4-Year Follow-Up

PubMed Central

Fea, Antonio Maria; Consolandi, Giulia; Zola, Marta; Pignata, Giulia; Cannizzo, Paola; Lavia, Carlo; Rolle, Teresa; Grignolo, Federico Maria

2015-01-01

Purpose. To report the long-term follow-up results in patients with cataract and primary open-angle glaucoma (POAG) randomly assigned to cataract surgery combined with micro-bypass stent implantation or phacoemulsification alone. Methods. 36 subjects with cataract and POAG were randomized in a 1 : 2 ratio to either iStent implantation and cataract surgery (combined group) or cataract surgery alone (control group). 24 subjects agreed to be evaluated again 48 months after surgery. Patients returned one month later for unmedicated washout assessment. Results. At the long-term follow-up visit we reported a mean IOP of 15,9 ± 2,3 mmHg in the iStent group and 17 ± 2,5 mmHg in the control group (p = NS). After washout, a 14,2% between group difference in favour of the combined group was statistically significant (p = 0,02) for mean IOP reduction. A significant reduction in the mean number of medications was observed in both groups compared to baseline values (p = 0,005 in the combined group and p = 0,01 in the control group). Conclusion. Patients in the combined group maintained low IOP levels after long-term follow-up. Cataract surgery alone showed a loss of efficacy in controlling IOP over time. Both treatments reduced the number of ocular hypotensive medications prescribed. This trial is registered with: NCT00847158. PMID:26587282

Phaco chop technique for cataract surgery in the dog.

PubMed

Warren, Christi

2004-01-01

Phaco chop is a bimanual phacoemulsification technique to remove cataracts. The technique was first presented at the 1993 3rd American-International Congress on Cataract, IOL, and Refractive Surgery in Seattle by Dr Kunihiro Nagahara. He compared the lens with a block of wood and by applying chopping forces parallel to the natural planes of the lens lamellae, as one does in splitting wood, a nucleus can be cleaved with surprisingly little force and time. Dr Nagahara used the phaco tip to impale and high vacuum to hold the nucleus while a second instrument, or chopper, hooked the equator and was pulled centrally, splitting the nucleus along its natural cleavage planes. This was a breakthrough for surgeons who had been utilizing several minutes of phaco energy sculpting grooves and bowls in a lens. Studies have shown that compared with four-quadrant 'divide and conquer', the phaco chop technique uses less phaco time and energy, significantly reducing endothelial cell damage. Other advantages of phaco chop include reduction of zonular and capsular stress because forces are directed toward an opposing instrument and the phaco tip is kept in a central 'safe zone' in the middle of the pupil. This technique has also been successfully adapted to the canine phacoemulsification procedure. The larger canine lens requires some modifications, and lenses with hard nuclear and cortical material may not be amenable to this procedure.

Surgical outcomes after application of a liquid adhesive ocular bandage to clear corneal incisions during cataract surgery.

PubMed

Uy, Harvey S; Kenyon, Kenneth R

2013-11-01

To compare the anatomic and refractive outcomes in eyes having phacoemulsification with 1 of 3 clear corneal incision (CCI) closure methods. Ambulatory surgical center, Makati, Philippines. Prospective randomized clinical trial. Patients having phacoemulsification cataract surgery had wound closure using no additional treatment (control), a single 10-0 nylon suture, or a liquid adhesive ocular bandage (Ocuseal). The main outcome measures were wound-edge closure rates, surgically induced astigmatism (SIA), foreign-body sensation, and intraocular pressure (IOP) 1, 3, 5, 7, and 14 days postoperatively. The study evaluated 90 eyes. There was a significant improvement in wound-edge closure rates in the suture group and the ocular bandage group compared with the control group (P<.001). A significant increase in SIA occurred in the sutured group but not in the control or ocular bandage groups (P<.001). The ocular bandage group had significantly less foreign-body sensation than the control and suture groups (P<.001). There were no significant differences in IOP between the groups (P=.515). The liquid adhesive ocular bandage resulted in improved wound-edge closure, reduced SIA, and diminished foreign-body sensation. Suturing was associated with improved wound-edge closure but increased SIA and foreign-body sensation. Unsutured incisions led to delayed wound-edge closure and increased foreign-body sensation. Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Delayed presentation of retained acrylic intraocular lens (IOL) fragment after uncomplicated cataract surgery.

PubMed

Capitena, Cara E; Gamett, Kevin; Pantcheva, Mina B

2016-10-01

To report a case of delayed presentation of a severed acrylic single-piece intraocular lens (IOL) haptic fragment causing corneal edema after uneventful phacoemulsification surgery. An 85-year-old male presented with inferior corneal decompensation six months after a reportedly uneventful phacoemulsification in his left eye. A distal haptic fragment of an acrylic single-piece posterior chamber intraocular lens was found in the inferior anterior chamber angle. Intraoperative examination revealed that the dislocated fragment originated from the temporal haptic, the remainder of which was adherent to the anterior surface of the capsular bag. The clipped edge of the haptic fragment showed a clean, flat surface, suggesting it was severed by a sharp object. The findings were considered consistent with cutting of the fragment during implantation presumably from improper lens loading, improper implantation technique, or defective implantation devices. This is the first case report of a foldable acrylic intraocular lens severed during routine uncomplicated cataract surgery that was not noted at the time of the surgery or in the immediate postoperative period. Delayed presentation of severed IOL fragments should be considered in cases of late onset corneal edema post-operatively, when other causes have been ruled out. Careful implantation technique and thorough examination of the intraocular lens after implantation to assess for lens damage intraoperatively is essential to avoid such rare complications.

New light for old eyes: comparing melanopsin-mediated non-visual benefits of blue-light and UV-blocking intraocular lenses.

PubMed

Schmoll, Conrad; Khan, Ashraf; Aspinall, Peter; Goudie, Colin; Koay, Peter; Tendo, Christelle; Cameron, James; Roe, Jenny; Deary, Ian; Dhillon, Bal

2014-01-01

Melanopsin-expressing photosensitive retinal ganglion cells form a blue-light-sensitive non-visual system mediating diverse physiological effects including circadian entrainment and cognitive alertness. Reduced blue wavelength retinal illumination through cataract formation is thought to blunt these responses while cataract surgery and intraocular lens (IOL) implantation have been shown to have beneficial effects on sleep and cognition. We aimed to use the reaction time (RT) task and the Epworth Sleepiness Score (ESS) as a validated objective platform to compare non-visual benefits of UV- and blue-blocking IOLs. Patients were prospectively randomised to receive either a UV- or blue-blocking IOL, performing an RT test and ESS questionnaire before and after surgery. Optical blurring at the second test controlled for visual improvement. Non-operative age-matched controls were recruited for comparison. 80 participants completed the study. Those undergoing first-eye phacoemulsification demonstrated significant improvements in RT over control (p=0.001) and second-eye surgery patients (p=0.03). Moreover, reduced daytime sleepiness was measured by ESS for the first-eye surgery group (p=0.008) but not for the second-eye group (p=0.09). Choice of UV- or blue-blocking IOL made no significant difference to magnitude of cognitive improvement (p=0.272). Phacoemulsification, particularly first-eye surgery, has a strong positive effect on cognition and daytime alertness, regardless of IOL type.

Cataract: trends in surgical procedures and visual outcomes; a study in a tertiary care hospital.

PubMed

Naeem, Mohammad; Khan, Ayasha; Khan, Muhammad Zia-ul-Islam; Adil, Muhammad; Abbas, Syed Hussain; Khan, Muhammad Usman; Naz, Syeda Maria

2012-03-01

To determine the current procedures in practice and visual outcome following a cataract surgery. The study was conducted from January 7 to April 7, 2011 in the Eye Unit of the Lady Reading Hospital, Peshawar, involving 181 patients. Basic demographics of the patients as well as the type of cataract surgery were noted. Risk factors like diabetes mellitus and glaucoma were also noted for each patient. A pre-operative visual acuity was determined. The patient was examined after two months to determine the visual improvement. Out of 181 patients, 117 were males and 64 were females. Age ranged from 5 years to 83 years with a median age of 60. Most common procedure performed (60.2%) was extra capsular cataract extraction with posterior chamber intraocular lense (ECCE), followed by Phacoemulsification (24.3%). Visual outcome was good in 88.3%, borderline in 8.3% and poor in 3.3% patients. The main reasons for poor visual outcomes were diabetic retinopathy 42.8%, glaucoma-related vision loss 19.0%, history of trauma with retinal detachment 9.5%, and age-related macular degeneration 9.5%. Poor visual outcome was found in diabetic and Glaucoma patients. Surgical complications (3.8%) were rare. Overall a good visual outcome was noted in cataract surgery, which was similar to World Health Organisation guidelines. Extra capsular cataract extraction was the most common procedure followed by Phacoemulsification.

Patients with Fuchs Endothelial Dystrophy and Cataract Undergoing Descemet Stripping Automated Endothelial Keratoplasty and Phacoemulsification with Intraocular Lens Implant: Staged versus Combined Procedure Outcomes.

PubMed

Sykakis, Evripidis; Lam, Fook Chang; Georgoudis, Panagiotis; Hamada, Samer; Lake, Damian

2015-01-01

Purpose. To compare the surgical outcomes of staged and combined phacoemulsification with intraocular lens implant (phaco+IOL) and Descemet stripping automated endothelial keratoplasty (DSAEK) in patients with Fuchs' endothelial dystrophy and cataract. Setting. Corneoplastic Unit and Eye Bank, Queen Victoria Hospital, East Grinstead, UK. Methods. Retrospective study of patients who had combined phaco+IOL and DSAEK (group 1) or phaco+IOL followed within 2 months by DSAEK (group 2). Patients who had previous eye surgery or any other ocular comorbidities were excluded. Results. There were 28 eyes in group 1 and 31 in group 2. There were no significant differences in the demographics and corneal tissue characteristics of the two groups. The endothelial disc dislocation and rebubbling rate within 1 week in group 1 was 21.42% and in group 2 was 3.2% (P = 0.04), while the endothelial cell density at 12 months was 1510 ± 433 for group 1 and 1535 ± 482 for group 2 (P = 0.89). The mean 12-month logMAR visual acuity was 0.28 ± 0.24 for group 1 and 0.33 ± 0.15 for group 2 (P = 0.38). Conclusions. Although the combined procedure seems to be associated with a higher complication rate the final outcomes seem to be similar to both methods.

Patients with Fuchs Endothelial Dystrophy and Cataract Undergoing Descemet Stripping Automated Endothelial Keratoplasty and Phacoemulsification with Intraocular Lens Implant: Staged versus Combined Procedure Outcomes

PubMed Central

Lam, Fook Chang; Georgoudis, Panagiotis; Hamada, Samer; Lake, Damian

2015-01-01

Purpose. To compare the surgical outcomes of staged and combined phacoemulsification with intraocular lens implant (phaco+IOL) and Descemet stripping automated endothelial keratoplasty (DSAEK) in patients with Fuchs' endothelial dystrophy and cataract. Setting. Corneoplastic Unit and Eye Bank, Queen Victoria Hospital, East Grinstead, UK. Methods. Retrospective study of patients who had combined phaco+IOL and DSAEK (group 1) or phaco+IOL followed within 2 months by DSAEK (group 2). Patients who had previous eye surgery or any other ocular comorbidities were excluded. Results. There were 28 eyes in group 1 and 31 in group 2. There were no significant differences in the demographics and corneal tissue characteristics of the two groups. The endothelial disc dislocation and rebubbling rate within 1 week in group 1 was 21.42% and in group 2 was 3.2% (P = 0.04), while the endothelial cell density at 12 months was 1510 ± 433 for group 1 and 1535 ± 482 for group 2 (P = 0.89). The mean 12-month logMAR visual acuity was 0.28 ± 0.24 for group 1 and 0.33 ± 0.15 for group 2 (P = 0.38). Conclusions. Although the combined procedure seems to be associated with a higher complication rate the final outcomes seem to be similar to both methods. PMID:26064669

Heat profiling of phacoemulsification tip using a thermal scanning camera.

PubMed

Ngo, Wei Kiong; Lim, Louis W; Tan, Colin S H; Heng, Wee Jin

2013-12-01

An experimental study to measure the heat profile of the phacoemulsification (phaco) tip using standard continuous phaco and hyperpulse phaco with and without waveform power modulation in the Millennium Microsurgical System with Custom Control Software (CCS). The phaco tip was imaged in air using a thermal camera. The highest temperature was measured 15 s after application of phaco power. Continuous, hyperpulse and waveform power modulations of the Millennium Microsurgical System were used with different power settings (20, 50 and 100 %) and duty cycles (40, 60 and 90 %), with the irrigation turned on and off. Using continuous phaco with the irrigation on, the phaco tip temperature remains <28.0 °C. With irrigation off, the temperature is higher compared to irrigation on but still remains <45.0 °C. Comparing the temperatures for all three power modulations when irrigation is on, at each phaco power and duty cycle setting, the temperature of the phaco tip is highest with continuous phaco, followed by hyperpulse with rise time 1, then hyperpulse with rise time 2. When irrigation is off, the highest temperatures are recorded using the hyperpulse with rise time 2, followed by continuous phaco, then hyperpulse with rise time 1. Hyperpulse and waveform modulations reduce heat generation compared to the continuous mode when irrigation is turned on. Lower duty cycles and lower ultrasound power produce less heat at the phaco tip.

Effect of pulsed laser light in patients with dry eye syndrome.

PubMed

Guilloto Caballero, S; García Madrona, J L; Colmenero Reina, E

2017-11-01

The objective of this study was to determine the clinical benefits of pulsed light therapy for the treatment of Dry Eye Syndrome (DES) due to the decrease in aqueous tear production (aqueous deficient DES) and/or excessive tear evaporation (evaporative DES) due to Meibomian Gland Dysfunction (MGD). A study was conducted on 72 eyes corresponding to 36 patients with DES. Out of these 72 eyes, 60 underwent refractive surgery (48 with femtosecond laser, 6 were operated with a mechanical microkeratome, and 6 with refractive photo-keratectomy[RPK], 6 treated with phacoemulsification, and 6 with no previous surgical treatment. Pulsed laser light (Intense Pulsed Light Regulated [IRPL ® ]) was use to stimulate the secretion of the Meibomian glands during 4 sessions, one every 15 days. Patients with aqueous deficient DES did not show any improvement. Eyes with no previous surgery and those treated with phacoemulsification and PRK had a favourable outcome. On the other hand, less conclusive results were observed in the eyes treated with excimer laser. This treatment could be very helpful to treat evaporative DES produced by MGD. On the other hand, it is not helpful for those cases related to an isolated damage in the aqueous phase, or the mucin phase. Copyright © 2017 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.

Objective measurement of postocclusion surge during phacoemulsification in human eye-bank eyes.

PubMed

Georgescu, Dan; Payne, Marielle; Olson, Randall J

2007-03-01

To objectively compare the postocclusion vacuum surge among different phacoemulsification machines and devices. Experimental study. Infiniti, Legacy, Millennium, and Sovereign were tested in an eye-bank eye. All the machines were tested with 20-gauge non-ABS tips, 430 mm Hg vacuum pressure, 24 ml/minute aspiration rate, peristaltic pump, and 75 cm bottle height. In addition, Infiniti and Legacy were also tested with 20-gauge bypass tips (ABS), 125 cm bottle height, and 40 ml/minute flow rate. We also tested 19-gauge tips with Infiniti and Sovereign and the venturi pump for Millennium. Significant differences were found between all the machines tested with Millennium peristaltic generating the least and Millennium Venturi the most surge. ABS tips significantly decreased the surge for Legacy but not for Infiniti. Cruise Control (CC) had a significant effect on Sovereign but not on Millennium. Increasing the bottle height decreased surge while increasing the flow increased surge for both Infiniti and Legacy. The 19-gauge tips increased surge for both Infiniti and Sovereign. Surge varied over a range of 40 microm to more than 2 mm. ABS and CC decrease surge, especially when the machine is not functioning near the limits of surge prevention. Certain parameters, such as a 19-gauge tip and high flow, dramatically increased surge, whereas elevating the bottle ameliorates it. Understanding the impact of all these features will help in minimizing the problem.

Volume-based characterization of postocclusion surge.

PubMed

Zacharias, Jaime; Zacharias, Sergio

2005-10-01

To propose an alternative method to characterize postocclusion surge using a collapsible artificial anterior chamber to replace the currently used rigid anterior chamber model. Fundación Oftamológica Los Andes, Santiago, Chile. The distal end of a phacoemulsification handpiece was placed inside a compliant artificial anterior chamber. Digital recordings of chamber pressure, chamber volume, inflow, and outflow were performed during occlusion break of the phacoemulsification tip. The occlusion break profile of 2 different consoles was compared. Occlusion break while using a rigid anterior chamber model produced a simultaneous increase of chamber inflow and outflow. In the rigid chamber model, pressure decreased sharply, reaching negative pressure values. Alternatively, with the collapsible chamber model, a delay was observed in the inflow that occurs to compensate the outflow surge. Also, the chamber pressure drop was smaller in magnitude, never undershooting below atmospheric pressure into negative values. Using 500 mm Hg as vacuum limit, the Infiniti System (Alcon) performed better that the Legacy (Alcon), showing an 18% reduction in peak volume variation. The collapsible anterior chamber model provides a more realistic representation of the postocclusion surge events that occur in the real eye during cataract surgery. Peak volume fluctuation (mL), half volume recovery time(s), and volume fluctuation integral value (mL x s) are proposed as realistic indicators to characterize the postocclusion surge performance. These indicators show that the Infiniti System has a better postocclusion surge behavior than the Legacy System.

Phaco-efficiency test and re-aspiration analysis of repulsed particle in phacoemulsification.

PubMed

Kim, Jae-hyung; Ko, Dong-Ah; Kim, Jae Yong; Kim, Myoung Joon; Tchah, Hungwon

2013-04-01

To measure the efficiency of phacoemulsification, we have developed a new experimental model for testing phaco-efficiency and analyzed re-aspiration of repulsed particles. Using a Kitaro wetlab system, a piece of blood agar (BA) was placed in an artificial chamber and the phacoemulsifier was placed horizontally. The settings of the phacoemulsifier (Infiniti, Alcon Laboratories) were 26 cc/min for aspiration, 350 cc/min for vacuum, and 95 cm of bottle height. The time to remove BAs was measured using Ozil 100 %, Ozil 40 %, and longitudinal 40 % of phaco power. The angle between the re-aspirated BA particles and the axis of the phacoemulsifier (re-aspiration zone, degree) was analyzed. The average time (seconds) to remove BAs was lower in the Ozil 100 % and the Ozil 40 % mode than in the longitudinal mode (0.37 ± 0.39, 0.85 ± 0.57, and 2.22 ± 1.40 respectively, P value < 0.01). Repulsion exceeding 1 mm occurred more frequently in the longitudinal mode than in the Ozil 100 % mode (100 % vs 40 %, P value = 0.01, Fisher's exact test). The average of re-aspiration zone was 25.9 ± 14.5 in the longitudinal 40 % and 54.0 ± 23.0 in the Ozil 40 % (P value = 0.016). The Ozil mode was more efficient than the longitudinal mode. In addition, the Ozil mode provided less repulsion and wider aspiration zone.

Prospective evaluation of external ocular microbial growth and aqueous humor contamination during cataract surgery.

PubMed

Tervo, T; Ljungberg, P; Kautiainen, T; Puska, P; Lehto, I; Raivio, I; Järvinen, E; Kuusela, P; Tarkkanen, A

1999-01-01

To analyze the route of aqueous humor contamination leading to the development of postoperative endophthalmitis. Department of Ophthalmology, University of Helsinki, Finland. Forty-nine eyes of 49 patients (31 having phacoemulsification and 18 extracapsular cataract extraction [ECCE]) participated in the study. Four bacterial cultures were taken: preoperative conjunctival swab, lid margin culture, intraoperative lacrimal lake sample, and immediate postoperative anterior chamber fluid sample. Preoperative lid margin cultures were positive in 59.2% of eyes, conjunctival cultures in 69.4%, and lacrimal lake cultures in 24.9%. Four aqueous humor samples (8.2%) showed bacterial growth in the anterior chamber aspirate: 3 in the phacoemulsification and 1 in the ECCE group. The bacteria isolated in this study, Staphylococcus epidermidis and Propionibacterium acnes (2 positive isolates each) were sensitive to the preoperative topical antibiotics used. No aqueous humor sample or any from other locations showed gram-negative microbe growth. The most frequently recovered microbes in all samples collected from the 3 other sources were S epidermidis and other coagulase-negative staphylococcus species, followed by P acnes and other propionibacterium species. Staphylococcus aureus, and diptheroids. The ocular surface significantly contributed to the transmission of microbes into the eye during cataract surgery. These microbes could not be eradicated by topical preoperative antibiotics. However, no patient developed postoperative endophthalmitis. Natural defense mechanisms appear to fend off a minor inoculum with these microbes of relatively low pathogenicity.

Reliability of automatic biometric iris recognition after phacoemulsification or drug-induced pupil dilation.

PubMed

Seyeddain, Orang; Kraker, Hannes; Redlberger, Andreas; Dexl, Alois K; Grabner, Günther; Emesz, Martin

2014-01-01

To investigate the reliability of a biometric iris recognition system for personal authentication after cataract surgery or iatrogenic pupil dilation. This was a prospective, nonrandomized, single-center, cohort study for evaluating the performance of an iris recognition system 2-24 hours after phacoemulsification and intraocular lens implantation (group 1) and before and after iatrogenic pupil dilation (group 2). Of the 173 eyes that could be enrolled before cataract surgery, 164 (94.8%) were easily recognized postoperatively, whereas in 9 (5.2%) this was not possible. However, these 9 eyes could be reenrolled and afterwards recognized successfully. In group 2, of a total of 184 eyes that were enrolled in miosis, a total of 22 (11.9%) could not be recognized in mydriasis and therefore needed reenrollment. No single case of false-positive acceptance occurred in either group. The results of this trial indicate that standard cataract surgery seems not to be a limiting factor for iris recognition in the large majority of cases. Some patients (5.2% in this study) might need "reenrollment" after cataract surgery. Iris recognition was primarily successful in eyes with medically dilated pupils in nearly 9 out of 10 eyes. No single case of false-positive acceptance occurred in either group in this trial. It seems therefore that iris recognition is a valid biometric method in the majority of cases after cataract surgery or after pupil dilation.

Histologically proven epithelial ingrowth in failed Descemet stripping automated endothelial keratoplasty (DSAEK) managed by repeat DSAEK

PubMed Central

Ghosh, Saurabh; Bonshek, Richard; Morgan, Stephen J

2013-01-01

Purpose To report a case of corneal graft failure due to epithelial ingrowth after an uneventful combined Descemet stripping automated endothelial keratoplasty (DSAEK) and phacoemulsification cataract surgery with intraocular lens implant treated successfully with a repeat DSAEK. Methods A 77-year-old male patient underwent combined DSAEK and phacoemulsification with intraocular lens implant implantation for Fuchs’ endothelial dystrophy plus cataract in the right eye. The donor cornea was cut on the Moria ALTK system and introduced using a suture pull-through technique. After an episode of endothelial rejection, the graft failed, with signs suggesting epithelial ingrowth. It was stripped from the host cornea using a Descemet’s membrane stripper, and a Simcoe irrigation-aspiration cannula was used to remove all traces of interface material. The excised lenticule was examined histologically using a hematoxylin and eosin stain. Result The patient regained and maintained excellent visual acuity with no sign of recurrence of epithelial ingrowth. Histopathological evaluation of the donor tissue of the first graft showed epithelial ingrowth on the stromal surface of the graft and very few endothelial cells, in keeping with the diagnosis of graft failure. Conclusion Epithelial ingrowth is a possible cause of endothelial graft failure, but histologically proven cases are rare. Surgical intervention can achieve successful clearance, with the potential for cure and an excellent outcome. PMID:23754868

Surgical management and histologic and immunohistochemical features of a cataract and retrolental plaque secondary to persistent hyperplastic tunica vasculosa lentis/persistent hyperplastic primary vitreous (PHTVL/PHPV) in a Bloodhound puppy.

PubMed

Gemensky-Metzler, Anne J; Wilkie, David A

2004-01-01

The objective of this study was to describe the clinical, histologic and immunohistochemical features, the surgical treatment, and outcome of a cataract secondary to persistent hyperplastic tunica vasculosa lentis/persistent hyperplastic primary vitreous (PHTVL/PHPV) in a dog. A 4-month-old male Bloodhound dog presented for evaluation of a cataract. A complete ophthalmic examination and ocular ultrasonography were performed. A resorbing cataract with intralenticular hemorrhage, lens induced uveitis, and PHTVL/PHPV were diagnosed. Extracapsular cataract extraction using phacoemulsification was performed. A primary posterior capsulectomy was performed to remove a retrolental plaque with the posterior capsule; the excised plaque was submitted for histopathology and immunohistochemical staining. A 41-Diopter intraocular lens (IOL) was implanted. Functional vision was maintained postoperatively during the 21-month follow-up period. Histologically, the posterior capsule was coiled and exhibited duplication. The retrolental plaque was comprised of dense fibrous connective tissue, blood vessels, free red blood cells, hemosiderin-laden macrophages, a pocket of neural tissue and numerous perivascular mast cells. With immunohistochemical staining, the neural elements were determined to be glial cells compatible with astrocytes. Cataract secondary to PHTVL/PHPV can be successfully treated using phacoemulsification and planned posterior capsulectomy. Posterior lens capsule duplication, mast cells and astrocytic glial cells may be normal components of the fibrovascular retrolental plaque associated with PHTVL/PHPV.

Evaluation of response variables in computer-simulated virtual cataract surgery

NASA Astrophysics Data System (ADS)

Söderberg, Per G.; Laurell, Carl-Gustaf; Simawi, Wamidh; Nordqvist, Per; Skarman, Eva; Nordh, Leif

2006-02-01

We have developed a virtual reality (VR) simulator for phacoemulsification (phaco) surgery. The current work aimed at evaluating the precision in the estimation of response variables identified for measurement of the performance of VR phaco surgery. We identified 31 response variables measuring; the overall procedure, the foot pedal technique, the phacoemulsification technique, erroneous manipulation, and damage to ocular structures. Totally, 8 medical or optometry students with a good knowledge of ocular anatomy and physiology but naive to cataract surgery performed three sessions each of VR Phaco surgery. For measurement, the surgical procedure was divided into a sculpting phase and an evacuation phase. The 31 response variables were measured for each phase in all three sessions. The variance components for individuals and iterations of sessions within individuals were estimated with an analysis of variance assuming a hierarchal model. The consequences of estimated variabilities for sample size requirements were determined. It was found that generally there was more variability for iterated sessions within individuals for measurements of the sculpting phase than for measurements of the evacuation phase. This resulted in larger required sample sizes for detection of difference between independent groups or change within group, for the sculpting phase as compared to for the evacuation phase. It is concluded that several of the identified response variables can be measured with sufficient precision for evaluation of VR phaco surgery.

A clinical study to evaluate the results after toric intraocular lens implantation in cases of corneal astigmatism.

PubMed

Moulick, P S; Mohindra, V K; Gurunadh, V S; Patel, Parth; Gupta, Sandeep; Khan, M A

2018-04-01

Modern day cataract surgery aims at a spectacle free vision which becomes difficult in cases with pre-operative astigmatism more than 1.5 D. Implantation of toric intra-ocular lenses (IOL) after phacoemulsification in such eyes is one of the ways to counteract this problem. Thirty eyes with pre-operative astigmatism between 1.5 D and 4.5 D were implanted with toric IOLs following uneventful phaco-emulsification. The estimation of the axis of implantation of this toric IOL included calculating the surgically induced astigmatism (SIA) of the surgeon. Post-operatively, 20 (66.67%) patients had a visual acuity 6/9 or better and 17 (57%) had a visual acuity of 6/6 at 12 weeks. The mean postoperative uncorrected visual acuity (UCVA) was 0.12 ± 0.15 at 12 weeks. The difference between means of preoperative best corrected visual acuity (BCVA) LogMAR and postoperative UCVA at 12 wk LogMAR was found to be statistically significant at p  = 0.001. Mean (SD) scores of pre-op astigmatism of study group was -2.20 (0.67) and residual astigmatism was -0.32 (0.44). The difference between means of pre-op astigmatism and residual astigmatism in the study group was significant at p  = 0.001 with 95% CI -2.22 to -1.50. This significant difference was because of the toric IOL implantation.

A comparison of patient pain and visual outcome using topical anesthesia versus regional anesthesia during cataract surgery.

PubMed

Hosoda, Yoshikatsu; Kuriyama, Shoji; Jingami, Yoko; Hattori, Hidetsugu; Hayashi, Hisako; Matsumoto, Miho

2016-01-01

The purpose of this study was to compare the level of patient pain during the phacoemulsification and implantation of foldable intraocular lenses while under topical, intracameral, or sub-Tenon lidocaine. This was a retrospective study. Three hundred and one eyes subjected to cataract surgery were included in this study. All eyes underwent phacoemulsification surgery and intraocular lens implantation using topical, sub-Tenon, or intracameral anesthesia. The topical group received 4% lidocaine drops, and the intracameral group received a 0.1-0.2 cc infusion of 1% preservative-free lidocaine into the anterior chamber through the side port combined with topical drops of lidocaine. The sub-Tenon group received 2% lidocaine. Best-corrected visual acuity, corneal endothelial cell loss, and intraoperative pain level were evaluated. Pain level was assessed on a visual analog scale (range 0-2). There were no significant differences in visual outcome and corneal endothelial cell loss between the three groups. The mean pain score in the sub-Tenon group was significantly lower than that in the topical and intracameral groups (P=0.0009 and P=0.0055, respectively). In 250 eyes without high myopia (< -6D), there were no significant differences in mean pain score between the sub-Tenon and intracameral groups (P=0.1417). No additional anesthesia was required in all groups. Intracameral lidocaine provides sufficient pain suppressive effects in eyes without high myopia, while sub-Tenon anesthesia is better for cataract surgery in eyes with high myopia.

Safety and efficacy of two ocular anesthetic methods for phacoemulsification: topical anesthesia and viscoanesthesia (VisThesia).

PubMed

Perone, J M; Popovici, A; Ouled-Moussa, R; Herasymyuk, O; Reynders, S

2007-01-01

VisThesia is a new ophthalmic viscosurgical device (OVD) which has 1% lidocaine combined with 1.5% sodium hyaluronate. This is a prospective evaluation of the safety and efficacy of VisThesia used in association with phacoemulsification. A total of 114 eyes were divided into two groups. Fifty-nine eyes were treated with tetracaine + oxybuprocaine topical anesthesia and DuoVisc OVD and 55 eyes were treated with VisThesia, for use as both topical anesthetic and OVD. Endothelial cell counts were measured at 30 days postoperatively and compared to preoperative baseline values. Pain and discomfort was subjectively evaluated by patients using a visual analog pain scale (0-10). All surgeries were uneventful with no intraoperative or immediate postoperative complications. Patients receiving topical anesthesia had a mean pain score of 1.1+/-6.8 compared to a mean score of 1.3+/-4.6 for patients receiving VisThesia (p=0.59). Postoperatively, endothelial cell loss at 1 month was greater for patients receiving VisThesia (20.32%+/-43.75) than for those receiving the topical anesthetic (8.8%+/-59.6; p<0.0001). The results from the visual analog pain scale were comparable between groups, showing that VisThesia provides similar pain relief to topical anesthesia. Specular microscopy performed at 30 days postoperatively showed a significantly greater loss of endothelial cells with the use of VisThesia, suggesting that the 1% lidocaine concentration used in VisThesia may be toxic to corneal endothelial cells.

Reducing angiographic cystoid macular edema and blood-aqueous barrier disruption after small-incision phacoemulsification and foldable intraocular lens implantation: multicenter prospective randomized comparison of topical diclofenac 0.1% and betamethasone 0.1%.

PubMed

Asano, Sayaka; Miyake, Kensaku; Ota, Ichiro; Sugita, Gentaro; Kimura, Wataru; Sakka, Yuji; Yabe, Nobuyuki

2008-01-01

To compare the effectiveness of a topical nonsteroidal drug (diclofenac 0.1%) and a topical steroidal drug (betamethasone 0.1%) in preventing cystoid macular edema (CME) and blood-aqueous barrier (BAB) disruption after small-incision cataract surgery and foldable intraocular lens (IOL) implantation. Shohzankai Medical Foundation Miyake Eye Hospital, Tokyo, Japan. This multicenter interventional double-masked randomized study comprised 142 patients having phacoemulsification and foldable IOL implantation. Seventy-one patients were randomized to receive diclofenac eyedrops and 71, betamethasone eyedrops for 8 weeks postoperatively. The incidence and severity of CME were evaluated by fluorescein angiography. Blood-aqueous barrier disruption was determined by laser flare-cell photometry. Of the patients, 63 were men and 79 were women. Five weeks after surgery, the incidence of fluorescein angiographic CME was lower in the diclofenac group (18.8%) than in the betamethasone group (58.0%) (P<.001). At 1 and 2 weeks, the amount of anterior chamber flare was statistically significantly less in the diclofenac group than in the betamethasone group (P<.05). At 8 weeks, intraocular pressure was statistically significantly higher in the betamethasone group (P = .0003). Diclofenac was more effective than betamethasone in preventing angiographic CME and BAB disruption after small-incision cataract surgery. Thus, nonsteroidal antiinflammatory agents should be considered for routine treatment of eyes having cataract surgery.

Goniotomy with a single-use dual blade: Short-term results.

PubMed

Greenwood, Michael D; Seibold, Leonard K; Radcliffe, Nathan M; Dorairaj, Syril K; Aref, Ahmad A; Román, Jesús Jimenez; Lazcano-Gomez, Gabriel S; Darlington, Jason K; Abdullah, Suhail; Jasek, Mark C; Bahjri, Khaled A; Berdahl, John P

2017-09-01

To evaluate the intraocular pressure (IOP)-lowering efficacy and safety of a single-use dual blade (Kahook) in patients with mild to end-stage glaucoma. International multicenter ophthalmic care centers. Prospective interventional case series. Consecutive patients with glaucoma who had phacoemulsification plus goniotomy with the single-use dual blade were enrolled in this study. Each center collected deidentified clinical data, including preoperative and postoperative IOP, medication use, adverse events, and whether additional surgery was required during a 6-month follow-up. Of the 71 eyes included in this study, 70% had primary open-angle glaucoma. Other diagnoses included angle-closure, pigmentary, pseudoexfoliative, and normal-tension glaucoma. Sixty-five percent of eyes were classified as having mild to moderate glaucoma and 35%, severe glaucoma. The mean baseline IOP decreased from 17.4 mm Hg ± 5.2 (SD) to 12.8 ± 2.6 mm Hg 6 months postoperatively and the hypotensive medication use decreased from 1.6 ± 1.3 to 0.9 ± 1.0, respectively (P < .001 and P = .005, respectively). The most common observation was blood reflux during surgery (39.4%). Single-use dual blade goniotomy plus phacoemulsification resulted in a significant and sustained reduction in IOP and a decrease in glaucoma medications after 6 months of follow-up. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Effect of preoperative counseling on fear from visual sensations during phacoemulsification under topical anesthesia.

PubMed

Haripriya, Aravind; Tan, Colin S H; Venkatesh, Rengaraj; Aravind, Srinivasan; Dev, Anand; Au Eong, Kah-Guan

2011-05-01

To determine whether preoperative counseling on possible intraoperative visual perceptions during cataract surgery helps reduce the patients' fear during surgery. Aravind Eye Hospital, Madurai, India. Randomized masked clinical trial. Patients having phacoemulsification under topical anesthesia were randomized to receive additional preoperative counseling or no additional preoperative counseling on potential intraoperative visual perceptions. After surgery, all patients were interviewed about their intraoperative experiences. Of 851 patients, 558 (65.6%) received additional preoperative counseling and 293 (34.4%) received no additional counseling. A lower proportion of patients in the counseled group were frightened than in the group not counseled for visual sensation (4.5% versus 10.6%, P<.001). Analyzed separately by specific visual sensations, similar results were found for light perception (7/558 [1.3%] versus 13/293 [4.4%], P=.007), colors (P=.001), and movement (P=.020). The mean fear score was significantly lower in the counseled group than in the not-counseled group for light perception (0.03 versus 0.12, P=.002), colors (P=.001), movement (P=.005), and flashes (P=.035). Preoperative counseling was a significant factor affecting fear after accounting for age, sex, operated eye, and duration of surgery (multivariate odds ratio, 4.3; 95% confidence interval, 1.6-11.6; P=.003). Preoperative counseling on possible visual sensations during cataract surgery under topical anesthesia significantly reduced the mean fear score and the proportion of patients reporting being frightened. Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Simultaneous versus sequential penetrating keratoplasty and cataract surgery.

PubMed

Hayashi, Ken; Hayashi, Hideyuki

2006-10-01

To compare the surgical outcomes of simultaneous penetrating keratoplasty and cataract surgery with those of sequential surgery. Thirty-nine eyes of 39 patients scheduled for simultaneous keratoplasty and cataract surgery and 23 eyes of 23 patients scheduled for sequential keratoplasty and secondary phacoemulsification surgery were recruited. Refractive error, regular and irregular corneal astigmatism determined by Fourier analysis, and endothelial cell loss were studied at 1 week and 3, 6, and 12 months after combined surgery in the simultaneous surgery group or after subsequent phacoemulsification surgery in the sequential surgery group. At 3 and more months after surgery, mean refractive error was significantly greater in the simultaneous surgery group than in the sequential surgery group, although no difference was seen at 1 week. The refractive error at 12 months was within 2 D of that targeted in 15 eyes (39%) in the simultaneous surgery group and within 2 D in 16 eyes (70%) in the sequential surgery group; the incidence was significantly greater in the sequential group (P = 0.0344). The regular and irregular astigmatism was not significantly different between the groups at 3 and more months after surgery. No significant difference was also found in the percentage of endothelial cell loss between the groups. Although corneal astigmatism and endothelial cell loss were not different, refractive error from target refraction was greater after simultaneous keratoplasty and cataract surgery than after sequential surgery, indicating a better outcome after sequential surgery than after simultaneous surgery.

Deep Sclerectomy with Goniosynechiolysis Ab Interno for Chronic Glaucoma Associated with Peripheral Anterior Synechiae

PubMed Central

Raak, Peter; Ponto, Katharina; Stoffelns, Bernhard; Lorenz, Katrin; Scharioth, Gábor B.

2015-01-01

Purpose. To report one-year results of phacoemulsification combined with deep sclerectomy and goniosynechiolysis ab interno for chronic glaucoma associated with peripheral anterior synechiae (PAS). Methods. We retrospectively analyzed medical charts of 16 patients (20 eyes) treated by one-site combined phacoemulsification and deep sclerectomy with goniosynechiolysis ab interno. PAS were transected by a spatula introduced into the anterior chamber through a paracentesis. To account for the correlation of right and left eyes a linear mixed model with unstructured covariance structure was calculated. Results. The mean preoperative intraocular pressure (IOP) was 20.3 ± 5.2 mmHg with 2.4 ± 1.0 medications. One year postoperatively, the mean IOP was 15.3 ± 3.3 mmHg (P = 0.004, paired t-test) with 0.6 ± 1.0 medications. A postoperative IOP of ≤21 mmHg without medication was achieved in 17 of 19 eyes (89.5%) and in 12/19 eyes (63.2%) at 3 and 12 months after surgery, respectively. In the remaining eyes (10.5% at 3 months and 36.8% at 12 months), additional medication led to an IOP ≤21 mmHg or the target pressure. No case required further glaucoma surgery. In one eye, conversion of the surgery to trabeculectomy was necessary due to Descemet's window rupture. Conclusions. With goniosynechiolysis ab interno, effective and safe nonpenetrating glaucoma surgery is possible in presence of PAS. PMID:26199738

The phaco machine: analysing new technology.

PubMed

Fishkind, William J

2013-01-01

The phaco machine is frequently overlooked as the crucial surgical instrument it is. Understanding how to set parameters is initiated by understanding fundamental concepts of machine function. This study analyses the critical concepts of partial occlusion phaco, occlusion phaco and pump technology. In addition, phaco energy categories as well as variations of phaco energy production are explored. Contemporary power modulations and pump controls allow for the enhancement of partial occlusion phacoemulsification. These significant changes in the anterior chamber dynamics produce a balanced environment for phaco; less complications; and improved patient outcomes.

Doctor, where is my iris?

PubMed

Sophocleous, Sophocles

2016-05-05

Phacoemulsification cataract surgery with small clear corneal incision (CCI) is the standard of care for cataract treatment. Self-sealing, clear corneal wounds have been found to be stable and able to withstand high pressures. Nevertheless, there are a few cases published describing patients with previous cataract surgery and manually performed CCI who sustained blunt trauma with associated wound dehiscence, iris disinsertion and expulsion through the wound. The case described here demonstrates an eye that had traumatic aniridia post-blunt trauma, while the intraocular lens and the rest of the ocular structures remained intact. 2016 BMJ Publishing Group Ltd.

Comparative evaluation of aspheric toric intraocular lens implantation and limbal relaxing incisions in eyes with cataracts and ≤3 dioptres of astigmatism.

PubMed

Lam, Douglas K T; Chow, Vanissa W S; Ye, Cong; Ng, Paul Ka-Fai; Wang, Zheng; Jhanji, Vishal

2016-02-01

To compare the visual outcomes of aspheric toric intraocular lens (IOL) implantation and limbal relaxing incisions (LRI) for management of coexisting age-related cataracts and astigmatism. In this prospective study, sixty eyes of 60 patients with visually significant cataract and coexisting corneal astigmatism ≤3 dioptres (D) were randomised to undergo phacoemulsification with either aspheric toric IOL or aspheric monofocal IOL with LRI. The main outcome measures were postoperative 3-month uncorrected visual acuity (UCVA), contrast sensitivity, rotational stability of the toric IOL and spectacle independence. The postoperative UCVA, contrast sensitivity and refractive astigmatism were significantly better than the baseline measurements for both groups (p≤0.001). There was no significant difference detected for these parameters between LRI and toric IOL groups postoperatively (p≥0.119). At both postoperative month 1 and 3, the percentages of eyes in need of spectacles were lower in toric group than LRI group (p≤0.030). IOL misalignment was noted in three eyes in the toric IOL group (mean misalignment 7.67±4.04°). On vector analysis, magnitude of error (ME) was negative in the LRI group indicating undercorrection, whereas the ME was close to zero for toric group. Both toric IOL implantation and LRI were effective in correcting corneal astigmatism ≤3 D during phacoemulsification, while LRI tended to undercorrect astigmatism. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Robot-assisted intraocular surgery: development of the IRISS and feasibility studies in an animal model

PubMed Central

Rahimy, E; Wilson, J; Tsao, T-C; Schwartz, S; Hubschman, J-P

2013-01-01

Purpose The aim of this study is to develop a novel robotic surgical platform, the IRISS (Intraocular Robotic Interventional and Surgical System), capable of performing both anterior and posterior segment intraocular surgery, and assess its performance in terms of range of motion, speed of motion, accuracy, and overall capacities. Patients and methods To test the feasibility of performing ‘bimanual' intraocular surgical tasks using the IRISS, we defined four steps out of typical anterior (phacoemulsification) and posterior (pars plana vitrectomy (PPV)) segment surgery. Selected phacoemulsification steps included construction of a continuous curvilinear capsulorhexis and cortex removal in infusion–aspiration (I/A) mode. Vitrectomy steps consisted of performing a core PPV, followed by aspiration of the posterior hyaloid with the vitreous cutter to induce a posterior vitreous detachment (PVD) assisted with triamcinolone, and simulation of the microcannulation of a temporal retinal vein. For each evaluation, the duration and the successful completion of the task with or without complications or involuntary events was assessed. Results Intraocular procedures were successfully performed on 16 porcine eyes. Four eyes underwent creation of a round, curvilinear anterior capsulorhexis without radialization. Four eyes had I/A of lens cortical material completed without posterior capsular tear. Four eyes completed 23-gauge PPV followed by successful PVD induction without any complications. Finally, simulation of microcannulation of a temporal retinal vein was successfully achieved in four eyes without any retinal tears/perforations noted. Conclusion Robotic-assisted intraocular surgery with the IRISS may be technically feasible in humans. Further studies are pending to improve this particular surgical platform. PMID:23722720

In vivo architectural analysis of 3.2 mm clear corneal incisions for phacoemulsification using optical coherence tomography.

PubMed

Torres, Luis F; Saez-Espinola, Fidelia; Colina, Juner M; Retchkiman, Myriam; Patel, Milan R; Agurto, Ricardo; Garcia, Gerardo; Diaz, Jose L; Huang, David; Schanzlin, David J; Chayet, Arturo S

2006-11-01

To analyze in vivo the architecture of clear corneal incisions (CCIs) for phacoemulsification using optical coherence tomography (OCT). Anterior Segment Department, Asociacion Para Evitar la Ceguera en Mexico, Hospital Dr Luis Sanchez Bulnes, Mexico. A prospective masked study analyzed 20 unsutured CCIs placed superiorly and created in a uniplanar fashion with a 3.2 mm slit-angled metal keratome. All wounds were evaluated with a retinal OCT model 1, 3, and 30 days postoperatively. Intraocular pressure (IOP) and incision leakage were checked. The architecture was described according to the angle of incidence, apposition of the epithelial and endothelial margins, and wound sealing. No leakage was detected. The angle varied from 33 to 85 degrees; angles greater than 75 degrees were done by a surgeon in training. Wound apposition at the epithelial margin was achieved in all cases. In contrast, imperfect apposition of the endothelial margin was seen in 45% of incisions on day 1 and in 15% on day 30. Incomplete sealing of the wound was seen by OCT in 25% of cases at 24 hours and persisted in 10% of all cases at 1 month. This gaping occurred on the endothelial side and never translated to the epithelial margin. No statistical correlation was found between gaping and the angle of the incision, IOP variations, or surgeon experience. Although in vivo CCIs caused minor anatomic imperfections, they were clinically stable independent of incision angle, IOP variation, and surgeon experience. Incision stability may be related to careful wound construction, epithelial viability, stromal edema, and efficient endothelial pumping.

Laboratory analysis of phacoemulsifier compliance and capacity.

PubMed

Nejad, Mitra; Injev, Valentine P; Miller, Kevin M

2012-11-01

To compare the compliance and capacity of 7 fluidics modules used by 6 phacoemulsifiers from 3 manufacturers. Jules Stein Eye Institute, Los Angeles, California, USA. Experimental study. Previous-model and current-model phacoemulsifiers from 3 manufacturers were subjected to laboratory analysis of compliance and capacity. Previous-generation models tested included the Legacy Advantec, Whitestar Sovereign Phacoemulsification System, and Millennium Microsurgical System. Current models tested were the Infiniti Vision System with standard and Intrepid cassettes, Whitestar Signature Phacoemulsification System, and Stellaris Vision Enhancement System. To measure compliance, the aspiration line was connected to an electronic pressure transducer and small volumes of fluid were injected or aspirated. To measure capacity, the space between the distal end of the aspiration line and the pump was filled with methylene blue-dyed fluid. The Legacy was the most compliant phacoemulsifier. The old and new Whitestar systems, Millennium system, and Stellaris system showed similar midrange compliances. The Infiniti Vision System with the Intrepid fluidic management system was the least compliant. The Infiniti cassettes had the greatest capacity, which is a detriment from a surge-control perspective, and Signature cassettes had the least capacity. The Infiniti Intrepid system had the lowest compliance of the 6 units tested, which is optimum from a surge-control perspective. All other things being equal, the Infiniti should have the safest occlusion-break surge response. Mr. Injev is an employee of Alcon Laboratories. Dr. Miller is a consultant to and investigator for Alcon Laboratories. Ms. Nejad has no financial or proprietary interest in any material or method mentioned. Copyright © 2012 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Stroke dynamics and frequency of 3 phacoemulsification machines.

PubMed

Tognetto, Daniele; Cecchini, Paolo; Leon, Pia; Di Nicola, Marta; Ravalico, Giuseppe

2012-02-01

To measure the working frequency and the stroke dynamics of the phaco tip of 3 phacoemulsification machines. University Eye Clinic of Trieste, Italy. Experimental study. A video wet fixture was assembled to measure the working frequency using a micro camera and a micropulsed strobe-light system. A different video wet fixture was created to measure tip displacement as vectorial movement at different phaco powers using a microscopic video apparatus. The working frequency of the Infiniti Ozil machine was 43.0 kHz in longitudinal mode and 31.6 kHz in torsional mode. The frequency of the Whitestar Signature machine was 29.0 kHz in longitudinal mode and 38.0 kHz with the Ellips FX handpiece. The Stellaris machine had a frequency of 28.8 kHz. The longitudinal stroke of the 3 machines at different phaco powers was statistically significantly different. The Stellaris machine had the highest stroke extent (139 μm). The lateral movement of the Infiniti Ozil and Whitestar Signature machines differed significantly. No movement on the y-axis was observed for the Infiniti Ozil machine in torsional mode. The elliptical path of the Ellips FX handpiece had different x and y components at different phaco powers. The 3 phaco machines performed differently in terms of working frequency and stroke dynamics. The knowledge of the peculiar lateral and elliptical path strokes of Infiniti and Whitestar Signature machines may allow the surgeon to fully use these features for lens removal. Copyright © 2012 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Objective comparison of 4 nonlongitudinal ultrasound modalities regarding efficiency and chatter.

PubMed

DeMill, David L; Zaugg, Brian E; Pettey, Jeff H; Jensen, Jason D; Jardine, Griffin J; Wong, Gilbert; Olson, Randall J

2012-06-01

To compare efficiency and chatter of Infiniti Ozil with and without Intelligent Phacoemulsification (IP) and the Signature Ellips with and without FX. John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. Experimental study. Brunescent 2.0 mm human lens cubes were created by an instrument devised for this study. Cubes were tested (10 per test) for time of particle removal (efficiency) and for the number of times the lens particle bounced off the tip (chatter) at 300 mm Hg and 550 mm Hg, 50% and 100% power, and 50% and 100% amplitudes (amplitude for Ozil only). Of the ultrasound settings, efficiency varied from a mean of 3.3 seconds ± 1.4 (SD) to 50.4 ± 11.7 seconds and chatter from 0.0 to 52.0 ± 16.7 bounces per run. The Ozil-IP was generally more efficient than the Ozil and the Ellips FX more efficient than the Ellips. At optimized values, the Ozil-IP and Ellips-FX were similar. In general, efficiency and chatter were better at 550 mm Hg and at 50% power. The amplitude effect was complex. Efficiency closely correlated with chatter (Pearson r(2) = .31, P<.0001). Objective comparison of phacoemulsification efficiency and chatter found that optimized Ozil-IP and Ellips-FX were similar in both parameters and in general, both performed better than preceding technology. The study parameters can significantly affect efficiency and chatter, which strongly correlate with each other. Copyright © 2012 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Corticocapsular cleavage during phacoemulsification: Viscodissection versus hydrodissection. Miyake-Apple view analysis.

PubMed

Vasavada, Vaishali; Vasavada, Viraj A; Werner, Liliana; Mamalis, Nick; Vasavada, Abhay R; Crandall, Alan S

2008-07-01

To compare the corticocapsular separation created by viscodissection and by hydrodissection using Miyake-Apple video-photographic analysis. University-based center. Fourteen cadaver eyes were randomized to hydrodissection (Group 1, n=7) or viscodissection (Group 2, n=7). Twelve eyes were prepared for Miyake-Apple viewing. One eye in each group was prepared to simulate a closed chamber. On Miyake-Apple viewing, corticocapsular separation was graded from 0 to 3 after hydrodissection/viscodissection and at the sculpting, nuclear division, and early and late fragment removal stages. The surgeon's subjective impression of the mechanical cushion effect was noted. Histopathology of the capsular bag was performed in 4 eyes in each group to determine the amount of residual lens epithelial cells (LECs). More space was created and maintained between the capsule and cortex in Group 2 than in Group 1. The mean scores in Groups 1 and 2 were endpoint of hydrodissection/viscodissection 1.92+/-0.38 and 2.58+/-0.38, respectively (P=.05); sculpting, 1.6+/-0.42 and 2.3+/-0.45, respectively (P=.05); nuclear division, 0.9+/-0.42 and 1.5+/-0.35, respectively (P=.13); early fragment removal, 0.6+/-0.22 and 1.0+/-0, respectively (P=.04); and late fragment removal, 0.1+/-0.22 and 0.4+/-0.22, respectively (P=.17). Although only early fragment removal achieved statistical significance, the surgeon's impression confirmed greater cushion effect with viscodissection. Residual LECs in the 2 groups were comparable. Viscodissection as an adjunct to hydrodissection created and maintained greater corticocapsular separation than hydrodissection alone during phacoemulsification.

Novel Gonioscopy Score and Predictive Factors for Intraocular Pressure Lowering After Phacoemulsification.

PubMed

Perez, Claudio I; Chansangpetch, Sunee; Feinstein, Max; Mora, Marta; Nguyen, Anwell; Badr, Mai; Masis, Marisse; Lin, Shan C

2018-05-04

To evaluate a novel gonioscopy score as a potential predictor for intraocular pressure (IOP) reduction after cataract surgery. Prospective study that included consecutive patients with or without glaucoma, either with open or narrow angles but without peripheral anterior synechiae, who underwent phacoemulsification. Eyes with intraoperative complications and secondary glaucoma were excluded. A preoperative gonioscopy score was created, summing the Shaffer gonioscopy grading in 4 quadrants (range 0-16). To determine variables associated with IOP change at 6 months, univariate and multivariate linear mixed-effects regression analysis was performed adjusting for age, sex, and preoperative IOP. 188 eyes from 137 patients were enrolled. The mean age of the patients was 75.0 (±8.5) years and the average preoperative IOP was 15.6 (±3.6) mm Hg with 0.7 (range 0-4) glaucoma medications. The mean IOP reduction after phaco was 3.0 (±2.6) mm Hg at postoperative month 6. After multivariate analysis, preop IOP (β=0.49 [0.41 - 0.58] P<0.0001), gonioscopy score (β=-0.17 [-0.24 - -0.09] P<0.0001), ACD (β=-0.88 [-1.64 - -0.14] P=0.02) and IOP/ACD ratio (β=0.45 [0.07 - 0.83] P=0.021) were associated with IOP reduction at 6 months. Preoperative predictors for IOP reduction after cataract surgery were preoperative IOP, ACD, gonioscopy score and IOP/ACD ratio. The IOP/ACD ratio and gonioscopy score can be easy parameters to obtain and may help clinicians to estimate the IOP reduction after phaco.

Acute and chronic fluid misdirection syndrome: pathophysiology and treatment.

PubMed

Grzybowski, Andrzej; Kanclerz, Piotr

2018-01-01

To summarize our current understanding of the specific pathogenic mechanisms of the fluid misdirection syndrome and possible treatment methods. We used the PubMed web platform to find relevant studies using the following keywords: infusion misdirection syndrome, aqueous misdirection syndrome, ciliary block, ciliovitreal block, capsular block, intraoperative fluid misdirection, subcapsular fluid entrapment, acute intraoperative rock-hard eye syndrome, positive vitreous pressure glaucoma, and malignant glaucoma. Other publications were also considered as a potential source of information when referenced in relevant articles. We collected and analyzed 55 articles dated from 1951 to 2016. Acute intraoperative rock-hard eye syndrome is characterized by a very shallow anterior chamber with the absence of suprachoroidal effusion or hemorrhage and no noticeable pathology of the iris-lens diaphragm. It usually occurs during uneventful phacoemulsification, particularly in hyperopic eyes. The pathophysiology of acute fluid misdirection syndrome is based on inappropriate movement of balanced salt solution via the zonular fibers. This syndrome has also been described as occurring from hours to months, or years, after the initial surgery. The pathophysiology of malignant glaucoma is based on similar mechanisms of cilio-lenticular block of aqueous flow leading to the misdirection of aqueous posteriorly into or besides the vitreous gel. Faced with these situations, vitreous decompression is required, preferably with hyaloido-capsulo-iridectomy. In phakic eyes, concomitant cataract extraction would be desirable. We believe both of these clinical conditions should be considered as one syndrome. We suggest the term acute fluid misdirection syndrome for the cascade of events during phacoemulsification surgery. Chronic fluid misdirection syndrome better describes the nature of malignant glaucoma.

Which colours are seen by the patient during cataract surgery? Results of an intraoperative interview.

PubMed

Wenzel, M; Schulze Schwering, M

2016-03-01

To discover what cataract patients see during phacoemulsification and if these light phenomena influence their anxiety levels during surgery. In all, 200 patients were interviewed intraoperatively at the Eye Hospital, Petrisberg, Trier, Germany. The quality of the visual experiences was described and if these were pleasant, neutral or unpleasant. Systemic sedation was noted. Among 200 patients (209 eyes): 88 were men (91 eyes; 44%) and 112 were women (118 eyes; 56%). Median age (years): men (71), women (70). Mean operating time was 8 min. 49/209 (23%) were not anxious before and during surgery. 110/209 (52%) were more anxious before than during surgery, 50/209 (24%) were still anxious during surgery, 27/209 (13%) got sedation with midazolam (1-5 mg). Colours in descending order seen: blue, red, pink, yellow, green, purple, turquois, and orange. The most dominant colour combination was red/blue. Structures were seen by 162/209 (78%). Most (61%) intraoperative visual experiences were pleasant, 38% were neutral, and 1% found them transiently unpleasant. Three patients felt blinded by the light of the operating microscope. The experience of colours and other light phenomena was pleasant for most patients during phacoemulsification under topical anaesthesia. They occur spontaneously when the patient is fixating on the operating light. They are not dependent on the individual or environment. Sedation only in 13%. Direct questioning for visual sensations by the operating surgeon may lead to less need for sedation and lead to less side effects for elderly and multimorbidity people postoperatively. The surgeon can use this knowledge to reassure patients during surgery.

Effect of biometric characteristics on biomechanical properties of the cornea in cataract patient.

PubMed

Song, Xue-Fei; Langenbucher, Achim; Gatzioufas, Zisis; Seitz, Berthold; El-Husseiny, Moatasem

2016-01-01

To determine the impact of biometric characteristics on the biomechanical properties of the human cornea using the ocular response analyzer (ORA) and standard comprehensive ophthalmic examinations before and after standard phacoemulsification. This study comprised 54 eyes with cataract with significant lens opacification in stages I or II that underwent phacoemulsification (2.8 mm incision). Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg), and corneal-compensated intraocular pressure (IOPcc) were measured by ORA preoperatively and at 1mo postoperatively. Biometric characteristics were derived from corneal topography [TMS-5, anterior equivalent (EQTMS) and cylindric (CYLTMS) power], corneal tomography [Casia, anterior and posterior equivalent (EQaCASIC, EQpCASIA) and cylindric (CYLaCASIA, CYLpCASIA) power], keratometry [IOLMaster, anterior equivalent (EQIOL) and cylindric (CYLIOL) power] and autorefractor [anterior equivalent (EQAR)]. Results from ORA were analyzed and correlated with those from all other examinations taken at the same time point. Preoperatively, CH correlated with EQpCASIA and CYLpCASIA only (P=0.001, P=0.002). Postoperatively, IOPg and IOPcc correlated with all equivalent powers (EQTMS, EQIOL, EQAR, EQaCASIA and EQpCASIA) (P=0.001, P=0.007, P=0.001, P=0.015, P=0.03 for IOPg and P<0.001, P=0.003, P<0.001, P=0.009, P=0.014 for IOPcc). CH correlated postoperatively with EQaCASIA and EQpCASIC only (P=0.021, P=0.022). Biometric characteristics may significantly affect biomechanical properties of the cornea in terms of CH, IOPcc and IOPg before, but even more after cataract surgery.

Short-Term Clinical Results of Ab Interno Trabeculotomy Using the Trabectome with or without Cataract Surgery for Open-Angle Glaucoma Patients of High Intraocular Pressure

PubMed Central

Huang, Alex S.; Swamy, Ramya

2017-01-01

Purpose. To assess the safety and efficacy of Trabectome procedure in patients with preoperative intraocular pressure (IOP) of 30 mmHg or higher. Methods. All patients who had underwent Trabectome stand-alone or Trabectome combined with phacoemulsification were included. Survival analysis was performed by using Kaplan-Meier, and success was defined as IOP ≤ 21 mmHg, 20% or more IOP reduction from baseline for any two consecutive visits after 3 months, and no secondary glaucoma surgery. Results. A total of 49 cases were included with an average age of 66 (range: 13–91). 28 cases had Trabectome stand-alone and 21 cases had Trabectome combined with phacoemulsification. Mean IOP was reduced from a baseline of 35.6 ± 6.3 mmHg to 16.8 ± 3.8 mmHg at 12 months (p < 0.01∗), while the number of medications was reduced from 3.1 ± 1.3 to 1.8 ± 1.4 (p < 0.01∗). Survival rate at 12 months was 80%. 9 cases required secondary glaucoma surgery, and 1 case was reported with hypotony at day one, but resolved within one week. Conclusion. Trabectome seems to be safe and effective in patients with preoperative IOP of 30 mmHg or greater. Even in this cohort with high preoperative IOP, the end result is a mean IOP in the physiologic range. PMID:28484649

OPTICAL PRINCIPLES, BIOMECHANICS, AND INITIAL CLINICAL PERFORMANCE OF A DUAL-OPTIC ACCOMMODATING INTRAOCULAR LENS (AN AMERICAN OPHTHALMOLOGICAL SOCIETY THESIS)

PubMed Central

McLeod, Stephen D.

2006-01-01

Purpose To design and develop an accommodating intraocular lens (IOL) for endocapsular fixation with extended accommodative range that can be adapted to current standard extracapsular phacoemulsification technique. Methods Ray tracing analysis and lens design; finite element modeling of biomechanical properties; cadaver eye implantation; initial clinical evaluation. Results Ray tracing analysis indicated that a dual-optic design with a high plus-power front optic coupled to an optically compensatory minus posterior optic produced greater change in conjugation power of the eye compared to that produced by axial movement of a single-optic IOL, and that magnification effects were unlikely to account for improved near vision. Finite element modeling indicated that the two optics can be linked by spring-loaded haptics that allow anterior and posterior axial displacement of the front optic in response to changes in ciliary body tone and capsular tension. A dual-optic single-piece foldable silicone lens was constructed based on these principles. Subsequent initial clinical evaluation in 24 human eyes after phacoemulsification for cataract indicated mean 3.22 diopters of accommodation (range, 1 to 5 D) based on defocus curve measurement. Accommodative amplitude evaluation at 1- and 6-month follow-up in all eyes indicated that the accommodative range was maintained and that the lens was well tolerated. Conclusions A dual-optic design increases the accommodative effect of axial optic displacement, with minimal magnification effect. Initial clinical trials suggest that IOLs designed on this principle might provide true pseudophakic accommodation following cataract extraction and lens implantation. PMID:17471355

Progressive lenticular astigmatism in the clear lens.

PubMed

Tatham, Andrew; Prydal, Jeremy

2008-03-01

We describe a case of progressive lenticular astigmatism in a 53-year-old man with a clear lens. The patient acquired 5 diopters of lenticular astigmatism in his right eye over an 18-month period. The visual acuity was reduced to 6/60. Following phacoemulsification and intraocular lens implantation, the uncorrected visual acuity was 6/5. Progressive astigmatism is usually corneal in origin and in an otherwise healthy eye, significant lenticular astigmatism is rare. When lenticular astigmatism occurs, it is usually associated with a cortical cataract; however, astigmatism may precede the development of a clinically visible cataract.

Curvularia lunata endophthalmitis.

PubMed

Berbel, Rodrigo Fabri; Casella, Antonio Marcelo Barbante; de Freitas, Denise; Höfling-Lima, Ana Luisa

2011-10-01

The aim of this study was to report a case of a 52-year-old man with a rare fungal endophthalmitis after penetrating ocular trauma with a fish hook. The patient was submitted to wound repair and hook extraction. Three weeks after the trauma, a cataract extraction with phacoemulsification and in-the-bag intraocular lens implantation was performed. After the development of endophthalmitis, vitrectomy and lens explantation with positive culture for Curvularia lunata were carried out. The infection was controlled with the administration of systemic itraconazole and intraocular voriconazole. The use of intravitreal voriconazole injection is a viable option in cases of Curvularia fungal endophthalmitis.

Plateau iris secondary to iridociliary cysts.

PubMed

Vila-Arteaga, J; Díaz-Céspedes, R A; Suriano, M M

2015-11-01

We present a case of plateau iris and glaucoma due to multiple unilateral iridociliary cysts. The patient was treated with iridotomy Nd: YAG laser and 360° iridoplasty, without achieving pressure control. Phacoemulsification improved the hypertension. Dynamic gonioscopy and OCT of the anterior chamber was also performed before and after treatment. Iridociliary cysts are a benign condition that can cause iris plateau configuration, and can produce a difficult to treat ocular hypertension. Cystotomy, peripheral iridoplasty, and other treatments have been proposed. Copyright © 2014 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

[Evaluation of the efficacy of diode laser endocyclophotocoagulation combined with cataract surgery in glaucoma].

PubMed

Ezzouhairi, S M

2015-11-01

Surgical techniques, which reduce the secretion of aqueous humor are underutilized in the surgical management of glaucoma; the diode laser coupled to an endoscope, endocyclophotocoagulation (ECP), is an emerging technology in the treatment of glaucoma. Indeed, thanks to its direct, focal and controllable approach to diode laser treatment of the ciliary processes, ECP renders this a safer technique compared to transscleral diode laser. We present preliminary results and an evaluation of the efficacy of ECP combined with cataract surgery performed at the Al Bassar clinic in Mohammedia, Morocco. We conducted a retrospective study on a series of 82 patients who underwent combined surgery: diode laser endocyclophotocoagulation and cataract for treatment of glaucoma during the period from December 2012 to July 2013. For this study, we recorded: age and gender of the patients, number and power of diode laser spots, pre- and postoperative intraocular pressure (IOP), and the number of anti-glaucoma treatments prescribed pre- and postoperatively (3 months minimum). Technically, a 20-gauge endo-ocular probe is inserted through the corneal incision used for phacoemulsification. The probe is equipped with a light source, a camera and a pulsed 810 nm laser beam; it is connected to an Endo-optiks type generator, which allows for direct visualization of the ciliary processes and their precise treatment. The surgical procedure is both simple and quick. Postoperative follow-up is unchanged from the management of cataract extraction by phacoemulsification. The average age in our series was 69.5 years (range 33-81 years), mean follow-up was 5.7 months. The reduction in intraocular pressure was 28.5%. In 40% of patients, a significant reduction in medications was noted, and in 20%, a total suspension of anti-glaucoma medications. No serious complications were noted in our series. This technique can perfectly fit into the medical, natural and/or surgical armamentarium medical, physical, surgical to halt progression of glaucomatous disease. The IOP lowering obtained by this combined surgery is significantly greater than that obtained after phacoemulsification alone in open-angle glaucoma. It can accommodate many situations for which conventional surgery has limitations. In addition, this technique has the advantage of preserving the bulbar conjunctiva for any subsequent glaucoma surgeries. Our preliminary results are very satisfactory. This combined technique is simple, safe and effective. This allows broadening of its indications to include moderate glaucoma, stabilized or not, in addition to refractory glaucoma. Also, from an economic point of view, the gain for the patient is significant. Of course, longer-term follow-up is required to confirm these results. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Evaluation of the efficacy and safety of a standardised intracameral combination of mydriatics and anaesthetics for cataract surgery

PubMed Central

Labetoulle, Marc; Findl, Oliver; Malecaze, François; Alió, Jorge; Cochener, Béatrice; Lobo, Conceição; Lazreg, Sihem; Hartani, Dahbia; Colin, Joseph; Tassignon, Marie-José; Behndig, Anders

2016-01-01

Background/aims To compare the efficacy and safety of intracameral (IC) administration at the beginning of cataract surgery, of Mydrane, a standardised ophthalmic combination of tropicamide 0.02%, phenylephrine 0.31% and lidocaine 1%, to a standard topical regimen. Methods In this international phase III, prospective, randomised study, the selected eye of 555 patients undergoing phacoemulsification with intraocular lens (IOL) implantation received 200 μL of Mydrane (Mydrane group) just after the first incision or a topical regimen of one drop each of tropicamide 0.5% and phenylephrine 10% repeated three times (reference group). The primary efficacy variable was achievement of capsulorhexis without additional mydriatics. The non-inferiority of Mydrane to the topical regimen was tested. The main outcome measures were pupil size, patient perception of ocular discomfort and safety. Results Capsulorhexis without additional mydriatics was performed in 98.9% of patients and 94.7% in the Mydrane and reference groups, respectively. Both groups achieved adequate mydriasis (>7 mm) during capsulorhexis, phacoemulsification and IOL insertion. IOL insertion was classified as ‘routine’ in a statistically greater number of eyes in the Mydrane group compared with the reference group (p=0.047). Patients in the Mydrane group reported statistically greater comfort than the reference group before IOL insertion (p=0.034). Safety data were similar between groups. Conclusions Mydrane is an effective and safe alternative to standard eye drops for initiating and maintaining intraoperative mydriasis and analgesia. Patients who received IC Mydrane were significantly more comfortable before IOL insertion than the reference group. Surgeons found IOL insertion less technically challenging with IC Mydrane. Trial registration number NCT02101359; Results. PMID:26531052

One-Day Use of Preoperative Topical Nonsteroidal Anti-Inflammatory Drug Prevents Intraoperative Prostaglandin Level Elevation During Femtosecond Laser-Assisted Cataract Surgery.

PubMed

Kiss, Huba J; Takacs, Agnes I; Kranitz, Kinga; Sandor, Gabor L; Toth, Gabor; Gilanyi, Beatrix; Nagy, Zoltan Z

2016-08-01

To determine if pretreatment with topical nonsteroidal anti-inflammatory drug (NSAID) prior to femtosecond laser-assisted cataract surgery (FLACS) prevents intraoperative prostaglandin level elevation as a potential risk factor of postoperative complications. Thirty-six patients with clinically significant cataract and without any concomitant general or ophthalmic disease were enrolled into the three age-matched groups of the study. The mean age of the patients was 62.3 ± 13.1 years. The first group of patients underwent traditional phacoemulsification (Control group), on the second group of patients FLACS was performed, and the third group of patients received topical 0.1% nepafenac pretreatment for 1one day prior to FLACS. Before the phacoemulsification part of the cataract surgery, approximately 110 µL of aqueous humor was collected in all groups. Total prostaglandin concentrations of the collected aqueous humor samples were evaluated by enzyme immunoassay (EIA). The mean of the total prostaglandin concentrations of the aqueous humor samples was 208.8 ± 140.5 pg/mL in patients in the control group, 1449.1 ± 1019.7 pg/mL in the FLACS group (p > 0.001), and 92.2 ± 51.7 pg/mL in the group pretreated with topical NSAID before the FLACS (p > 0.001 compared to FLACS; p > 0.01 compared to control), respectively. FLACS surgery increases intracameral prostaglandin concentration. However, using preoperative 1-day-long nonsteroid anti-inflammatory drops prior to FLACS, this intraoperative increase diminishes. Our study raises the possibility that NSAID pretreatment may be routinely administered before FLACS cataract surgeries to achieve a further decrease in the potential complications of increased total prostaglandin concentration during FLACS surgeries.

Two-Port Pars Plana Anterior and Central Core Vitrectomy (Lam Floaterectomy) in Combination With Phacoemulsification and Intraocular Lens Implantation Under Topical Anesthesia for Patients with Cataract and Significant Floaters: Results of the First 50 Consecutive Cases.

PubMed

Lam, Dennis S C; Leung, Hiu Ying; Liu, Shu; Radke, Nishant; Yuan, Ye; Lee, Vincent Y W

2017-01-01

To study the safety and efficacy of 2-port pars plana anterior and central core vitrectomy (Lam floaterectomy) in combination with phacoemulsification (phaco) and intraocular lens implantation (IOL) for patients with cataract and significant floaters under topical anesthesia. Retrospective review of the first 50 consecutive cases. A standardized treatment protocol was used for patients with cataract and significant (moderate to severe) floaters (duration > 3 months). Data analysis included intraoperative and postoperative complications, floater status, and patient satisfaction. There were 50 eyes (38 patients) with a male-to-female ratio of 1 to 2.3. Twelve patients had bilateral eye surgeries. Mean age was 58.10 ± 9.85 years (range, 39-83). All patients completed the 3-month follow-up. One eye had mild vitreous hemorrhage at the end of surgery arising from sclerotomy wound oozing. No other intraoperative compli-cations were encountered. Postoperatively, there was 1 case of transient hypotony and 1 case of congestion at sclerotomy wound. No cases of retinal break or detachment, or clinically significant macular edema, were reported. There were 5 cases (10%) of mild residual floaters and 1 case (2%) of floater recurrence. Total floater clearance rate was 88%. Patient satisfaction rates were 80%, 14%, 6%, and 0% for very satisfied, satis-fied, acceptable, and unsatisfied, respectively. The 3-month results in terms of safety and efficacy of the Lam floaterectomy in combination with phaco and IOLfor patients with cataract and significant floaters under topical anesthesia are encouraging. Further larger-scale, prospective, multicenter studies seem warranted. Copyright© 2017 Asia-Pacific Academy of Ophthalmology.

The Effects of Phacoemulsification and Intraocular Lens Implantation on Anatomical and Functional Parameters in Patients with Primary Angle Closure: A Prospective Study. (An American Ophthalmological Society Thesis).

PubMed

Traverso, Carlo Enrico; Cutolo, Carlo Alberto

2017-08-01

To investigate the clinical, anatomical, and patient-reported outcomes of phacoemulsification (PE) with intraocular lens implantation performed to treat primary angle closure (PAC) and primary angle-closure glaucoma (PACG). Patients were evaluated at baseline and at 6 months after PE. The examination included visual acuity, intraocular pressure (IOP), visual field, optic nerve head, endothelial cell count (ECC), aqueous depth, and ocular biometric parameters. Patient-reported visual function and health status were assessed. Coprimary outcome measures were IOP changes, angle widening, and patient-reported visual function; secondary outcome measures were visual acuity changes, use of IOP-lowering medications, and complications. Univariate and multivariate analyses were performed to determine the predictors of IOP change. Thirty-nine cases were identified, and postoperative data were analyzed for 59 eyes, 39 with PACG and 20 with PAC. Globally, PE resulted in a mean reduction in IOP of -6.33 mm Hg (95% CI, -8.64 to -4.01, P <.001). Aqueous depth and angle measurements improved ( P <.01), whereas ECC significantly decreased ( P <.001). Both corrected and uncorrected visual acuity improved ( P <.01). The EQ visual analog scale did not change ( P =.16), but VFQ-25 improved ( P <.01). The IOP-lowering effect of PE was greater in the PACG compared to the PAC group ( P =.04). In both groups, preoperative IOP was the most significant predictor of IOP change ( P <.01). No sight-threatening complications were recorded. Our data support the usefulness of PE in lowering the IOP in patients with PAC and PACG. Although PE resulted in several anatomical and patient-reported visual improvements, we observe that a marked decrease in ECC should be carefully weighed before surgery.

Aqueous Humor Levels of TGF-β2 and TNF-α in Indonesian Eyes With Acute Primary Angle Closure.

PubMed

Artini, Widya; Gondhowiardjo, Tjahjono Darminto; Supiandi, Edi S; Tin, Aung

2012-01-01

To measure aqueous humor levels of TGF-β2 and TNF-α in Indonesian eyes with acute primary angle closure (APAC) and to investigate their relationship to response to treatment. A prospective observational study. On presentation, aqueous humor samples were taken from APAC eyes by paracentesis. All APAC eyes then underwent laser peripheral iridotomy (LPI). Two weeks following LPI, trabeculectomy was performed if the intraocular pressure (IOP) was still high. Alternatively, phacoemulsification was performed in cases of normal IOP. Aqueous humor samples were taken again at the time of both surgical procedures. Age-matched cataract patients were included as a control group. Cytokine samples were measured by enzyme-linked immunosorbent assay (ELISA). Forty-three Indonesian APAC subjects were recruited in this study. The mean presenting IOP was 56.4 ± 0.52 mmHg and 53% underwent trabeculectomy. Comparison of the APAC eyes to the control group showed there was a significant difference in the mean levels of TGF-β2 (2007.7 ± 827.2 pg/mL vs 466.1 ± 219.3 pg/mL, p < 0.001) and TNF-α (0.714 ± 0.33 pg/mL vs 0.228 ± 0.16 pg/mL, p < 0.001). There was no significant difference in the presented TGF-β2 and TNF-α levels between the trabeculectomy and phacoemulsification groups (p:0.391 and p:0.494). Between presentation and surgery in the trabeculectomy subgroup, both cytokine levels appeared to be significantly different (p < 0.035 and p < 0.038). This study showed the aqueous humor levels of TGF-β2 and TNF-α appeared high at presentation but decreased subsequently, with no difference detected between groups with persistently high IOP and those with normalized IOP.

A survey of perceived training differences between ophthalmology residents in Hong Kong and China.

PubMed

Young, Alvin L; Jhanji, Vishal; Liang, Yuanbo; Congdon, Nathan; Chow, Simon; Wang, Fenghua; Zhang, Xiujuan; Man, Xiaofei; Yang, Mingming; Lin, Zhong; Yuen, Hunter G L; Lam, Dennis S C

2015-09-28

To study the differences in ophthalmology resident training between China and the Hong Kong Special Administrative Region (HKSAR). Training programs were selected from among the largest and best-known teaching hospitals. Ophthalmology residents were sent an anonymous 48-item questionnaire by mail. Work satisfaction, time allocation between training activities and volume of surgery performed were determined. 50/75 residents (66.7 %) from China and 20/26 (76.9 %) from HKSAR completed the survey. Age (28.9 ± 2.5 vs. 30.2 ± 2.9 years, p = 0.15) and number of years in training (3.4 ± 1.6 vs. 2.8 ± 1.5, p = 0.19) were comparable between groups. The number of cataract procedures performed by HKSAR trainees (extra-capsular, median 80.0, quartile range: 30.0, 100.0; phacoemulsification, median: 20.0, quartile range: 0.0, 100.0) exceeded that for Chinese residents (extra-capsular: median = 0, p < 0.0001; phacoemulsification: median = 0, p < 0.0001). Chinese trainees spent more time completing medical charts (>50 % of time on charts: 62.5 % versus 5.3 %, p < 0.0001) and received less supervision (≥90 % of training supervised: 4.4 % versus 65 %, p < 0.0001). Chinese residents were more likely to feel underpaid (96.0 % vs. 31.6 %, p < 0.0001) and hoped their children would not practice medicine (69.4 % vs. 5.0 %, p = 0.0001) compared HKSAR residents. In this study, ophthalmology residents in China report strikingly less surgical experience and supervision, and lower satisfaction than HKSAR residents. The HKSAR model of hands-on resident training might be useful in improving the low cataract surgical rate in China.

Consistency of corneal sublayer thickness measurements using Fourier-domain optical coherence tomography after phacoemulsification.

PubMed

López-Miguel, Alberto; Calabuig-Goena, María; Marqués-Fernández, Victoria; Fernández, Itziar; Alió, Jorge L; Maldonado, Miguel J

2016-11-04

To assess the reliability of corneal epithelial thickness (CET), nonepithelial central corneal thickness (NECCT), and central corneal thickness (CCT) measurements using Cirrus high-definition optical coherence tomography (HD-OCT) in patients who did and did not undergo cataract surgery. Forty patients who underwent uneventful phacoemulsification and 40 healthy participants were recruited to evaluate the intraobserver repeatability and interobserver reproducibility of CET, NECCT, and CCT measurements using Cirrus HD-OCT. To analyze repeatability, one examiner obtained 5 consecutive scans in each participant; for interobserver reproducibility, another examiner randomly obtained another scan. Within-subject standard deviation, coefficient of variation (CV), limits of agreement, and intraclass correlation coefficient (ICC) data were obtained. For intraobserver repeatability, the intrasession CV (CVw) and ICC values of the CET in the operated and nonoperated groups were 3.7% and 0.80 and 3.8% and 0.73, respectively; for NECCT, 0.7% and 0.98 and 0.8% and 0.97; and for CCT, 0.6% and 0.99 and 0.7% and 0.98. For interobserver reproducibility, the CVw and ICC values for the CET in the operated and nonoperated groups were 2.6% and 0.82 and 2.3% and 0.62, respectively; for NECCT, 0.7% and 0.98 and 0.5% and 0.98; and for CCT, 0.5% and 0.99 and 0.4% and 0.99. The corneal sublayer thickness can be measured reliably using Cirrus HD-OCT in patients who underwent cataract surgery and elderly participants; however, the CET consistency is poorer than the NECCT. Corneal epithelial thickness modifications exceeding 4% reflect true thickness changes instead of random error variations using HD-OCT.

Development of a virtual reality training curriculum for phacoemulsification surgery.

PubMed

Spiteri, A V; Aggarwal, R; Kersey, T L; Sira, M; Benjamin, L; Darzi, A W; Bloom, P A

2014-01-01

Training within a proficiency-based virtual reality (VR) curriculum may reduce errors during real surgical procedures. This study used a scientific methodology to develop a VR training curriculum for phacoemulsification surgery (PS). Ten novice-(n) (performed <10 cataract operations), 10 intermediate-(i) (50-200), and 10 experienced-(e) (>500) surgeons were recruited. Construct validity was defined as the ability to differentiate between the three levels of experience, based on the simulator-derived metrics for two abstract modules (four tasks) and three procedural modules (five tasks) on a high-fidelity VR simulator. Proficiency measures were based on the performance of experienced surgeons. Abstract modules demonstrated a 'ceiling effect' with construct validity established between groups (n) and (i) but not between groups (i) and (e)-Forceps 1 (46, 87, and 95; P<0.001). Increasing difficulty of task showed significantly reduced performance in (n) but minimal difference for (i) and (e)-Anti-tremor 4 (0, 51, and 59; P<0.001), Forceps 4 (11, 73, and 94; P<0.001). Procedural modules were found to be construct valid between groups (n) and (i) and between groups (i) and (e)-Lens-cracking (0, 22, and 51; P<0.05) and Phaco-quadrants (16, 53, and 87; P<0.05). This was also the case with Capsulorhexis (0, 19, and 63; P<0.05) with the performance decreasing in the (n) and (i) group but improving in the (e) group (0, 55, and 73; P<0.05) and (0, 48, and 76; P<0.05) as task difficulty increased. Experienced/intermediate benchmark skill levels are defined allowing the development of a proficiency-based VR training curriculum for PS for novices using a structured scientific methodology.

The Incidence and Risk Factors of Lens-iris Diaphragm Retropulsion Syndrome during Phacoemulsification

PubMed Central

Lim, Dong Hui; Shin, Dong Hoon; Han, Gyule; Chung, Eui-Sang

2017-01-01

Purpose In the present study, the incidence and risk factors of lens-iris diaphragm retropulsion syndrome (LIDRS) were evaluated. Methods Patients who underwent cataract surgery using phacoemulsification between June 2014 and December 2014 were included in the study. The preoperative ocular biometric and intraoperative surgical parameters were examined. The incidence of LIDRS and various risk factors were analyzed using an independent t-test, Pearson's chi-square test, and univariable and multivariable logistic regression analyses. Results Among 124 eyes of 124 patients, 100 (80.6%) had no LIDRS and 24 (19.4%) had LIDRS. LIDRS occurred in 13 of 31 vitrectomized eyes (41.9%) and 11 of 93 non-vitrectomized eyes (11.8%). Based on univariable analysis, age (odds ratio [OR], 0.920; p = 0.001), vitrectomized eye (OR, 5.038; p = 0.001), spherical equivalent (OR, 0.778; p < 0.001), axial length (OR, 1.716; p < 0.001), anterior chamber depth (OR, 3.328; p = 0.037), and 3.0 mm vs. 2.2 mm incision size (OR, 4.964; p = 0.001) were statistically significant risk factors associated with the development of LIDRS. Conditional multivariable logistic regression showed that vitrectomized eye (OR, 3.865; 95% confidence interval [CI], 1.201 to 12.436; p = 0.023), long axial length (OR, 1.709; 95% CI, 1.264 to 2.310; p = 0.001), and 3.0 vs. 2.2 mm incision size (OR, 3.571; 95% CI, 1.120 to 11.393; p = 0.031) were significant independent risk factors associated with LIDRS. Conclusions LIDRS is a relatively common occurrence and was found to be associated with vitrectomized eye, long axial length, and larger incision size. Evaluating risk factors prior to cataract surgery can help reduce associated morbidity. PMID:28682016

The Auckland Cataract Study II: Reducing Complications by Preoperative Risk Stratification and Case Allocation in a Teaching Hospital.

PubMed

Kim, Bia Z; Patel, Dipika V; McKelvie, James; Sherwin, Trevor; McGhee, Charles N J

2017-09-01

To assess the effect of preoperative risk stratification for phacoemulsification surgery on intraoperative complications in a teaching hospital. Prospective cohort study. Prospective assessment of consecutive phacoemulsification cases (N = 500) enabled calculation of a risk score (M-score of 0-8) using a risk stratification system. M-scores of >3 were allocated to senior surgeons. All surgeries were performed in a public teaching hospital setting, Auckland, New Zealand, in early 2016. Postoperatively, data were reviewed for complications and corrected distance visual acuity (CDVA). Results were compared to a prospective study (N = 500, phase 1) performed prior to formal introduction of risk stratification. Intraoperative complications increased with increasing M-scores (P = .044). Median M-score for complicated cases was higher (P = .022). Odds ratio (OR) for a complication increased 1.269 per unit increase in M-score (95% confidence interval [CI] 1.007-1.599, P = .043). Overall rate of any intraoperative complication was 5.0%. Intraoperative complication rates decreased from 8.4% to 5.0% (OR = 0.576, P = .043) comparing phase 1 and phase 2 (formal introduction of risk stratification). The severity of complications also reduced. A significant decrease in complications for M = 0 (ie, minimal risk cases) was also identified comparing the current study (3.1%) to phase 1 (7.2%), P = .034. There was no change in postoperative complication risks (OR 0.812, P = .434) or in mean postoperative CDVA (20/30, P = .484) comparing current with phase 1 outcomes. A simple preoperative risk stratification system, based on standard patient information gathered at preoperative consultation, appears to reduce intraoperative complications and support safer surgical training by appropriate allocation of higher-risk cases. Copyright © 2017 Elsevier Inc. All rights reserved.

Evaluation of the efficacy and safety of a standardised intracameral combination of mydriatics and anaesthetics for cataract surgery.

PubMed

Labetoulle, Marc; Findl, Oliver; Malecaze, François; Alió, Jorge; Cochener, Béatrice; Lobo, Conceição; Lazreg, Sihem; Hartani, Dahbia; Colin, Joseph; Tassignon, Marie-José; Behndig, Anders

2016-07-01

To compare the efficacy and safety of intracameral (IC) administration at the beginning of cataract surgery, of Mydrane, a standardised ophthalmic combination of tropicamide 0.02%, phenylephrine 0.31% and lidocaine 1%, to a standard topical regimen. In this international phase III, prospective, randomised study, the selected eye of 555 patients undergoing phacoemulsification with intraocular lens (IOL) implantation received 200 μL of Mydrane (Mydrane group) just after the first incision or a topical regimen of one drop each of tropicamide 0.5% and phenylephrine 10% repeated three times (reference group). The primary efficacy variable was achievement of capsulorhexis without additional mydriatics. The non-inferiority of Mydrane to the topical regimen was tested. The main outcome measures were pupil size, patient perception of ocular discomfort and safety. Capsulorhexis without additional mydriatics was performed in 98.9% of patients and 94.7% in the Mydrane and reference groups, respectively. Both groups achieved adequate mydriasis (>7 mm) during capsulorhexis, phacoemulsification and IOL insertion. IOL insertion was classified as 'routine' in a statistically greater number of eyes in the Mydrane group compared with the reference group (p=0.047). Patients in the Mydrane group reported statistically greater comfort than the reference group before IOL insertion (p=0.034). Safety data were similar between groups. Mydrane is an effective and safe alternative to standard eye drops for initiating and maintaining intraoperative mydriasis and analgesia. Patients who received IC Mydrane were significantly more comfortable before IOL insertion than the reference group. Surgeons found IOL insertion less technically challenging with IC Mydrane. NCT02101359; Results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

The role of phacoemulsification in glaucoma therapy: A systematic review and meta-analysis.

PubMed

Masis, Marisse; Mineault, Patrick J; Phan, Eileen; Lin, Shan C

2017-09-06

Cataract extraction is a safe and effective surgery that has been performed in its modern form for several decades. Many studies have noted that cataract extraction could also have a clinically significant role in the control of comorbid glaucoma. Lens extraction decreases the pressure within the eye, and intraocular pressure (IOP) is the only controllable risk factor in glaucoma proven to be effective. A systematic analysis of current evidence is needed to establish strong practice patterns and identify areas where further research is required. We performed systematic review and meta-analysis of the clinical data to estimate the net effect of cataract surgery on IOP. A total of 37 treatment arms from 32 different studies from January 1997 to January 2017 were included. IOP reduction was highly correlated across follow-up periods. For angle-closure glaucoma, results showed an IOP decrease of -6.4 mmHg (95% CI: -9.4 to -3.4) at final follow-up (12 months and longer). For the open-angle glaucoma group, there was an overall IOP change of -2.7 mmHg (95% CI -3.7 to -1.7) from baseline. For pseudoexfoliation glaucoma further research is needed to reach an adequate evidence-based conclusion. The influence of inherent sources of bias, including loss to follow-up, washout and medication use, and lack of a control group, was evaluated numerically. These sources of bias pulled the IOP estimate in opposite directions and are therefore unlikely to affect the main conclusions substantially. Future prospective clinical trials, including other outcomes such as quality of life, clinical severity information, and cost-effectiveness analysis, are needed to determine the role of phacoemulsification alone within the glaucoma treatment algorithm. Copyright © 2017 Elsevier Inc. All rights reserved.

Using artificial intelligence to predict the risk for posterior capsule opacification after phacoemulsification.

PubMed

Mohammadi, Seyed-Farzad; Sabbaghi, Mostafa; Z-Mehrjardi, Hadi; Hashemi, Hassan; Alizadeh, Somayeh; Majdi, Mercede; Taee, Farough

2012-03-01

To apply artificial intelligence models to predict the occurrence of posterior capsule opacification (PCO) after phacoemulsification. Farabi Eye Hospital, Tehran, Iran. Clinical-based cross-sectional study. The posterior capsule status of eyes operated on for age-related cataract and the need for laser capsulotomy were determined. After a literature review, data polishing, and expert consultation, 10 input variables were selected. The QUEST algorithm was used to develop a decision tree. Three back-propagation artificial neural networks were constructed with 4, 20, and 40 neurons in 2 hidden layers and trained with the same transfer functions (log-sigmoid and linear transfer) and training protocol with randomly selected eyes. They were then tested on the remaining eyes and the networks compared for their performance. Performance indices were used to compare resultant models with the results of logistic regression analysis. The models were trained using 282 randomly selected eyes and then tested using 70 eyes. Laser capsulotomy for clinically significant PCO was indicated or had been performed 2 years postoperatively in 40 eyes. A sample decision tree was produced with accuracy of 50% (likelihood ratio 0.8). The best artificial neural network, which showed 87% accuracy and a positive likelihood ratio of 8, was achieved with 40 neurons. The area under the receiver-operating-characteristic curve was 0.71. In comparison, logistic regression reached accuracy of 80%; however, the likelihood ratio was not measurable because the sensitivity was zero. A prototype artificial neural network was developed that predicted posterior capsule status (requiring capsulotomy) with reasonable accuracy. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2012 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

360-degree suture trabeculotomy ab interno to treat open-angle glaucoma: 2-year outcomes

PubMed Central

Sato, Tomoki; Kawaji, Takahiro; Hirata, Akira; Mizoguchi, Takanori

2018-01-01

Purpose The purpose of this study was to evaluate the efficacy of 360-degree suture trabeculotomy (360S-LOT) ab interno for treating open-angle glaucoma (OAG). Risk factors of surgical failure were examined. Patients and methods 360S-LOT ab interno alone was performed for patients with uncontrolled OAG, and combined 360S-LOT ab interno/phacoemulsification was performed for patients with controlled OAG with a visually significant cataract between March 2014 and September 2015 at a single center. The patients were prospectively followed for 2 years. The main outcome measures included 2-year intraocular pressure (IOP), number of anti-glaucoma medications used, postoperative complications, and predictive factors of surgical failure. Kaplan–Meier analysis was performed, with surgical success (with or without medication use) defined as postoperative IOP ≤15 mmHg and IOP reduction ≥20% (criterion A) or IOP ≤12 mmHg and IOP reduction ≥30% (criterion B). Predictive factors were evaluated using Cox proportional hazard ratios. Results A total of 64 eyes of 64 patients were included, and 50 (78%) eyes of 64 eyes underwent a phacoemulsification combination procedure. Surgery significantly reduced IOP from 18.4 ± 2.9 mmHg before surgery to 13.4 ± 3.0 mmHg after surgery (P < 0.001). Patients used an average of 1.8 ± 1.5 medications before surgery and 1.3 ± 1.5 medications after surgery (P = 0.101). No serious postoperative complications were observed. The probability of surgical success was 49.2% and 16.0% using criteria A and B, respectively. No risk factors of surgical failure were identified. Conclusion The 360S-LOT ab interno procedure is a favorable option for treating eyes with mild or moderate OAG. PMID:29844656

Reliability study of biometrics "do not contact" in myopia.

PubMed

Migliorini, R; Fratipietro, M; Comberiati, A M; Pattavina, L; Arrico, L

The aim of the study is a comparison between the actually achieved after surgery condition versus the expected refractive condition of the eye as calculated via a biometer. The study was conducted in a random group of 38 eyes of patients undergoing surgery by phacoemulsification. The mean absolute error was calculated between the predicted values from the measurements with the optical biometer and those obtained in the post-operative error which was at around 0.47% Our study shows results not far from those reported in the literature, and in relation, to the mean absolute error is among the lowest values at 0.47 ± 0.11 SEM.

Methylene blue-related corneal edema and iris discoloration.

PubMed

Timucin, Ozgur Bulent; Karadag, Mehmet Fatih; Aslanci, Mehmet Emin; Baykara, Mehmet

2016-04-01

We report the case of a 70-year-old female patient who developed corneal edema and iris discoloration following the inadvertent use of 1% methylene blue instead of 0.025% trypan blue to stain the anterior capsule during cataract phacoemulsification surgery. Copious irrigation was performed upon realization of incorrect dye use. Corneal edema and iris discoloration developed during the early postoperative period and persisted at 24-months follow-up. However, keratoplasty was not required. The intracameral use of 1% methylene blue has a cytotoxic effect on the corneal endothelium and iris epithelium. Copious irrigation for at least 30 min using an anterior chamber maintainer may improve outcomes.

Real-time Optical Coherence Tomography Incorporated in the Operating Microscope during Cataract Surgery.

PubMed

Almutlak, Mohammed A; Aloniazan, Turki; May, William

2017-01-01

A 55-year-old male presented with reduced vision due to senile cataract. The patient consented to undergo real-time intraoperative anterior segment-optical coherence tomography (AS-OCT) during phacoemulsification with intraocular lens (IOL) implantation. Images were captured at various points during the surgery. The use of AS-OCT incorporated into the surgical microscope was evaluated as an adjunct to cataract surgery. We were able to successfully evaluate, in real-time, wound architecture, the attachment of Descemet's membrane, the posterior capsule, and IOL position. Real-time AS-OCT can be used to proactively address potential complications and verify IOL placement intraoperatively.

Traumatic anterior dislocation of the crystalline lens and its surgical management.

PubMed

Srećković, Sunčica; Janićijević Petrović, Mirjana; Jovanović, Svetlana; Paunović, Svetlana; Sarenac, Tatjana

2012-02-01

This paper reports a case of a 57-year old female who had sustained a blunt ocular trauma resulting in anterior dislocation of the crystalline lens and acute painful visual loss in the left eye. The patient was managed with anterior chamber intracapsular phacoemulsification through a small anterior capsulotomy, pars plana vitrectomy, and surgical iridotomy. Aphakia was corrected by a contact lens. Two months after the surgery, the best corrected visual acuity was 0.9 in the left eye. The vision and retina remained stable in her follow-up examination 1 year later. Anterior dislocation of the crystalline lens can cause severe complications so that dislocated lens should be removed immediately.

Lenticular meridional astigmatism secondary to iris mesectodermal leiomyoma.

PubMed

Chalam, K V; Cutler Peck, Carolee M; Grover, Sandeep; Radhakrishnan, Ravi

2012-01-01

A 61-year-old African American man presented with decreased vision of 2 months duration. Examination revealed a significant lenticular astigmatism and sectoral cataract as a result of an amelanotic iris lesion. Slitlamp optical coherence tomography (OCT) revealed angle crowding. An excisional biopsy was performed along with phacoemulsification in the right eye, with intraocular lens implantation for meridional lenticular astigmatism. Histopathology and histoimmunochemistry confirmed a diagnosis of uveal mesectodermal leiomyoma. Lenticular astigmatism may be a subtle sign of an anterior segment tumor. Anterior segment slitlamp OCT is an effective tool in diagnosing as well as monitoring small interval changes in these types of tumors. Copyright © 2012 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Long term followup of cataracts in children after renal transplantation.

PubMed Central

Wilson, W A; Fine, R N

1979-01-01

In reviewing the course of 218 renal transplantation recipients 55% have developed PSC of which eleven patients have had surgery on one or both eyes; The operations in general have been uncomplicated, and the visual results have been excellent with the exception of one case that had a detached retina. The cataracts were probably induced by heavy corticosteroid therapy as the larger the dosage and the younger the recipient, the more prone were they to the development of lens changes. Phacoemulsification was preferred in this series as the more expeditious technique, leading to a clearer anterior chamber with less chance of developing a secondary cataract. Images FIGURE 1 FIGURE 2 PMID:397659

A retrospective randomized study to compare the energy delivered using CDE with different techniques and OZil settings by different surgeons in phacoemulsification.

PubMed

Chen, Ming; Sweeney, Henry W; Luke, Becky; Chen, Mindy; Brown, Mathew

2009-01-01

Cumulative dissipated energy (CDE) was used with Infiniti((R)) Vision System (Alcon Labs) as an energy delivery guide to compare four different phaco techniques and phaco settings. The supracapsular phaco technique and burst mode is known for efficiency and surgery is faster compared with the old phaco unit. In this study, we found that supracapsular phaco with burst mode had the least CDE in both cataract and nuclear sclerosis cataract with the new Infiniti((R)) unit. We suggest that CDE can be used as one of the references to modify technique and setting to improve outcome for surgeons, especially for new surgeons.

A retrospective randomized study to compare the energy delivered using CDE with different techniques and OZil® settings by different surgeons in phacoemulsification

PubMed Central

Chen, Ming; Sweeney, Henry W; Luke, Becky; Chen, Mindy; Brown, Mathew

2009-01-01

Cumulative dissipated energy (CDE) was used with Infiniti® Vision System (Alcon Labs) as an energy delivery guide to compare four different phaco techniques and phaco settings. The supracapsular phaco technique and burst mode is known for efficiency and surgery is faster compared with the old phaco unit. In this study, we found that supracapsular phaco with burst mode had the least CDE in both cataract and nuclear sclerosis cataract with the new Infiniti® unit. We suggest that CDE can be used as one of the references to modify technique and setting to improve outcome for surgeons, especially for new surgeons. PMID:19688027

An unusual case of posttrabeculectomy conjunctival granuloma.

PubMed

Choudhary, Samiksha; Sen, Swarnali; Gupta, Omprakash

2018-01-01

We report an unusual case of granulomatous inflammation that presented adjacent to bleb 3 weeks postoperatively after combined phacoemulsification and trabeculectomy surgery with mitomycin-C due to retained microfragments of methyl cellulose sponge. The commonly used antimetabolite delivery devices are made of cellulose. Methyl cellulose sponges are friable, and they are likely to leave behind microfragments in subconjunctival space. In our case, bleb integrity was maintained, unlike the earlier reported cases which presented with bleb leak. Hence, one should have high index of suspicion in unusual cases of postoperative inflammation not resolving conservatively. Although rare, retained sponge particles can be a cause of early bleb-related inflammation which can lead to bleb failure.

An unusual case of posttrabeculectomy conjunctival granuloma

PubMed Central

Choudhary, Samiksha; Sen, Swarnali; Gupta, Omprakash

2018-01-01

We report an unusual case of granulomatous inflammation that presented adjacent to bleb 3 weeks postoperatively after combined phacoemulsification and trabeculectomy surgery with mitomycin-C due to retained microfragments of methyl cellulose sponge. The commonly used antimetabolite delivery devices are made of cellulose. Methyl cellulose sponges are friable, and they are likely to leave behind microfragments in subconjunctival space. In our case, bleb integrity was maintained, unlike the earlier reported cases which presented with bleb leak. Hence, one should have high index of suspicion in unusual cases of postoperative inflammation not resolving conservatively. Although rare, retained sponge particles can be a cause of early bleb-related inflammation which can lead to bleb failure. PMID:29563697

Trabectome (Trabeculectomy—Internal Approach): Additional Experience and Extended Follow-Up

PubMed Central

Minckler, Don; Mosaed, Sameh; Dustin, Laurie; MS, Brian Francis

2008-01-01

Purpose To report a retrospective case series of 1127 Trabectome surgical procedures, including 738 Trabectome-only and 366 Trabectome-phacoemulsification surgeries. Methods Electroablation of meshwork via a temporal corneal incision. Outcomes included changes in intraocular pressure (IOP) and medication use, complications, and Kaplan-Meier success estimates. Results For all cases, mean preoperative IOP of 23.8 ± 7.7 mm Hg decreased by 39% to 16.5 ± 4.0 mm Hg at 24 months (n = 50). Intraoperative reflux bleeding occurred in 77.6%. Medications decreased from 2.8 to 1.2 by 24 months. Sixty-five patients (5.8%) had IOP elevation > 10 mm Hg above baseline on day 1. Failure led to trabeculectomy in 5.9% (n = 67) and shunt installation in 1.6% (n = 18). Kaplan-Meier failure was defined across groups with at least 2 weeks follow-up as IOP > 21 mm Hg with or without medications and not reduced by 20% below baseline on 2 consecutive visits or repeat surgery. For Trabectome-only cases, mean preoperative IOP of 25.7 ± 7.7 mm Hg was reduced by 40% to 16.6 ± 4.0 mm Hg at 24 months (n = 46). No prolonged hypotony, choroidal effusion, choroidal hemorrhage, or infections occurred. Failure led to trabeculectomy in 8.1% (n = 60) and shunt installation in 1.9% (n = 14). Medications decreased from 2.93 to 1.2 by 24 months. For Trabectome-phacoemulsification cases, baseline IOP of 20.0 ± 6.2 mm Hg decreased at 12 months to 15.9 ± 3.3 mm Hg (18%) (n = 45) and medications decreased from 2.63 ± 1.12 to 1.50 ± 1.36. Sixteen (4.4%) of 365 had prior failed trabeculectomy, and 139 of 365 (38%) had prior laser trabeculoplasty. Conclusion Trabectome offers a minimally invasive method of improving IOP control in open-angle glaucomas. PMID:19277230

Multiple methods of surgical treatment combined with primary IOL implantation on traumatic lens subluxation/dislocation in patients with secondary glaucoma

PubMed Central

Wang, Rui; Bi, Chun-Chao; Lei, Chun-Ling; Sun, Wen-Tao; Wang, Shan-Shan; Dong, Xiao-Juan

2014-01-01

AIM To describe clinical findings and complications from cases of traumatic lens subluxation/dislocation in patients with secondary glaucoma, and discuss the multiple treating methods of operation combined with primary intraocular lens (IOL) implantation. METHODS Non-comparative retrospective observational case series. Participants: 30 cases (30 eyes) of lens subluxation/dislocation in patients with secondary glaucoma were investigated which accepted the surgical treatment by author in the Ophthalmology of Xi'an No.4 Hospital from 2007 to 2011. According to the different situations of lens subluxation/dislocation, various surgical procedures were performed such as crystalline lens phacoemulsification, crystalline lens phacoemulsification combined anterior vitrectomy, intracapsular cataract extraction combined anterior vitrectomy, lensectomy combined anterior vitrectomy though peripheral transparent cornea incision, pars plana lensectomy combined pars plana vitrectomy, and intravitreal cavity crystalline lens phacofragmentation combined pars plana vitrectomy. And whether to implement trabeculectomy depended on the different situations of secondary glaucoma. The posterior chamber intraocular lenses (PC-IOLs) were implanted in the capsular-bag or trassclerally sutured in the sulus decided by whether the capsular were present. Main outcome measures: visual acuity, intraocular pressure, the situation of intraocular lens and complications after the operations. RESULTS The follow-up time was 11-36mo (21.4±7.13). Postoperative visual acuity of all eyes were improved; 28 cases maintained IOP below 21 mm Hg; 2 cases had slightly IOL subluxation, 4 cases had slightly tilted lens optical area; 1 case had postoperative choroidal detachment; 4 cases had postoperative corneal edema more than 1wk, but eventually recovered transparent; 2 cases had mild postoperative vitreous hemorrhage, and absorbed 4wk later. There was no postoperative retinal detachment, IOL dislocation, and endophthalmitis. CONCLUSION To take early treatment of traumatic lens subluxation/dislocation in patients with secondary glaucoma by individual surgical plan based on the different eye conditions would be safe and effective, which can effectively control the intraocular pressure and restore some vision. PMID:24790868

Comparison of the Ahmed and Baerveldt glaucoma shunts with combined cataract extraction.

PubMed

Rai, Amrit S; Shoham-Hazon, Nir; Christakis, Panos G; Rai, Amandeep S; Ahmed, Iqbal Ike K

2018-04-01

To compare the surgical outcomes of combined phacoemulsification with either Ahmed glaucoma valve (AGV) or Baerveldt glaucoma implant (BGI). Retrospective cohort study. A total of 104 eyes that underwent combined phacoemulsification with either AGV (PhacoAGV; n = 57) or BGI (PhacoBGI; n = 47) implantation. Failure was defined as uncontrolled intraocular pressure (IOP; <5 mm Hg, ≥18 mm Hg, or <20% reduction), additional glaucoma surgery, vision-threatening complications, or progression to no-light-perception vision. The PhacoAGV group was older (p = 0.03), had poorer baseline visual acuity (VA; p = 0.001), and had fewer previous glaucoma surgeries (p = 0.04). Both groups had similar baseline IOP (PhacoAGV: 26.4 ± 8.3 mm Hg; PhacoBGI: 25.7 ± 7.3; p = 0.66) and glaucoma medications (PhacoAGV: 3.8 ± 1.0; PhacoBGI: 3.6 ± 1.5; p = 0.54). At 2 years, failure rates were 44% in the PhacoAGV group and 23% in the PhacoBGI group (p = 0.02). Both groups had similar mean IOP reduction (PhacoAGV: 45%; PhacoBGI: 47%, p = 0.67) and medication use reduction (PhacoAGV: 47%; PhacoBGI: 58%, p = 0.38). The PhacoBGI group had higher IOP and medication use up to 1 month (p < 0.05). Both groups improved in VA from baseline (p < 0.05) and had similar overall complication rates (p = 0.31). The PhacoBGI group required more overall interventions (p < 0.0005). This comparative study found no difference in IOP, glaucoma medications, or complication rates between PhacoAGV and PhacoBGI at 2 years, despite BGIs being implanted in patients at higher risk for failure. The PhacoAGV group had higher failure rates at 2 years. Both groups had significant improvements in VA due to removal of their cataracts. The PhacoBGI group required more interventions, but most of these were minor slit-lamp procedures. Copyright © 2018. Published by Elsevier Inc.

Preliminary study of the association between corneal histocytological changes and surgically induced astigmatism after phacoemulsification.

PubMed

Du, Xing; Zhao, Guiqiu; Wang, Qing; Yang, Xian; Gao, Ang; Lin, Jing; Wang, Qian; Xu, Qiang

2014-11-20

Surgically induced astigmatism (SIA) was one of the factors that influences the desirable refractive outcome, and it was related to the length, type, location, structure of the incision and to the suture closure technique, etc. The aim was to evaluate the association of corneal histocytological changes with SIA after phacoemulsification. The study enrolled 68 cases of cataract patient (68 eyes). Corneal histocytological parameters at corneal incision, central cornea and contralateral incision obtained by confocal microscope through focusing (CMTF) were compared preoperatively and 1 week, 2 weeks, 1 month, 3 months and 6 months postoperatively. These biometric parameters included the endothelial cell density, keratocyte density of posterior stromal layer, and the morphological changes. SIA was calculated by Jaffe's vector analysis. 1 From preoperatively to 1 week, 2 weeks, 1 month, 3 months and 6 months postoperatively, the endothelail cell density was decreased significantly (p < 0.05). Keratocyte density of posterior stroma layer was increased significantly only at 1 week, 2 weeks, 1 month, 3 months postoperatively (p <0.05), but not statistically significant (p = 0.173) at 6 months postoperatively compared to preoperative values. 2 The histocytological observations indicated that the morphology changed significantly postoperatively at the corneal incision, including the cell absent area, wave-like area, dot-like and mass-like hyperreflection, stripe-like absent area, in the endothelial layer, and the keratocyte activation, microfolds, irregular hyporeflective or hyperreflective belt, and a little dot-like hyperreflection in the posterior stroma layer. 3 The reduction of the endothelial cell density at the corneal incision at 1 week, 2 weeks, 1 month postoperatively, were positively correlated with SIA (P1 week = 0.003, P2 weeks = 0.003, P1 month = 0.032), while others were not associated with SIA statistically. The reduction of endothelail cell density and the histocytological changes at the corneal incision were associated with SIA. The underlining mechanism needs further study.

Free radical development in phacoemulsification cataract surgery.

PubMed

Takahashi, Hiroshi

2005-02-01

Phacoemulsification and aspiration (PEA) has become the most popular cataract surgery, due to the establishment of safe surgical techniques and development of associated instruments. However, corneal endothelial damage still represents a serious complication, as excessive damage can lead to irreversible bullous keratopathy. In addition to causes such as mechanical or heat injuries, free radical formation due to ultrasound has been posited as another cause of corneal endothelium damage in PEA. Ultrasound in aqueous solution induces cavitation, directly causing water molecule disintegration and resulting in the formation of hydroxylradicals, the most potent of the reactive oxygen species. Considering the oxidative insult to endothelial cells caused by free radicals, their presence in the anterior chamber may represent one of the most harmful factors during these procedures. Indeed, some researchers have recently started to evaluate PEA from the perspective of oxidative stress. Conversely, the major ingredient in ophthalmic viscosurgical devices (OVDs), which are indispensable for maintaining the anterior chamber in PEA surgery, is sodium hyaluronate, a known free radical scavenger. OVDs can thus be expected to provide some anti-free radical effect during PEA procedures. In addition, since commercially available OVDs display different properties regarding retention in the anterior chamber during PEA, the anti-free radical effect of OVDs is likely to depend on behavior during irrigation and aspiration. The present study followed standard PEA procedures in an eye model and measured hydroxylradicals in the anterior chamber using electron spin resonance. The kinetics of free radical intensity and effects of several OVDs during clinical PEA were also demonstrated. These studies may be of significance in re-evaluating OVDs as a chemical protectant for corneal endothelium, since the OVD has thus far only been regarded as a physical barrier. In addition, many reports about corneal endothelium damage during PEA have been published, but objective evaluation of various damaging factors has been difficult. The present assay of free radicals in a simulation of clinical PEA offers the first method to quantitatively assess stress on the corneal endothelium.

Comparison of Visual Quality after Implantation of Big Bag and Akreos Adapt Intraocular Lenses in Patients with High Myopia.

PubMed

Ma, Shengsheng; Zheng, Dongjian; Lin, Ling; Meng, Fanjian; Yuan, Yonggang

2015-03-01

To compare vision quality following phacoemulsification cataract extraction and implantation of a Big Bag or Akreos Adapt intraocular lens (IOL) in patients diagnosed with high myopia complicated with cataract. This was a randomized prospective control study. The patients with high myopia. complicated with cataract, with axial length ≥ 28 mm, and corneal astigmatism ≤ 1D were enrolled and randomly divided into the Big Bag and Akreos Adapt IOL groups. All patients underwent phacoemulsification cataract extraction and lens implantation. At 3 months after surgery, intraocular high-order aberration was measured by a Tracey-iTrace wavefront aberrometer at a pupil diameter of 5 mm in an absolutely dark room and statistically compared between two groups. The images of the anterior segment of eyes were photographed with a Scheimpflug camera using Penta-cam three-dimensional anterior segment analyzer. The tilt and decentration of the IOL were calculated by Image-pro plus 6.0 imaging analysis software and statistically compared between two groups. In total, 127 patients (127 eyes), including 52 males and 75 females, were enrolled in this study. The total high-order aberration and coma in the Akreos Adapt group (59 eyes) were significantly higher compared with those in the Big Bag (P < 0.05). The clover and spherical aberration did not differ between the two groups (P > 0.05). The horizontal and vertical decentration were significantly smaller in the Big Bag lens group than in the Akreos Adapt group (both P < 0.05), whereas the tilt of IOL did not significantly differ between the two groups (P > 0.05). Both Big Bag and Akreos Adapt IOLs possess relatively good intraocular stability implanted in patients with high myopia. Compared with the Akreos Adapt IOL, the Big Bag IOL presents with smaller intraocular high-order aberration. Coma is the major difference between the two groups.

A fluidics comparison of Alcon Infiniti, Bausch & Lomb Stellaris, and Advanced Medical Optics Signature phacoemulsification machines.

PubMed

Georgescu, Dan; Kuo, Annie F; Kinard, Krista I; Olson, Randall J

2008-06-01

To compare three phacoemulsification machines for measurement accuracy and postocclusion surge (POS) in human cadaver eyes. In vitro comparisons of machine accuracy and POS. Tip vacuum and flow were compared with machine indicated vacuum and flow. All machines were placed in two human cadaver eyes and POS was determined. Vacuum (% of actual) was 101.9% +/- 1.7% for Infiniti (Alcon, Fort Worth, Texas, USA), 93.2% +/- 3.9% for Stellaris (Bausch & Lomb, Rochester, New York, USA), and 107.8% +/- 4.6% for Signature (Advanced Medical Optics, Santa, Ana, California, USA; P < .0001). At 60 ml/minute flow, actual flow and unoccluded flow vacuum (UFV) was 55.8 +/- 0.4 ml/minute and 197.7 +/- 0.7 mm Hg for Infiniti, 53.5 +/- 0.0 ml/minute and 179.8 +/- 0.9 mm Hg for Stellaris, and 58.5 +/- 0.0 ml/minute and 115.1 +/- 2.3 mm Hg for Signature (P < .0001). POS in an 32-year-old eye was 0.33 +/- 0.05 mm for Infiniti, 0.16 +/- 0.06 mm for Stellaris, and 0.13 +/- 0.04 mm for Signature at 550 mm Hg, 60 cm bottle height, 45 ml/minute flow with 19-gauge tips (P < .0001 for Infiniti vs Stellaris and Signature). POS in an 81-year-old eye was 1.51 +/- 0.22 mm for Infiniti, 0.83 +/- 0.06 mm for Stellaris, 0.67 +/- 0.01 mm for Signature at 400 mm Hg vacuum, 70 cm bottle height, 40 ml/minute flow with 19-gauge tips (P < .0001). Machine-indicated accuracy, POS, and UFV were statistically significantly different. Signature had the lowest POS and vacuum to maintain flow. Regarding POS, Stellaris was close to Signature; regarding vacuum to maintain flow, Infiniti and Stellaris were similar. Minimizing POS and vacuum to maintain flow potentially are important in avoiding ocular damage and surgical complications.

Basic studies on laser-assisted phacoemulsification using diode-pumped Er:YAG laser

NASA Astrophysics Data System (ADS)

Hausladen, Florian; Wurm, Holger; Stock, Karl

2016-03-01

The aim of this study was to determine the potential of a novel diode-pumped Er:YAG laser for phacoemulsification in basic experimental investigations. An appropriate experimental setup was created, including a translation stage for sample movement, a sample holder, a water spray for sample humidification and a surgical microscope with a CCD camera for video documentation. The analysis of the laser cuts and histological sections was done by light microscopy. As samples porcine eye lenses hardened by formalin were used. In ablation experiments with different spot diameters and radiant powers and a constant repetition rate νr = 200 Hz the maximum ablation depths of (4.346 +/- 0.044) mm have reached at (Ø = 480 μm, Φ = 24.15 W) with a maximum extend of thermal damage of (0.165 +/- 0.030) mm. The average ablation efficiency is 0.241 mm3/J. With a spot diameter of 308 μm the maximum ablation depth is (4.238 +/- 0.040) mm at 24.65 W with a mean ablation efficiency of 0.293 mm3/J. The extend of the thermally damaged region is (0.171 +/- 0.024) mm at this laser power. Using a sapphire cylinder with a diameter of 412 μm (length 38.5 mm) in direct tissue contact with water spray for sample humidification the ablation depth reaches (1.017 +/- 0.074) mm at 4.93 W and (1.840 +/- 0.092) mm at 9.87 W with a mean efficiency of 0.261 mm3/J. A thermal damage zone of (0.064 +/-0.024) mm at 9.87 W was measured. Additionally, at this high power, a progressive contamination and destruction of the cylinder end facet was observed. In conclusion, the investigations show that the diode-pumped Er:YAG laser has considerable potential for cataract surgery.

Comparative analysis of endothelial cell loss following phacoemulsification in pupils of different sizes.

PubMed

Maggon, Rakesh; Bhattacharjee, Raghudev; Shankar, Sandeep; Kar, Rajesh Chandra; Sharma, Vivek; Roy, Shyamal

2017-12-01

To compare Endothelial cell(EC) loss following Phacoemulsification (PKE) in pupils of different sizes. A prospective double masked observational study in which a total of 150 eyes of 150 patients between 50 & 70 years of age with senile cataract of nuclear sclerosis grade II were enrolled. Patients were allocated into three groups of 50 eyes each in Group A (pupil size <5 mm), Group B (pupil size 5-7 mm) and Group C (pupil size >7 mm). Pupillary size was measured by determining the height of slit on slit-lamp biomicroscope examination. PKE was done by the same expert surgeon using vertical chop technique and a foldable intraocular lens was implanted in the capsular bag. Corneal EC count and pachymetry were performed twice and average of 2 readings was taken for the purpose of this study. Measurements were taken preoperatively and postoperatively on day 1, day 7 and day 30. The mean EC count loss on postoperative day 1 in Group A was 19.45%, Group B 14.89%, Group C 10.19% with statistical significant difference between Group A and Group B, as also Group A and Group C. The difference was not significant between Group B and Group C, though there was a fall in EC count in Group C as well. Increase in corneal thickness on postoperative day 1 in group A was 5.43%, Group B 3.55%, Group C 2.14% with statistical significant difference between Group A and Group B, as also Group A and Group C with no difference in Group B and Group C. PKE done in eyes with maximal pupillary dilatation of <5 mm causes a greater EC loss and results in thicker corneas postoperatively as compared to eyes with pupillary dilatation of >5 mm at the end of one month.

A comparison of two different formulations of diclofenac sodium 0.1% in the treatment of inflammation following cataract-intraocular lens surgery.

PubMed

Mester, Ulrich; Lohmann, Chris; Pleyer, U; Steinkamp, G; Völcker, E; Kruger, H; Raj, Palaniswamy Sunder

2002-01-01

To compare the efficacy, tolerability and local tolerance of diclofenac sodium 0.1% containing hydroxypropylgamma cyclodextrin preserved with benzalkonium chloride 0.005% (Voltaren Ophtha CD), with that of diclofenac sodium 0.1% preserved with thiomersal 0.004% (Voltaren Ophtha) in the treatment of inflammation after cataract-intraocular lens surgery. Randomised 2:1, double-masked, parallel-group study in six centres in Germany. 299 patients scheduled to undergo phacoemulsification with posterior chamber intraocular lens implantation. Study medications were instilled four times in the 30 minutes before surgery and four times daily from the first postoperative day. The key efficacy variable was the reduction in anterior chamber flare (photons/millisecond) from day 1 to day 6 to 8. Patients underwent comprehensive ocular examinations, including laser flaremetry (KOWA), preoperatively and postoperatively at days 1, 6 to 8 and 24 to 32. 268 patients (Voltaren Ophtha CD 177, Voltaren Ophtha 91) completed the day 6 to 8 visit without any protocol violations. Reduction in the degree of intraocular inflammation with Voltaren Ophtha CD was equivalent to that achieved with Voltaren Ophtha at the day 6 to 8 [95% confidence interval (CI) -3.07 to +0.54] and day 24 to 32 (95% CI -1.44 to +1.40) visits. Although there was no significant (p = 0.464) difference between the two study groups in patients' global assessment of local tolerance at day 24 to 32, ocular discomfort was significantly (p = 0.023) less with Voltaren Ophtha CD compared with Voltaren Ophtha. Voltaren Ophtha CD was as effective and well tolerated but had less ocular discomfort compared with Voltaren Ophtha in the treatment of ocular inflammation after phacoemulsification with intraocular lens implantation. This new formulation of diclofenac sodium 0.1% may be used as an alternative to the existing formulations of ophthalmic diclofenac sodium 0.1%.

Femtosecond laser cataract surgery: technology and clinical practice.

PubMed

Roberts, Timothy V; Lawless, Michael; Chan, Colin Ck; Jacobs, Mark; Ng, David; Bali, Shveta J; Hodge, Chris; Sutton, Gerard

2013-03-01

The recent introduction of femtosecond lasers to cataract surgery has generated much interest among ophthalmologists around the world. Laser cataract surgery integrates high-resolution anterior segment imaging systems with a femtosecond laser, allowing key steps of the procedure, including the primary and side-port corneal incisions, the anterior capsulotomy and fragmentation of the lens nucleus, to be performed with computer-guided laser precision. There is emerging evidence of reduced phacoemulsification time, better wound architecture and a more stable refractive result with femtosecond cataract surgery, as well as reports documenting an initial learning curve. This article will review the current state of technology and discuss our clinical experience. © 2012 The Authors. Clinical and Experimental Ophthalmology © 2012 Royal Australian and New Zealand College of Ophthalmologists.

[Results after planned extracapsular cataract extraction with the Klöti stripper and implantation of UV light-absorbent Simcoe lenses with a 10-degree loop tilt].

PubMed

Gnad, H D; Skorpik, C; Paroussis, P

1985-08-09

Planned ECCE remains a valuable alternative to phacoemulsification due to its protection of the endothelial cells of the cornea. In contrast to the most commonly used infusion-aspiration systems, Kloeti's vitreous stripper provides, in addition, an excellent cutting mechanism enabling the removal of hard parts of the parenchyma or capsular remnants. The aspheric shaped UV light absorbing Simcoe lenses with a 10 grade loop angle used as lens replacement over the past 2 years in 300 cases did not cause any noteworthy complications. In 94% of cases a visual acuity of at least 0.5 was achieved; no case of cystoid macular edema has been observed so far.

Macular protection with IOLs

NASA Astrophysics Data System (ADS)

Soderberg, Per G.; Lofgren, Stefan; Ayala, Marcelo; Dong, Xiuqin; Kakar, Manoj; Mody, Vino; Meyer, Linda; Laurell, Carl-Gustaf

2004-07-01

The clinical outcome within one month after phacoemulsification cataract extraction with implantation of the blue-blocking SN60AT IOL was examined prospectively and compared to a retrospectively examined material of implantations of the equivalent SA30AL without blue-blocker. There was no difference in best corrected visual acuity gain between the two lenses. In addition, the subjective color perception was examined for with a questionnaire after the first implantation of blue-blocking IOL and after the second implantation of blue-blocking IOL. Only one patient noted a changed color perception. There are thus strong theoretical reasons to block blue light in IOLs and no short term clinical inconvenience. But, it remains to be proven in long term follow up studies that the blue-blocking IOL protects against macular degeneration.

Anterior capsule phimosis and capsular block syndrome in a patient with Steinert myotonic dystrophy: a case report

PubMed Central

2009-01-01

A 55-year-old man with myotonic dystrophy underwent phacoemulsification with IOL implantation in the right eye. 3 months after surgery, the patient showed a decreased visual acuity and an intraocular pressure (IOP) of 30 mmHg. Slit lamp examination showed a dense fibrosis of the anterior capsule with capsulorexis' shrinkage. Gonioscopy showed a closed angle. After a YAG laser iridotomy no decrease in the IOP was detected; following surgical peeling of the anterior capsule, the slit lamp showed a distended capsular bag. A YAG laser posterior capsulotomy was performed, without decrease in the IOP. Myotonic patients need to be closely followed up after cataract surgery, because in case of CBS development a prompt posterior capsulotomy could avoid more severe complications. PMID:20062622

Eye health care in the Czech Republic.

PubMed

Kocur, Ivo; Kuchynka, Pavel

2002-01-01

An analysis of eye health care in the Czech Republic as of 1998 was performed. A questionnaire was used to obtain information from all 59 in-patient eye departments. The number of ophthalmologists per 1 million inhabitants was 95. The number of cataract operations per 1 million inhabitants was 4,209: phaco-emulsification (36,926 surgeries, 85.2%), extracapsular extraction (6,094 surgeries, 14.1%) and intracapsular extraction (90 surgeries, 0.2%). Intra-ocular lenses were implanted in 99% of cases; 404 corneal transplantations and 1,220 operations for retinal detachment were performed. The number of pars plana vitrectomies for diabetic eye complications was 661. Selected regional clinical centres should be equipped and preferred by health insurance companies to provide comprehensive eye health care services and training. Copyright 2002 S. Karger AG, Basel

Bleeding during gonioscopy after deep sclerectomy.

PubMed

Moreno-Montañés, Javier; Rodríguez-Conde, Rosa

2003-10-01

To show a new complication after deep sclerectomy (DS). We described two eyes of two patients with open-angle glaucoma and cataract who were operated on of an uneventful phacoemulsification and DS with SK-gel implantation. Bleeding during gonioscopic examination occurred in both eyes 7 and 8 months after combined surgery. The blood originated from the vessels around the Descemet window, and was probably due to manipulation or rocking of the goniolens. Pressure was immediately applied to the gonioscopic lens and the hyphema was interrupted. These cases show the presence of new vessels around the Descemet window after DS with SK-gel. Bleeding from the Descemet window vessels can occur during gonioscopy even months after DS. We recommend conducting a careful gonioscopic examination in patients who have undergone DS to avoid this complication.

Fuchs' dystrophy associated with radial keratotomy: Lamellar or perforating keratoplasty?

PubMed

Rodriguez-Ausin, P; Antolin-Garcia, D; Santamaria Garcia, L; Blazquez-Fernandez, A-B

2017-05-01

A 70 year-old male patient with a history of radial keratotomy suffering from Fuchs' dystrophy and a cataract. The patient received a two-step surgery: lens phacoemulsification and intraocular lens implant, followed by descemet stripping automated endothelial keratoplasty in both eyes, four months later. There were no complications apart from a recurrent cystoid macular oedema in both eyes. The best corrected visual acuity was 20/40 both eyes, and the patient was satisfied. Descemet stripping automated endothelial keratoplasty may be considered as an alternative to penetrating keratoplasty in the case of endothelial dysfunction and radial keratotomy in patients with no corneal ectasia or significant stromal opacity. Copyright © 2016 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.

Solving intraocular lens-related pigment dispersion syndrome with repositioning of primary sulcus implanted single-piece IOL in the capsular bag.

PubMed

Kohnen, Thomas; Kook, Daniel

2009-08-01

We describe 2 cases of pigment dispersion syndrome (PDS) after uneventful phacoemulsification and implantation of a posterior chamber single-piece intraocular lens (IOL) with a sharp-edge design. In both cases, several days after IOL implantation, marked pigment dispersion was seen on the iris and in the trabecular meshwork, associated with an elevation in intraocular pressure (IOP). Thorough examination showed that the implanted IOL was in the ciliary sulcus. After surgical repositioning of both IOLs in the capsular bag, the pigment dispersion regressed and the IOP returned to normal limits. The 2 cases suggest that particularly in PDS patients, an IOL with an anterior sharp-edge design should be implanted in the capsular bag. Implantation in the ciliary sulcus should be avoided.

Performance of the SRK/T formula using A-Scan ultrasound biometry after phacoemulsification in eyes with short and long axial lengths.

PubMed

Karabela, Yunus; Eliacik, Mustafa; Kaya, Faruk

2016-07-08

The SRK/T formula is one of the third generation IOL calculation formulas. The purpose of this study was to evaluate the performance of the SRK/T formula in predicting a target refraction ±1.0D in short and long eyes using ultrasound biometry after phacoemulsification. The present study was a retrospective analysis, which included 38 eyes with an AL < 22.0 mm (short AL), and 62 eyes ≥24.6 mm (long AL) that underwent uncomplicated phacoemulsification. Preoperative AL was measured by ultrasound biometry and SRK/T formula was used for IOL calculation. Three different IOLs were implanted in the capsular bag. The prediction error was defined as the difference between the achieved postoperative refraction, and attempted predicted target refraction. Statistical analysis was performed with SPSS V21. In short ALs, the mean age was 65.13 ± 9.49 year, the mean AL was 21.55 ± 0.45 mm, the mean K1 and K2 were 45.76 ± 1.77D and 46.09 ± 1.61D, the mean IOL power was 23.96 ± 1.92D, the mean attempted (predicted) value was 0.07 ± 0.26D, the mean achieved value was 0.07 ± 0.63 D, the mean PE was 0.01 ± 0.60D, and the MAE was 0.51 ± 0.31D. A significant positive relationship with AL and K1, K2, IOL power and a strong negative relationship with PE and achieved postoperative was found. In long ALs, the mean age was 64.05 ± 7.31 year, the mean AL was 25.77 ± 1.64 mm, the mean K1 and K2 were 42.20 ± 1.57D and 42.17 ± 1.68D, the mean IOL power was 15.79 ± 5.17D, the mean attempted value was -0.434 ± 0.315D, the mean achieved value was -0.42 ± 0.96D, the mean PE was -0.004 ± 0.93D, the MAE was 0.68 ± 0.62D. A significant positive relationship with AL and K1, K2 and a significant positive relationship with PE and achieved value, otherwise a negative relationship with AL and IOL power was found. There was a little tendency towards hyperopic for short ALs and myopic for long ALs. The majority of eyes (94.74 %) for short ALs and (70.97 %) for long ALs were within ±1 D of the predicted refractive error. No significant relationship with PE and IOL types, AL, K1, K2, IOL power, and attempted value, besides with MAE and AL, K1, K2, age, attempted, achieved value were found in both groups. The SRK/T formula performs well and shows good predictability in eyes with short and long axial lengths.

Changes in astigmatism and corneal higher-order aberrations after phacoemulsification with toric intraocular lens implantation for mild keratoconus with cataract.

PubMed

Kamiya, Kazutaka; Shimizu, Kimiya; Miyake, Toshiyuki

2016-07-01

To assess the changes in astigmatism and higher-order aberrations (HOAs) after toric intraocular lens (IOL) implantation for mild non-progressive keratoconus with cataract. We prospectively examined 19 eyes of 19 consecutive keratoconic patients (mean age ± standard deviation, 63.1 ± 9.1 years) who underwent phacoemulsification with toric IOL implantation. We determined uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive astigmatism, corneal astigmatism, corneal HOAs and astigmatic axis rotation both preoperatively and 3 months postoperatively. Logarithm of the minimal angle of resolution (logMAR) UDVA was significantly improved from 1.14 ± 0.50 preoperatively to 0.46 ± 0.33 postoperatively (Wilcoxon signed-rank test, p < 0.001). LogMAR CDVA was also significantly improved from 0.27 ± 0.45 preoperatively to -0.01 ± 0.09 postoperatively (p < 0.001). In 5 of 6 eyes in which the target refraction was emmetropia, postoperative UDVA was better than 20/32. The achieved spherical equivalent correction was within ±0.5 diopters (D) of the targeted correction in 13 (68 %) eyes and 1.0 in 18 (95 %) eyes. The refractive astigmatism was significantly decreased from -1.92 ± 1.73 D preoperatively to -0.70 ± 0.60 D postoperatively (p = 0.006). The corneal astigmatism changed from 2.89 ± 1.30 D preoperatively to 2.98 ± 1.09 D postoperatively (p = 0.492), which was not statistically significant. The corneal HOAs for a 4-mm pupil was changed from 0.47 ± 0.23 µm preoperatively to 0.52 ± 0.26 µm postoperatively (p = 0.211), which was not statistically significant. According to our experience, toric IOL implantation for mild keratoconic patients having rigid gas-permeable lens intolerance appears to be effective for reducing refractive astigmatism without a significant induction of corneal HOAs.

Visual acuity, refractive error, and endothelial cell density six months after Descemet stripping and automated endothelial keratoplasty (DSAEK).

PubMed

Koenig, Steven B; Covert, Douglas J; Dupps, William J; Meisler, David M

2007-07-01

To evaluate visual acuity, refractive outcomes, and endothelial cell density 6 months after Descemet stripping and automated endothelial keratoplasty (DSAEK). We performed an institutional review board-approved prospective study of a surgical case series of 34 patients at 2 institutions undergoing DSAEK for Fuchs endothelial dystrophy, pseudophakic bullous keratopathy, or aphakic bullous keratopathy with or without simultaneous phacoemulsification and intraocular lens implantation. Clinical outcomes, including best spectacle-corrected visual acuity (BSCVA), spherical equivalent refraction, and refractive astigmatism and topographic or keratometric astigmatism, were assessed at the 6-month postoperative examination and compared with preoperative values with paired Student t tests. The change in endothelial cell density from the eye bank examination to 6 months after transplantation was similarly evaluated. BSCVA averaged 20/99 preoperatively and 20/42 postoperatively (P < 0.0001). After DSAEK, 30 (88.2%) of 34 patients showed improved BSCVA, and 21 (61.8%) of the 34 patients achieved a BSCVA of 20/40 or better. For patients not undergoing simultaneous phacoemulsification and intraocular lens implantation, a hyperopic shift in refraction of 1.19 +/- 1.32 D was noted. Refractive astigmatism, topographic astigmatism, and keratometry showed no statistically significant change. Endothelial cell density of donor corneas averaged 2826 +/- 370 cells/mm, whereas the mean postoperative density was 1396 +/- 440 cells/mm. This finding corresponded to an average loss of 1426 cells/mm (50% loss; P = 0.0001). The first half of cases experienced an average cell loss of 1674 cells/mm (59% loss) compared with 1181 (41% loss) in the second half of cases (P = 0.005). Three (9%) of 34 grafts experienced iatrogenic graft failure and required reoperation with new donor tissue. Also, 9 (27%) of 34 grafts experienced dislocation in the early postoperative period and required repositioning. In this prospective study of DSAEK for bullous keratopathy and Fuchs endothelial corneal dystrophy, improvement of visual acuity was achieved with only a mild tendency toward hyperopic shift and without significant induced astigmatism. Endothelial cell loss was significant, however, and may be related to surgical experience.

The 5-year incidence of bleb-related infection and its risk factors after filtering surgeries with adjunctive mitomycin C: collaborative bleb-related infection incidence and treatment study 2.

PubMed

Yamamoto, Tetsuya; Sawada, Akira; Mayama, Chihiro; Araie, Makoto; Ohkubo, Shinji; Sugiyama, Kazuhisa; Kuwayama, Yasuaki

2014-05-01

To report the 5-year incidence of bleb-related infection after mitomycin C-augmented glaucoma filtering surgery and to investigate the risk factors for infections. Prospective, observational cohort study. A total of 1098 eyes of 1098 glaucoma patients who had undergone mitomycin C-augmented trabeculectomy or trabeculectomy combined with phacoemulsification and intraocular lens implantation performed at 34 clinical centers. Patients were followed up at 6-month intervals for 5 years, with special attention given to bleb-related infections. The follow-up data were analyzed via Kaplan-Meier survival analysis and the Cox proportional hazards model. Incidence of bleb-related infection over 5 years and risk factors for infections. Of the 1098 eyes, a bleb-related infection developed in 21 eyes. Kaplan-Meier survival analysis revealed that the incidence of bleb-related infection was 2.2±0.5% (cumulative incidence ± standard error) at the 5-year follow-up for all cases, whereas it was 7.9±3.1% and 1.7±0.4% for cases with and without a history of bleb leakage, respectively (P = 0.000, log-rank test). When only eyes with a well-functioning bleb were counted, it was 3.9±1.0%. No differences were found between the trabeculectomy cases and the combined surgery cases (P = 0.398, log-rank test) or between cases with a fornix-based flap and those with a limbal-based flap (P = 0.651, log-rank test). The Cox model revealed that a history of bleb leakage and younger age were risk factors for infections. The 5-year cumulative incidence of bleb-related infection was 2.2±0.5% in eyes treated with mitomycin C-augmented trabeculectomy or trabeculectomy combined with phacoemulsification and intraocular lens implantation in our prospective, multicenter study. Bleb leakage and younger age were the main risk factors for infections. Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Efficacy of Cruise Control in controlling postocclusion surge with Legacy and Millennium venturi phacoemulsification machines.

PubMed

Wade, Matthew; Isom, Ryan; Georgescu, Dan; Olson, Randall J

2007-06-01

To determine the efficacy of the Cruise Control surge-limiting device (Staar Surgical) with phacoemulsification machines known to have high levels of surge. John A. Moran Eye Center Clinical Laboratories. In an in vitro study, postocclusion anterior chamber depth changes were measured in fresh phakic human eye-bank eyes using the Alcon Legacy and Bausch & Lomb Millennium venturi machines in conjunction with the Staar Cruise Control device. Both machines were tested with 19-gauge non-Aspiration Bypass System tips at high-surge settings (500 mm Hg vacuum pressure, 75 cm bottle height, 40 mL/min flow rate for the Legacy) and low-surge settings (400 mm Hg vacuum pressure, 125 cm bottle height, 40 mL/min flow rate for the Legacy). Adjusted parameters of flow, vacuum, and irrigation were used based on previous studies to create identical conditions for each device tested. The effect of the Cruise Control device on aspiration rates was also tested with both machines at the low-surge settings. At the high setting with the addition of Cruise Control, surge decreased significantly with the Legacy but was too large to measure with the Millennium venturi. At the low setting with the addition of Cruise Control, surge decreased significantly with both machines. Surge with the Millennium decreased from more than 1.0 mm to a mean of 0.21 mm +/- 0.02 (SD) (P<.0001). Surge with the Legacy decreased from a mean of 0.09 +/- 0.02 mm to 0.05 +/- 0 mm, a 42.9% decrease (P<.0001). The Millennium had the highest surge and aspiration rate before Cruise Control and the greatest percentage decrease in the surge and aspiration rates as a result of the addition of Cruise Control. In the Legacy machine, the Cruise Control device had a statistically and clinically significant effect. Cruise Control had a large effect on fluidics as well as surge amplitude with the Millennium machine. The greater the flow or greater the initial surge, the greater the impact of the Cruise Control device.

Trabeculotomy combined with phacoemulsification and implantation of an intraocular lens for the treatment of primary open-angle glaucoma and coexisting cataract.

PubMed

Tanihara, H; Honjo, M; Inatani, M; Honda, Y; Ogino, N; Ueno, S; Negi, A; Ichioka, H; Mizoguchi, T; Matsumura, M; Nagata, M

1997-10-01

The authors previously reported the usefulness of trabeculotomy ab externo for the treatment of primary open-angle glaucoma in adult patients. In an attempt to elucidate the long-term risk-to-benefit ratio of this surgical modality in combination with cataract surgery, the authors conducted a retrospective study of the surgical effects and complications of a triple procedure: phacoemulsification, implantation (of an intraocular lens), and trabeculotomy (PIT). The authors conducted a retrospective study of patients treated with PIT at multiple hospitals. Intraocular pressure (IOP) and visual function data were obtained from patients after PIT as an initial surgical treatment in cases where antiglaucoma medications failed to resolve uncontrolled IOP (higher than 21 mm Hg). Included in this study were 96 eyes of 64 patients with primary open-angle glaucoma and coexisting cataract. The mean follow-up period was 22.6 +/- 14.7 months (range 3-56 months). In 94 (98%) of the 96 eyes, the IOP was well controlled, having achieved a level of 21 mm Hg or lower at the final examinations. The mean preoperative IOP of the 33 eyes that underwent the triple procedure using a single flap method (PIT-I) was 24.3 +/- 3.9 mm Hg, with an average of 2.1 +/- 1.1 medications. At the final examinations, the mean IOP had dropped to 16.0 +/- 1.2 mm Hg, with an average of 1.2 +/- 1.2 medications. The mean preoperative IOP of the 63 eyes that underwent the triple procedure using a double flap method (PIT-II) was 26.2 +/- 6.2 mm Hg, with an average of 1.9 +/- 1.2 medications. At the final examination, the mean IOP for this group was 15.6 +/- 2.9 mm Hg, with an average of 1.0 +/- 0.9 medications. The long-term results from this multicenter study showed that the triple procedure, PIT, can be useful and effective as an initial surgical treatment for open-angle glaucoma in glaucoma patients with coexisting cataract.

Clinical study using a new phacoemulsification system with surgical intraocular pressure control.

PubMed

Solomon, Kerry D; Lorente, Ramón; Fanney, Doug; Cionni, Robert J

2016-04-01

To compare cumulative dissipated energy (CDE), aspiration fluid used, and aspiration time during phacoemulsification cataract extraction using 2 surgical configurations. Two clinical sites in the United States and 1 in Spain. Prospective randomized clinical case series. For each patient, the first eye having surgery was randomized to the active-fluidics configuration (Centurion Vision System with Active Fluidics, 0.9 mm 45-degree Intrepid Balanced tip, and 0.9 mm Intrepid Ultra infusion sleeve) or the gravity-fluidics configuration (Infiniti Vision System with gravity fluidics, 0.9 mm 45-degree Mini-Flared Kelman tip, and 0.9 mm Ultra infusion sleeve). Second-eye surgery was completed within 14 days after first-eye surgery using the alternate configuration. The CDE, aspiration fluid used, and aspiration time were compared between configurations, and adverse events were summarized. Patient demographics and cataract characteristics were similar between configurations (100 per group). The CDE was significantly lower with the active-fluidics configuration than with the gravity-fluidics configuration (mean ± standard error, 4.32 ± 0.28 percent-seconds) (P < .001). The active-fluidics configuration used significantly less aspiration fluid than the gravity-fluidics configuration (mean 46.56 ± 1.39 mL versus 52.68 ± 1.40 mL) (P < .001) and required significantly shorter aspiration time (mean 151.9 ± 4.1 seconds versus 167.6 ± 4.1 seconds) (P < .001). No serious ocular adverse events related to the study devices or device deficiencies were observed. Significantly less CDE, aspiration fluid used, and aspiration time were observed with the active-fluidics configuration than with the gravity-fluidics configuration, showing improved surgical efficiency. Drs. Solomon and Cionni are consultants to Alcon Research, Ltd., and received compensation for conduct of the study. Dr. Lorente received compensation for clinical work in the study. Mr. Fanney is an employee of Alcon Research, Ltd. Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Evaluation of anterior lenticonus in alport syndrome using tracey wavefront aberrometry and transmission electron microscopy.

PubMed

Kim, Kwan Soo; Kim, Mo Sae; Kim, Joon Mo; Choi, Chul Young

2010-01-01

To evaluate the efficacy of Tracey wavefront aberrometry (Tracey Technologies, Houston, TX) and transmission electron microscopy for the detection of anterior lenticonus in Alport syndrome. Tracey wavefront aberrometry was used to treat a patient with bilateral anterior lenticonus who had a history of Alport syndrome. For transmission electron microscopic examination, anterior lens capsules were obtained during clear lens phacoemulsification and intraocular lens implantation. Spherical aberrations were the predominant higher-order aberrations in the internal optics of both eyes. The Tracey wavefront aberrometer showed that most of the irregular astigmatism originated from the lenticular portion. Transmission electron microscopy of the specimens showed anterior lens capsules with decreased thickness and multiple dehiscences. Tracey wavefront aberrometry and transmission electron microscopy are effective tools for evaluation of anterior lenticonus in Alport syndrome. Copyright 2010, SLACK Incorporated.

Toric multifocal intraocular lens implantation in a case of bilateral anterior and posterior lenticonus in Alport syndrome

PubMed Central

Ladi, Jeevan S; Shah, Nitant A

2016-01-01

We report the first case of toric multifocal intraocular lens (IOL) implantation in both the eyes of a young patient of Alport syndrome with anterior and posterior lenticonus with a successful outcome. An 18-year-old female patient presented with progressively blurred vision in both eyes since 4–5 years not improving with glasses. Refraction showed high myopia with astigmatism; however, the vision did not improve beyond 6/60 with glasses correction. Clinical examination on slit lamp showed anterior and posterior lenticonus bilaterally with a classical oil droplet appearance. We performed clear lens extraction by phacoemulsification with toric multifocal IOL implantation in both eyes. Postoperatively, the patient achieved an excellent refractive outcome with the unaided vision of 6/9, N6 in both eyes. PMID:27958211

Is the Capsular Bag Perimeter Round or Elliptical?

PubMed Central

Amigó, Alfredo; Bonaque-González, Sergio

2016-01-01

Purpose: To report findings that could suggest an elliptical shape of the capsular bag. Methods: Five eyes of three patients with axial length greater than 24 mm underwent phacoemulsification cataract surgery with plate-haptic multifocal toric intraocular lens (IOL) implantation oriented in the vertical meridian. Results: In all cases, correct orientation of the IOLs was verified 30 minutes after surgery. After 24 hours, all eyes demonstrated unwanted rotation of the IOLs ranging from 15 to 45 degrees. The IOLs remained stable in the new position in all cases until adhesion of the capsular bag took place. Conclusion: These observations could suggest that the perimeter of the capsular bag has an elliptical shape. Therefore, the IOL tends to become fixated in a meridian of the capsular bag that best fits the diagonal diameter of the IOL. PMID:27413495

Intraocular lens scaffold technique to prevent posterior capsule rupture in cases of Morgagnian cataract.

PubMed

Parkash, Rohit Om; Mahajan, Shruti; Parkash, Tushya Om; Nayak, Vittal

2017-01-01

We describe a technique for performing safe phacoemulsification of a Morgagnian cataract using the intraocular lens (IOL) scaffold. An IOL scaffold has been used in cases in which posterior capsule rupture has occurred, leaving nonemulsified nuclear pieces. The scaffold provides a barrier that prevents the nuclear fragments from falling posteriorly into the vitreous cavity. Our technique uses the IOL as a scaffold to prevent the vulnerable posterior capsule from rupturing during nuclear emulsification in Morgagnian cataract. The technique prevents rupture of the floppy posterior capsule by providing a constant support to it. The scaffold provides stable inflation of the capsular bag and prevents inadvertent emulsification. Concurrently, it prevents dehiscence of weak zonular fibers by minimizing the stress on the zonular apparatus. Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

A case of perforating injury of eyeball and traumatic cataract caused by acupuncture.

PubMed

Shuang, Han; Yichun, Kong

2016-04-01

Perforating globe injury is the leading cause of monocular blindness and vision loss. A 58-year-old male was injured by acupuncture needle during acupuncture treatment for his cerebral infarction. To the best of our knowledge, this is the first case report of perforating injury of the eyeball and traumatic cataract caused by acupuncture. The patient was hospitalized due to diagnosis of perforating ocular injury, traumatic cataract, and corneal and iris perforating injury. Moreover, he had to accept treatments of phacoemulsification, anterior vitrectomy along with intraocular lens implantation in the sulcus to improve his visual acuity. As acupuncture therapy has been widely performed for various diseases and achieved highly approval, the aim of this report is to remind acupuncturists operating accurately to avoid unnecessary injury during the treatment process, or the cure can also become the weapon.

Recurrent uveitis and pigment dispersion in an eye with in-the-bag acrylic foldable intraocular lens.

PubMed

Thakur, Monica; Bhatia, Prashant; Chandrasekhar, Garudadri; Senthil, Sirisha

2016-02-26

Phacoemulsification with in-the-bag intraocular lens (IOL) implantation is the standard procedure for cataract surgery. Pigment dispersion and uveitis can result when an IOL is placed in the sulcus. We report a case of a 64-year-old woman, with pigmentary glaucoma, who developed recurrent uveitis following uneventful cataract surgery and an in-the-bag hydrophobic acrylic IOL implant. Recurrent uveitis did not subside despite use of topical steroids over 3 months. Dilated examination revealed capsulophimosis with anterior dislocation of the IOL haptic. The mechanical trauma to the iris due to the displaced haptic was implicated as the cause of recurrent uveitis, which completely resolved after capsular excision and IOL repositioning. This case illustrates a rare cause of recurrent uveitis due to IOL haptic dislocation following severe capsulophimosis. 2016 BMJ Publishing Group Ltd.

Surgical simulators in cataract surgery training.

PubMed

Sikder, Shameema; Tuwairqi, Khaled; Al-Kahtani, Eman; Myers, William G; Banerjee, Pat

2014-02-01

Virtual simulators have been widely implemented in medical and surgical training, including ophthalmology. The increasing number of published articles in this field mandates a review of the available results to assess current technology and explore future opportunities. A PubMed search was conducted and a total of 10 articles were reviewed. Virtual simulators have shown construct validity in many modules, successfully differentiating user experience levels during simulated phacoemulsification surgery. Simulators have also shown improvements in wet-lab performance. The implementation of simulators in the residency training has been associated with a decrease in cataract surgery complication rates. Virtual reality simulators are an effective tool in measuring performance and differentiating trainee skill level. Additionally, they may be useful in improving surgical skill and patient outcomes in cataract surgery. Future opportunities rely on taking advantage of technical improvements in simulators for education and research.

Isolated Capsulorhexis Flap Technique in Femtosecond Laser-Assisted Cataract Surgery to Protect the Corneal Endothelial Cells.

PubMed

Li, Shaowei; Chen, Xu; Zhao, Jun; Xu, Man; Yu, Zhouxing

2017-12-18

To present a novel technique that using capsulorhexis flap to protect corneal endothelial cells during femtosecond laser-assisted cataract surgery. During the procedure, an isolated capsulorhexis flap was used to lift it up carefully by using OVD until the flap attached to the corneal inner layer. It kept steady during the phaco phase, and been removed by I/A tip after intraocular lens implantation. In our pilot study, the damage to the corneal endothelial cells from the phacoemulsification procedure were no more than the traditional phaco procedure, even femtosecond laser assisted cataract surgery. Isolated capsulorhexis flap technique initiate a new approach to protect the endothelial cell. It is a simple technique with a short learning curve, but still need a further investigation to prove the protection of corneal endothelial cells.

[Value the correction of corneal astigmatism in cataract surgery].

PubMed

Wang, J; Cao, Y X

2018-05-11

The aim of modern micro-incision phacoemulsification combined with foldable intraocular lens implantation and femtosecond laser-assisted cataract surgery is evolving from a simple pursuit of recuperation to a refractive procedure, which involves the correction of ametropia according to preoperative and postoperative refractive conditions, especially corneal astigmatism, in order to achieve the goal of optimized postoperative uncorrected full range of vision. Nowadays, due attention to the effect of preoperative corneal astigmatism, surgery-induced astigmatism and residual astigmatism after operation is lacked, which affect postoperative visual acuity significantly. There are many effective ways to reduce corneal astigmatism after cataract surgery including selecting appropriate size and location of clear corneal incision, employing astigmatism keratotomy and the implantation of Toric intraocular lenses, which need to be appropriately applied and popularized. At the same time, surgical indications, predictability and safety should also be taken into account. (Chin J Ophthalmol, 2018, 54: 321-323) .

Suspected bacterial endophthalmitis following sustained-release dexamethasone intravitreal implant: a case report.

PubMed

Arıkan Yorgun, Mücella; Mutlu, Melek; Toklu, Yasin; Cakmak, Hasan Basri; Cağıl, Nurullah

2014-06-01

A 58-year-old man admitted to our opthalmology department with the complaint of branch retinal vein occlusion. He was treated with intravitreal Ozurdex in the right eye. Two days after the injection, the patient presented with ocular pain and the visual acuity was hand movement. A diagnosis of endophthalmitis was made. We performed emergent pars plana vitrectomy (PPV) and the implant was removed from the vitreous cavity using a retinal forceps. A combination of vancomycin 1.0 mg and amikacin 0.4 mg was injected intravitreally. However, because of the blurring in the vitreus one week after the procedure, phacoemulsification and a repeat PPV was performed. Five days after the last procedure the signs and symptoms of endophthalmitis were resolved. Our case demonstrated that endophthalmitis could develop after intravitreal implantation of Ozurdex. Surgical removal of the implant and immediate vitrectomy seems to be a useful treatment option in these cases.

Postoperative refraction in the second eye having cataract surgery.

PubMed

Leffler, Christopher T; Wilkes, Martin; Reeves, Juliana; Mahmood, Muneera A

2011-01-01

Introduction. Previous cataract surgery studies assumed that first-eye predicted and observed postoperative refractions are equally important for predicting second-eye postoperative refraction. Methods. In a retrospective analysis of 173 patients having bilateral sequential phacoemulsification, multivariable linear regression was used to predict the second-eye postoperative refraction based on refractions predicted by the SRK-T formula for both eyes, the first-eye postoperative refraction, and the difference in IOL selected between eyes. Results. The first-eye observed postoperative refraction was an independent predictor of the second eye postoperative refraction (P < 0.001) and was weighted more heavily than the first-eye predicted refraction. Compared with the SRK-T formula, this model reduced the root-mean-squared (RMS) error of the predicted refraction by 11.3%. Conclusions. The first-eye postoperative refraction is an independent predictor of the second-eye postoperative refraction. The first-eye predicted refraction is less important. These findings may be due to interocular symmetry.

A Virtual Reality Simulator Prototype for Learning and Assessing Phaco-sculpting Skills

NASA Astrophysics Data System (ADS)

Choi, Kup-Sze

This paper presents a virtual reality based simulator prototype for learning phacoemulsification in cataract surgery, with focus on the skills required for making a cross-shape trench in cataractous lens by an ultrasound probe during the phaco-sculpting procedure. An immersive virtual environment is created with 3D models of the lens and surgical tools. Haptic device is also used as 3D user interface. Phaco-sculpting is simulated by interactively deleting the constituting tetrahedrons of the lens model. Collisions between the virtual probe and the lens are effectively identified by partitioning the space containing the lens hierarchically with an octree. The simulator can be programmed to collect real-time quantitative user data for reviewing and assessing trainee's performance in an objective manner. A game-based learning environment can be created on top of the simulator by incorporating gaming elements based on the quantifiable performance metrics.

One-year outcomes of AquaLase cataract surgery.

PubMed

Yoo, Sonia H; Bhatt, Anand B

2007-01-01

The authors report surgical experience and clinical outcomes up to 1 year postoperatively in patients who underwent cataract surgery with the AquaLase liquefaction device (Alcon Laboratories, Fort Worth, TX). The device is a handpiece option for use with Alcon's Infiniti Vision System that uses heated balanced saline solution micropulses to liquefy lenticular material. Twenty-seven eyes of 23 patients underwent cataract extraction with the use of the AquaLase liquefaction device. The average age of participants was 68 years, and the average nuclear sclerotic grade was 1.96 on a 4-point scale. Outcomes were judged by metrics such as visual acuity, inflammation, endothelial cell count, and postoperative posterior capsule opacification. At 30 days postoperatively, 78% of eyes had a best-corrected visual acuity of 20/20. Visual acuity was 20/25 or better 1 year postoperatively in 88% of patients without complications except conversion to ultrasound phacoemulsification for two dense cataracts.

Thermal study of bare tips with various system parameters and incision sizes.

PubMed

Osher, Robert H; Injev, Valentine P

2006-05-01

To identify major and minor surgeon-controlled parameters that affect incision temperature when performing microincision lens removal using the Alcon Infiniti Vision System. In vitro research and development laboratory, Alcon Research, Irvine, California, USA. Phacoemulsification was performed in eye-bank cadaver eyes and the following parameters evaluated: incision, duty cycle, ultrasound (US) power, aspiration flow rate (AFR), vacuum, pulse, bottle height and balanced salt solution temperature, and tip design/size. Each parameter was varied while the others remained constant. The resulting temperature of the incision and US tip was measured using a thermal camera. Major contributors to elevated incision temperature included incision size, US power, duty cycle, AFR, vacuum setting, tip design, and presence of an ophthalmic viscosurgical device (OVD). Minor contributors included pulse frequency, bottle height, and temperature of the infusate. Microincision lens removal can be performed at safe temperatures with the knowledgeable selection of surgeon-controlled parameters.

A case of perforating injury of eyeball and traumatic cataract caused by acupuncture

PubMed Central

Shuang, Han; Yichun, Kong

2016-01-01

Perforating globe injury is the leading cause of monocular blindness and vision loss. A 58-year-old male was injured by acupuncture needle during acupuncture treatment for his cerebral infarction. To the best of our knowledge, this is the first case report of perforating injury of the eyeball and traumatic cataract caused by acupuncture. The patient was hospitalized due to diagnosis of perforating ocular injury, traumatic cataract, and corneal and iris perforating injury. Moreover, he had to accept treatments of phacoemulsification, anterior vitrectomy along with intraocular lens implantation in the sulcus to improve his visual acuity. As acupuncture therapy has been widely performed for various diseases and achieved highly approval, the aim of this report is to remind acupuncturists operating accurately to avoid unnecessary injury during the treatment process, or the cure can also become the weapon. PMID:27221689

Reverse pupillary block associated with pigment dispersion syndrome after in-the-bag intraocular lens implantation.

PubMed

Itagaki, Hideo; Kunikata, Toshio; Hiratsuka, Kentaro; Saito, Junichiro; Oshika, Tetsuro

2013-12-01

A 61-year-old man with high myopia who had received a systemic α1A-adrenoceptor antagonist had phacoemulsification and in-the-bag intraocular lens implantation in the right eye. One day postoperatively, marked pigment dispersion in the anterior chamber, posterior bowing of the iris, and iridodonesis were noted associated with a subsequent elevation in intraocular pressure (IOP). Pharmacological pupil dilation was effective in reducing pigment dispersion and IOP, and laser peripheral iridotomy was performed to alleviate posterior bowing of the iris. We hypothesize that dynamic changes in the aqueous humor flow by cataract surgery and latent flaccidity of the iris due to the systemic α1A-adrenoceptor antagonist caused reverse pupillary block. High myopia may be another risk factor for this complication. Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Pigment dispersion and chronic intraocular pressure elevation after sulcus placement of 3-piece acrylic intraocular lens.

PubMed

Almond, M Camille; Wu, Michael C; Chen, Philip P

2009-12-01

A 55-year-old man had phacoemulsification and implantation of a 3-piece acrylic intraocular lens (IOL) (AcrySof MA60AC) in the right eye. One month postoperatively, the intraocular pressure (IOP) was 48 mm Hg and peripheral transillumination defects were noted in the iris circumferentially, with the IOL optic edge visible as a silhouette. Gonioscopy showed dense pigmentation of the trabecular meshwork in the right eye, but in the left eye, only mild trabecular meshwork pigment was seen, along with a concave peripheral iris insertion. At 21 months, the right eye required 3 medications for IOP control. While pigment dispersion has been widely reported after placement of 1-piece acrylic IOLs in the ciliary sulcus, we conclude that in susceptible individuals with a concave peripheral iris insertion, pigment dispersion can occur with sulcus placement of a 3-piece acrylic model despite its thinner optic and angulated haptics.

Cataract surgery in a case of carotid cavernous fistula

PubMed Central

Nair, Akshay Gopinathan; Praveen, Smita Vittal; Noronha, Veena Olma

2014-01-01

A carotid-cavernous fistula (CCF) is an abnormal communication between the cavernous sinus and the carotid arterial system. The ocular manifestations include conjunctival chemosis, proptosis, globe displacement, raised intraocular pressure and optic neuropathy. Although management of CCF in these patients is necessary, the ophthalmologist may also have to treat other ocular morbidities such as cataract. Cataract surgery in patients with CCF may be associated with many possible complications, including suprachoroidal hemorrhage. We describe cataract extraction surgery in 60-year-old female with bilateral spontaneous low-flow CCF. She underwent phacoemulsification via a clear corneal route under topical anesthesia and had an uneventful postoperative phase and recovered successfully. Given the various possible ocular changes in CCF, one must proceed with an intraocular surgery with caution. In this communication, we wish to describe the surgical precautions and the possible pitfalls in cataract surgery in patients with CCF. PMID:25370401

Efficacy of Intracameral Moxifloxacin Endophthalmitis Prophylaxis at Aravind Eye Hospital.

PubMed

Haripriya, Aravind; Chang, David F; Namburar, Sathvik; Smita, Anand; Ravindran, Ravilla D

2016-02-01

To compare the rate of postoperative endophthalmitis before and after initiation of intracameral (IC) moxifloxacin for endophthalmitis prophylaxis in patients undergoing cataract surgery. Retrospective, clinical registry. All charity and private patients (116 714 eyes) who underwent cataract surgery between February 15, 2014, and April 15, 2015, at the Madurai Aravind Eye Hospital were included. Group 1 consisted of 37 777 eyes of charity patients who did not receive IC moxifloxacin, group 2 consisted of 38 160 eyes of charity patients who received IC moxifloxacin prophylaxis, and group 3 consisted of 40 777 eyes of private patients who did not receive IC moxifloxacin. The electronic health record data for each of the 3 groups were analyzed, and the postoperative endophthalmitis rates were statistically compared. The cost of endophthalmitis treatment (groups 1 and 2) and the cost of IC moxifloxacin prophylaxis (group 2) were calculated. Postoperative endophthalmitis rate before and after initiation of IC moxifloxacin endophthalmitis treatment cost. Manual, sutureless, small incision cataract surgery (M-SICS) accounted for approximately all of the 75 937 cataract surgeries in the charity population (97%), but only a minority of the 40 777 private surgeries (21% M-SICS; 79% phacoemulsification). Thirty eyes in group 1 (0.08%) and 6 eyes in group 2 (0.02%) were diagnosed with postoperative endophthalmitis (P < 0.0001). The group 3 endophthalmitis rate was 0.07% (29 eyes), which was also higher than the second group's rate (P < 0.0001). There were no adverse events attributed to IC moxifloxacin in group 2. The total cost of treating the 30 patients with endophthalmitis in group 1 was virtually identical to the total combined cost in group 2 of routine IC moxifloxacin prophylaxis and treatment of the 6 endophthalmitis cases. Routine IC moxifloxacin prophylaxis achieved a highly significant, 4-fold reduction in postoperative endophthalmitis in patients undergoing M-SICS. Compared with previous studies, having such a high volume of patients undergoing surgery during a relatively short 14-month time period strengthens the conclusion. This study provides further evidence that moxifloxacin is an effective IC prophylactic antibiotic and suggests that IC antibiotics should be considered for M-SICS and phacoemulsification. Copyright © 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Effectiveness and confounding factors of penetrating astigmatic keratotomy in clinical practice

PubMed Central

Yen, Chu-Yu; Tseng, Gow-Lieng

2018-01-01

Abstract Rationale: Penetrating astigmatic keratotomy (penetrating AK) is a well-known method to correct corneal astigmatism but rarely be performed nowadays. This article reevaluated the clinical effectiveness and confounding factors of penetrating AK. Patient concerns: Penetrating AK has been introduced to serve as one alternative operation for astigmatism correction, and is thought to have the potential advantage of being more affordable and easy to perform. The purpose of our study is to evaluate the effectiveness and confounding factors of penetrating AK. Diagnoses: The chart of 95 patients with corneal astigmatism (range: 0.75–3.25 diopters [D]) who received penetrating AK from January 2014 to December 2016 was collected. The corneal astigmatism were measured by an autokeratometer (Topcon KR8100PA topographer-autorefractor), and repeated with manual keratometer in low reproducibility cases. Interventions: All patients received penetrating AK by an experienced ophthalmologist (Dr. Gow-Lieng Tseng, MD, PHD) in the operation room. Among which, 66 patients received penetrating AK with phacoemulsification simultaneously (group A), whereas 29 patients received penetrating AK at least 3 months after phacoemulsification (group B). After excluding the patients combined with other procedures or lost followed up, 79 patients are remaining for analysis. The outcome was evaluated by net correction, the difference between preoperative corneal astigmatism (PCA) and residual corneal astigmatism (RCA). Two sample t tests and Pearson test were used for effectiveness evaluation. For confounding factors, multivariate linear regression was used for statistical analysis. Outcomes: The mean preoperative and postoperative refractive cylinders were 1.97 ± 0.77 and 1.08 ± 0.64 D, respectively, in group A and 2.62 ± 1.05 and 1.51 ± 0.89 D in group B. There were no statistically significant differences in net correction between these two groups (0.9 ± 0.66 vs. 1.1 ± 0.69, P = .214). Higher PCA were associated with higher net correction in both group A (P = .002) and group B (P = .019). Compound myopic astigmatism caused less net correction than others only in group A (P = 0.031). Lessons: Penetrating AK is an accessible, affordable, and effective way to correct corneal astigmatism. The results of this procedure are comparable to modern methods in patients with low to moderate corneal astigmatism. PMID:29369200

The Auckland Cataract Study: co-morbidity, surgical techniques, and clinical outcomes in a public hospital service

PubMed Central

Riley, Andrew F; Malik, Tahira Y; Grupcheva, Christina N; Fisk, Michael J; Craig, Jennifer P; McGhee, Charles N

2002-01-01

Aim: To prospectively assess cataract surgery in a major New Zealand public hospital by defining presenting clinical parameters and surgical and clinical outcomes in a cohort of subjects just below threshold for treatment, based upon a points based prioritisation system. Methods: The prospective observational study comprised 488 eyes of 480 subjects undergoing consecutive cataract operations at Auckland Hospital. All subjects underwent extensive ophthalmic examination before and after surgery. Details of the surgical procedure, including any intraoperative difficulties or complications, were documented. Postoperative review was performed at 1 day and 4 weeks after surgery. Demographic data, clinical outcomes, and adverse events were correlated by an independent assessor. Results: The mean age at surgery was 74.9 (SD 9.6) years with a female predominance (62%). Significant systemic disease affected 80% of subjects, with 20% of the overall cohort exhibiting diabetes mellitus. 26% of eyes exhibited coexisting ocular disease and in 7.6% this affected best spectacle corrected visual acuity (BSCVA). A mean spherical equivalent of −0.49 (1.03) D and mean BSCVA of 0.9 (0.6) log MAR units (Snellen equivalent approximately 6/48) was noted preoperatively. Local anaesthesia was employed in 99.8% of subjects (94.9% sub-Tenon's). The majority of procedures (97.3%) were small incision phacoemulsification with foldable lens implant. Complications included: 4.9% posterior capsule tears, 3.8% cystoid macular oedema, and one case (0.2%) of endophthalmitis. Mean BSCVA after surgery was 0.1 (0.2) log MAR units (6/7.5 Snellen equivalent), with a mean spherical equivalent of −0.46 (0.89) D, and was 6/12 or better in 88% of all eyes. A drop in BSCVA, thought to be directly attributable to the surgical intervention, was recorded in a small percentage of eyes (1.5%) after surgery. Conclusion: This study provides a representative assessment of the management of cataract in the New Zealand public hospital system. A predominantly elderly, female population, frequently exhibiting significant systemic illness and coexisting ocular disease, relatively advanced cataracts, and poor BSCVA, presented for cataract surgery. The majority of subjects underwent small incision, phacoemulsification, day case surgery. While almost 90% achieved at least 6/12 BSCVA post-surgery, approximately 5% sustained an adverse intraoperative event and 1.5% of eyes exhibited a reduction in BSCVA postoperatively. PMID:11815345

The Auckland Cataract Study: 2 year postoperative assessment of aspects of clinical, visual, corneal topographic and satisfaction outcomes

PubMed Central

Thompson, A M; Sachdev, N; Wong, T; Riley, A F; Grupcheva, C N; McGhee, C N

2004-01-01

Aim: To assess clinical, visual, computerised corneal topographic, and subjective satisfaction with visual acuity, in a cohort of subjects 2 years after phacoemulsification surgery in a public hospital in New Zealand. Methods: Prospective study of a representative sample of 97 subjects (20%) randomly selected from 480 subjects in the original Auckland Cataract Study (ACS) cohort. The clinical assessment protocol was identical to the ACS and included an extensive questionnaire to enable direct comparisons to be made between the two groups. Results: The study population was predominantly female (66%) with a mean age of 76.3 (SD 9.9) years. New systemic and ocular disease affected 18.4% and 10.3% of subjects respectively, and 10.3% required referral to either a general practitioner (2.1%) or ophthalmologist (8.2%). Mean best spectacle corrected visual acuity (BSCVA) was 0.2 (0.2) logMAR units (6/9 Snellen equivalent), with mean spherical equivalent −0.37 (1.01) dioptres (D) and astigmatism −1.07 (0.70) D 2 years postoperatively, compared to mean BSCVA 0.1 (0.2) logMAR units (6/7.5 Snellen equivalent), spherical equivalent −0.59 (1.07) D, and astigmatism −1.14 (0.77) D 4 weeks after surgery. 94.9% of subjects retained a BSCVA of 6/12 or better, irrespective of pre-existing ocular disease. The overall posterior capsule opacification (PCO) rate was 20.4% and this was visually insignificant in all but 3.1% of eyes that had already undergone Nd:YAG posterior capsulotomy. Orbscan II elevation technology demonstrated corneal stability 2 years after uncomplicated phacoemulsification. Although corneal astigmatism was eliminated in approximately half of the subjects 1 month postoperatively, astigmatism showed a tendency to regress towards the preoperative level with local corneal thickening at the site of incision 2 years after cataract surgery. Of fellow eyes, 61.2% had undergone cataract surgery. Overall, 75.3% of subjects were moderately to very satisfied with their current level of visual acuity. Conclusion: Two years after cataract surgery subjects are generally satisfied with their current level of vision and distance BSCVA is 6/12 or better in the majority of eyes. Although only a minority of eyes develop sufficient PCO to require capsulotomy 10.3% of eyes develop new vision threatening ocular pathology. PMID:15258022

Comparison of Floaters after Cataract Surgery with Different Viscoelastics.

PubMed

Kim, Jinsoo; Lee, Hak Jun; Park, In Won; Kwon, Soon Il

2018-01-01

Purpose : To investigate whether there is a difference between symptoms of floaters according to the type of ophthalmic viscosurgical devices(OVDs) used during phacoemulsification. Methods: A total of 112 eyes had undergone standard phacosurgery with the dispersive OVDs(Group1). Group2 comprised 117 eyes that underwent phacosurgery with the dispersive OVDs, but between continuous curvilinear capsulorhexis and hydrodissection, some OVDs had been removed. Group3 included 120 eyes that had undergone phacosurgery with the cohesive OVDs. Results: 14 eyes (12.5%) of Group1 had new-onset floater after surgery whereas 6 eyes (5.13%) in Group2, and 7 eyes (5.83%) in Group3 at the day after and a week after surgery. This was significantly higher in Group1 than Group2 and Group3, respectively (p=0.047,0.049). Conclusion: Cataract surgery with dispersive OVD can predispose the eye to an increased floater symptom. Therefore, surgeons should consider release some OVDs during hydrodissection with dispersive viscoelastics and keep trying to avoid IOP surge during surgery.

Comparison of Floaters after Cataract Surgery with Different Viscoelastics

PubMed Central

Kim, Jinsoo; Lee, Hak Jun; Park, In Won; Kwon, Soon Il

2018-01-01

Purpose: To investigate whether there is a difference between symptoms of floaters according to the type of ophthalmic viscosurgical devices(OVDs) used during phacoemulsification. Methods: A total of 112 eyes had undergone standard phacosurgery with the dispersive OVDs(Group1). Group2 comprised 117 eyes that underwent phacosurgery with the dispersive OVDs, but between continuous curvilinear capsulorhexis and hydrodissection, some OVDs had been removed. Group3 included 120 eyes that had undergone phacosurgery with the cohesive OVDs. Results: 14 eyes (12.5%) of Group1 had new-onset floater after surgery whereas 6 eyes (5.13%) in Group2, and 7 eyes (5.83%) in Group3 at the day after and a week after surgery. This was significantly higher in Group1 than Group2 and Group3, respectively (p=0.047,0.049). Conclusion: Cataract surgery with dispersive OVD can predispose the eye to an increased floater symptom. Therefore, surgeons should consider release some OVDs during hydrodissection with dispersive viscoelastics and keep trying to avoid IOP surge during surgery. PMID:29483813

Cataract surgery audit at an Australian urban teaching hospital.

PubMed

Kahawita, Shyalle K; Goggin, Michael

2015-08-01

To provide local data on visual acuity and surgical outcomes for cataract surgery performed in an Australian teaching hospital. Continuous audit over 7 years in a public teaching hospital. A total of 3740 eyes had cataract surgery performed at The Queen Elizabeth Hospital, South Australia, from May 2006 to September 2013. Visual acuity and complication rates were recorded for cataract surgery cases operated on between May 2006 and September 2013 on a digital database with data entry contemporaneous with final follow-up. Visual acuity and surgical complications. Of the patients, 91.4% achieved postoperative best-measured vision better than preoperative best-measured vision. The rate of posterior capsular tear was 2.59%, endophthalmitis was 0.11% and the overall complication rate was 11.7%. This audit is the first to document modern cataract surgery, overwhelmingly dominated by phacoemulsification in an Australian population and can be used to benchmark cataract surgery outcome in an urban Australian population. © 2015 Royal Australian and New Zealand College of Ophthalmologists.

Implantation of a Multifocal Toric Intraocular Lens after Radial Keratotomy and Cross-Linking with Hyperopia and Astigmatism Residues: A Case Report.

PubMed

Nuzzi, Raffaele; Monteu, Francesca; Tridico, Federico

2017-01-01

Radial keratotomy is a refractive surgical technique, widely used in the 80s and early 90s to correct myopia and astigmatism, but now overcome by more recent laser techniques. Important consequences, often in patients with more than 45 years of age, are progressive hyperopic shift and/or an increase in corneal astigmatism, whose main cause seems to be an increase in the curvature radius of the central portion of the cornea. This seems to be due to radial keratotomy incisions - with the consequent need for cross-linking - intraocular pressure, and corneal biomechanical parameters. The authors propose phacoemulsification with a customized multifocal toric intraocular lens implantation to correct the induced shift and hyperopic astigmatism. A decent postoperative visual acuity was observed with good patient satisfaction. A specific protocol must be applied to optimize the correct diagnosis, presurgical evaluation and postsurgical outcomes that are to be maintained over time, without regressions.

Visualization of fluid turbulence and acoustic cavitation during phacoemulsification.

PubMed

Tognetto, Daniele; Sanguinetti, Giorgia; Sirotti, Paolo; Brezar, Edoardo; Ravalico, Giuseppe

2005-02-01

To describe a technique for visualizing fluid turbulence and cavitational energy created by ultrasonic phaco tips. University Eye Clinic of Trieste, Trieste, Italy. Generation of cavitational energy by the phaco tip was visualized using an optical test bench comprising several components. The technique uses a telescope system to expand a laser light source into a coherent, collimated beam of light with a diameter of approximately 50.0 mm. The expanded laser beam shines on the test tube containing the tip activated in a medium of water or ophthalmic viscosurgical device (OVD). Two precision optical collimators complete the optical test bench and form the system used to focus data onto a charge-coupled device television camera connected to a recorder. Images of irrigation, irrigation combined with aspiration, irrigation/aspiration, and phacosonication were obtained with the tip immersed in a tube containing water or OVD. Optical image processing enabled acoustic cavitation to be visualized during phacosonication. The system is a possible means of evaluating a single phaco apparatus power setting and comparing phaco machines and techniques.

Postoperative Refraction in the Second Eye Having Cataract Surgery

PubMed Central

Leffler, Christopher T.; Wilkes, Martin; Reeves, Juliana; Mahmood, Muneera A.

2011-01-01

Introduction. Previous cataract surgery studies assumed that first-eye predicted and observed postoperative refractions are equally important for predicting second-eye postoperative refraction. Methods. In a retrospective analysis of 173 patients having bilateral sequential phacoemulsification, multivariable linear regression was used to predict the second-eye postoperative refraction based on refractions predicted by the SRK-T formula for both eyes, the first-eye postoperative refraction, and the difference in IOL selected between eyes. Results. The first-eye observed postoperative refraction was an independent predictor of the second eye postoperative refraction (P < 0.001) and was weighted more heavily than the first-eye predicted refraction. Compared with the SRK-T formula, this model reduced the root-mean-squared (RMS) error of the predicted refraction by 11.3%. Conclusions. The first-eye postoperative refraction is an independent predictor of the second-eye postoperative refraction. The first-eye predicted refraction is less important. These findings may be due to interocular symmetry. PMID:24533181

Actinomyces bowdenii ulcerative keratitis in a dog.

PubMed

Sherman, Amanda; Daniels, Joshua B; Wilkie, David A; Lutz, Elizabeth

2013-09-01

A 5-year-old spayed female diabetic mixed-breed dog underwent phacoemulsification and intraocular lens implantation to correct bilateral hypermature cataracts. Two months postsurgery, the patient presented with ulcerative keratitis and multifocal stromal abscessation OD, which was controlled, but never resolved, with topical fluoroquinolone therapy. The patient re-presented 2 months later with a new, raised, white gritty corneal opacity associated with hyperemia, chemosis, and blepharospasm OD. Cytology of the right cornea revealed filamentous bacteria, suggestive of Actinomyces spp. Actinomyces bowdenii was subsequently isolated in pure culture and identified via 16s rDNA sequencing. Actinomyces bowdenii has never before been described as a cause of ocular infection. An immunosuppressed corneal environment likely contributed to this opportunistic Actinomycosis. The infection was not controlled with fluoroquinolone therapy, and the isolate, in vitro, was resistant to three fluoroquinolones (ciprofloxacin, ofloxacin, and levofloxacin), which also has not been previously reported for this species of Actinomyces. A superficial keratectomy with conjunctival graft was employed to successfully manage the infection. © 2012 American College of Veterinary Ophthalmologists.

Biocompatibility of poloxamer hydrogel as an injectable intraocular lens: a pilot study.

PubMed

Kwon, Ji Won; Han, Young Keun; Lee, Woo Jin; Cho, Chong Su; Paik, Seung Joon; Cho, Dong Il; Lee, Jin Hak; Wee, Won Ryang

2005-03-01

To induce irreversible gelation of poloxamer, a thermosensitive polymer hydrogel, by using a photoinitiator and ultraviolet (UV) irradiation and to verify the biocompatibility and use of poloxamer as an injectable intraocular lens (IOL) material. Department of Ophthalmology, Seoul National University College of Medicine, Seoul Artificial Eye Center, Clinical Research Institute, Seoul National University Hospital, Seoul, Korea. In 10 rabbits, endocapsular phacoemulsification was performed and a poloxamer-photoinitiator mixture was injected into the capsular bag through a small capsulorhexis site. In 1 eye, the capsulorhexis site was closed with a small plug and the entire eye was irradiated with UV light for 5 minutes. Postoperatively, poloxamer transparency and effect on the conjunctiva, cornea, iris, vitreous, and retina were observed. A mixture comprising 25% poloxamer and 0.01% photoinitiator produced a poloxamer that remained transparent in the lens capsule for up to 6 months. No inflammatory response or toxicity was observed in the conjunctiva, cornea, iris, vitreous, or retina. Poloxamer is a potentially suitable material for an injectable IOL. Further study is needed.

Dynamic light scattering as an objective noninvasive method in veterinary ophthalmic diagnosis and research

NASA Astrophysics Data System (ADS)

Dubin, Stephen; Ansari, Rafat R.; Tulp, Orien; Steinberg, Sheldon; Koch, Seth; DellaVecchia, Michael A.; Cozmi, Mihaela; Victor, Mary

1999-06-01

The absence of verbal feedback, available from most human patients, is a major limitation in veterinary diagnosis in general and in the evaluation of ophthalmic lens opacity in particular. A novel compact dynamic light scattering (DLS) instrument, developed at NASA, offers significant mitigation to this limitation. It not only yields objective repeatable non-invasive estimation of lens opacity but also provides insight into the nature of chemical and physical alternations in the lens and other eye structures. For example, DLS measurements of the cataractous lens may be interpreted in terms of alpha crystalline protein size. In contrast to most conventional methods, the examination results are numerical and readily accommodate statistical analysis. We present results of DLS measurements in laboratory rabbits with naphthalene induced cataracts, rodents with genetically conditioned hypertension and/or diabetes mellitus; as well as applications of the DLS method in clinical veterinary patients. Use of DLS in examination of phacoemulsification fluid, urine and other biological materials, and potential applications in ocular toxically will also be discussed.

Smaller incision size leads to higher predictability in microcoaxial cataract surgery.

PubMed

Klamann, Matthias K J; Gonnermann, Johannes; Maier, Anna-Karina B; Torun, Necip; Bertelmann, Eckart

2013-01-01

The aim of the study was to compare the clinical outcomes of a 1.8 mm, 2.2 mm, and 2.75 mm microcoaxial cataract surgery system. METHODS. In this retrospective study, 129 eyes of 129 patients were included. Patients underwent phacoemulsification using a Stellaris system or an Infiniti system. The incision size was 1.8 mm, 2.2 mm, or 2.75 mm, respectively. Subjects were examined before surgery and 4 weeks after. The surgically induced astigmatism (SIA) was examined. The SIA in the 1.8 mm group was statistically lower compared to the 2.2 mm group (p=0.046) and the 2.75 mm group (p=0.017). There was no significant difference between the 2.2 mm group and the 2.75 mm group. With the use of appropriate support systems, 1.8 mm incisions appear to result in less SIA than 2.2 mm and 2.75 mm incisions. Advantages may arise from this, especially in the implantation of aspheric, toric, or multifocal lenses.

Surgical repair of large cyclodialysis clefts.

PubMed

Gross, Jacob B; Davis, Garvin H; Bell, Nicholas P; Feldman, Robert M; Blieden, Lauren S

2017-05-11

To describe a new surgical technique to effectively close large (>180 degrees) cyclodialysis clefts. Our method involves the use of procedures commonly associated with repair of retinal detachment and complex cataract extraction: phacoemulsification with placement of a capsular tension ring followed by pars plana vitrectomy and gas tamponade with light cryotherapy. We also used anterior segment optical coherence tomography (OCT) as a noninvasive mechanism to determine the extent of the clefts and compared those results with ultrasound biomicroscopy (UBM) and gonioscopy. This technique was used to repair large cyclodialysis clefts in 4 eyes. All 4 eyes had resolution of hypotony and improvement of visual acuity. One patient had an intraocular pressure spike requiring further surgical intervention. Anterior segment OCT imaging in all 4 patients showed a more extensive cleft than UBM or gonioscopy. This technique is effective in repairing large cyclodialysis clefts. Anterior segment OCT more accurately predicted the extent of each cleft, while UBM and gonioscopy both underestimated the size of the cleft.

Causes of Phakic Implantable Collamer Lens Explantation/Exchange at King Khaled Eye Specialist Hospital

PubMed Central

AlSabaani, Nasser A.; Behrens, Ashley; Jastanieah, Sabah; Al Malki, Salem; Al Jindan, Mohanna; Al Motowa, Saeed

2016-01-01

PURPOSE: The purpose of this study is to evaluate the causes of phakic implantable collamer lens (ICL) explantation/exchange at an eye hospital in Saudi Arabia. MATERIALS AND METHODS: A retrospective chart review was performed for patients who underwent ICL implantation from 2007 to March 2014 and data were collected on cases that underwent ICL explantation. RESULTS: Of the 787 ICL implants, 30 implants (3.8% [95% confidence interval 2.6%; 5.3%]) were explanted. The causes of explantation included incorrect lens size (22), cataract (4), high residual astigmatism (2), rhegmatogenous retinal detachment (1), and intolerable glare (1). Corrective measures mainly included an exchange with an appropriately sized lens (9), ICL explantation (11), with phacoemulsification and posterior chamber intraocular lens implantation (6), or replacement with an ICL of correct power (2). CONCLUSION: Incorrect ICL size was the most common cause of ICL explantation. More accurate sizing methods for ICL are required to reduce the explantation/exchange rate. PMID:27994391

[Intramuscular depot steroids : Possible treatment of postsurgical cystoid macula edema with steroid response?

PubMed

Seuthe, A-M; Szurman, P; Boden, K T

2017-11-01

We report on a patient with postsurgical cystoid macular edema (CME) after phacoemulsification and multifocal intraocular lens (MIOL) implantation. At first, there was a very good reaction to intravitreal triamcinolone, inducing complete regression of the edema without increasing intraocular pressure (IOP). One year later the patient suffered from retinal detachment and was treated with vitrectomy, laser, and gas tamponade. Afterward, he developed macular pucker with edema. After surgical treatment with pucker peeling and intravitreal triamcinolone, the patient showed a steroid response and an increase IOP. Postoperatively, there was a recurrence of CME. A coincidental administration of a steroid injection intramuscularly by the general practitioner achieved a prompt reduction of the CME without increasing IOP. This case shows that an initially good reaction to triamcinolone without increasing IOP does not rule out a future steroid response, and that a potential treatment option for CME in patients with a known steroid response could consist of intramuscularly injected steroids.

[Dry transconjunctival sutureless 25-gauge vitrectomy in the treatment of pediatric cataract].

PubMed

You, Cai-yun; Xie, Li-xin

2009-08-01

Posterior capsule opacification is the most frequent complication of pediatric cataract surgery. To prevent posterior capsule opacification, primary phacoemulsification, posterior capsulotomy and anterior vitrectomy with intraocular lens implantation is the preferred method in the treatment of pediatric cataract. Anterior vitrectomy cutter, with 18-gauge, maximum frequency at 600/min and has simultaneous cutting, irrigation and aspiration functions, is associated with more complications and poor outcomes. In 20-gauge surgery, pars plana vitrectomy is performed with two-port sclerotomy. The irrigation increases movement of vitreous and 20-gauge sclerotomy needs suture for closing. In 25-gauge surgery, the vitreous cutter can be introduced into the vitreous cavity directly though conjunctiva and sclera. The stab incision is roughly half the size of 20-gauge cutter, therefore, the sclerotomy incision can be left unsutured. Surgery with dry transconjunctival sutureless 25-gauge vitrectomy may decrease the requirement for secondary membrane surgery and the risk for retinal detachment. The application of dry transconjunctival sutureless 25-gauge vitrectomy in the treatment of pediatric cataract is reviewed.

Management of Chronic Hypotony following Bilateral Uveitis in a Patient Treated with Pembrolizumab for Cutaneous Metastatic Melanoma.

PubMed

Reid, Gerard; Lorigan, Paul; Heimann, Heinrich; Hovan, Marta

2018-04-19

To describe the presentation and management of severe ocular adverse events following treatment with pembrolizumab for cutaneous metastatic melanoma. Interventional case report. A 73-year-old Caucasian man receiving pembrolizumab treatment for metastatic melanoma presented with panuveitis and subsequent profound hypotony, choroidal effusions, and optic disk swelling bilaterally. Oral prednisolone controlled intraocular inflammation. However, bilateral hypotony persisted which was managed over a 12-month period with ocular viscoelastic device injections into the anterior chamber of both eyes. There was also phacoemulsification with pars plana vitrectomy (PPV) and silicone oil (SO) tamponade performed on the left eye only. Intraocular pressure (IOP) stabilized (>6 mmHg) with best-corrected visual acuity of 6/60. We report a severe adverse event from pembrolizumab therapy resulting in uveitis and persistent hypotony. Repeat injections of high viscosity OVD achieved an increase in IOP up to 12 months. This technique may be a useful adjuvant or alternative to PPV and SO.

Intraocular Lens Opacification After Endothelial Keratoplasty as Analyzed by Environmental Scanning Electron Microscopy.

PubMed

Verdaguer, Paula; Gris, Oscar; Casaroli-Marano, Ricardo P; Elies, Daniel; Muñoz-Gutierrez, Gerardo; Güell, Jose L

2015-08-01

To describe a case of hydrophilic intraocular lens (IOL) opacification based on IOL analysis after Descemet stripping automated endothelial keratoplasty. A 60-year-old woman had uneventful phacoemulsification after the implantation of a hydrophilic IOL (Akreos-Adapt; Bausch & Lomb) into both eyes. Because of postoperative corneal decompensation in the right eye, 2 Descemet stripping automated endothelial keratoplasty operations were performed within 1 year. After the second procedure, the graft was not well attached, requiring an intracameral injection of air on day 3. After 1 year, opacification was observed on the superior 2/3 of the anterior surface of the IOL, along with a significant decrease in visual acuity. The IOL was explanted 6 months after the opacification. Environmental scanning electron microscopy followed by x-ray microanalysis revealed an organic biofilm on the surface of the IOL. To our knowledge, this is the first reported case in which the material deposited on the lens is organic rather than calcific.

Intraocular Lens Use in an Astronaut During Long Duration Spaceflight.

PubMed

Mader, Thomas H; Gibson, C Robert; Schmid, Josef F; Lipsky, William; Sargsyan, Ashot E; Garcia, Kathleen; Williams, Jeffrey N

2018-01-01

The purpose of this paper is to report the first use of an intraocular lens (IOL) in an astronaut during long duration spaceflight (LDSF). An astronaut developed a unilateral cataract and underwent phacoemulsification with insertion of an acrylic IOL. Approximately 15 mo later he flew on a Soyuz spacecraft to the International Space Station (ISS), where he successfully completed a 6-mo mission. Ocular examination, including ultrasound (US), was performed before, during, and after his mission and he was questioned regarding visual changes during each portion of his flight. We documented no change in IOL position during his space mission. This astronaut reported excellent and stable vision during liftoff, entry into microgravity (MG), 6 mo on the ISS, descent, and landing. Our results suggest that modern IOLs are stable, effective, and well tolerated during LDSF.Mader TH, Gibson CR, Schmid JF, Lipsky W, Sargsyan AE, Garcia K, Williams JN. Intraocular lens use in an astronaut during long duration spaceflight. Aerosp Med Hum Perform. 2018; 89(1):63-65.

Electron microscopic examination of the anterior lens capsule in a case of Alport's syndrome.

PubMed

Citirik, Mehmet; Batman, Cosar; Men, Gamze; Tuncel, Murvet; Zilelioglu, Orhan

2007-09-01

To report a case of Alport's syndrome and to present electronmicroscopic examination findings of the anterior lens capsule of this patient. A 21-year-old man was referred for low visual acuity and retinal pigment epithelial changes in the left eye. The patient and his relatives underwent detailed ophthalmological examination, including electrophysiological testing. The patient also underwent electronmicroscopic examination of the anterior lens capsule. His visual acuity was 6/18 OD and 6/15 OS. Anterior lenticonus and subcapsular opacities were observed in the left eye. Cataract extraction by phacoemulsification with intraocular lens implantation was performed for his poor visual performance. During the capsulorhexis, the remarkably thin and fragile anterior capsule was noted and removed. Ultrastructural analysis of the anterior lens capsule showed a thinner central zone compared with the periphery. The course of Alport's syndrome can be ameliorated by early diagnosis. Therefore, the ophthalmological examination of a patient with anterior lenticonus must be combined with a detailed medical evaluation. Ultrastructural analysis of the lens capsule can support the diagnosis of Alport's syndrome.

Asymmetric Corneal Flattening Effect After Small Incision Cataract Surgery.

PubMed

Alpins, Noel; Ong, James K Y; Stamatelatos, George

2016-08-01

To determine whether the flattening effect of corneal incisions differs between the right and left eye. A retrospective study of preoperative and postoperative corneal astigmatism was performed for patients who had bilateral cataract surgery by a right-handed surgeon. The change in corneal astigmatism was attributed to the 2.2-mm phacoemulsification incision, and the incisional flattening effect was calculated. The incisions were grouped by position on the eye and whether they were performed on the preoperative steep corneal meridian. A total of 1,298 eyes of 649 patients were evaluated. The flattening effect of temporal 2.2-mm incisions performed on the preoperative corneal steep meridian was different for right eyes (0.53 diopters [D]) and left eyes (0.34 D) (P = .017). The flattening effect of superior 2.2-mm incisions performed on the preoperative corneal steep meridian was equivalent in the two eyes. The flattening effect of a corneal incision may depend on whether it has been performed on the right or the left eye. [J Refract Surg. 2016;32(9):598-603.]. Copyright 2016, SLACK Incorporated.

Use of the chop hook to stabilize the capsular bag in patients with crystalline lens dislocations and cataracts.

PubMed

Zeng, Yanfeng; Fan, Licheng; Lu, Peirong

2017-04-01

Objective To observe the treatment effects of chop hook-assisted phacoemulsification surgery in patients with crystalline lens dislocation. Methods Thirty-seven eyes with cataracts and crystalline lens dislocations underwent cataract surgery. An L-shaped chop hook was introduced into the anterior chamber, and the tip was pushed or pulled to the centre of the anterior capsular edge of the zonular dialysis during the cataract operation. Postoperative follow-up was conducted for ≥ 1 month. Results All patients' postoperative visual abilities improved except one patient with glaucoma. One patient who underwent -5D intraocular lens implantation exhibited vision of 1/50. Visual acuity was less than 6/20 in 6 eyes, 6/20 to 10/20 in 7 eyes, and greater than 10/20 in 22 eyes. Conclusions L-shaped chop hooks can be used to push or pull the anterior capsular edge of the zonular dialysis for protection and avoidance of further zonular damage. This strategy provides satisfactory effects and reduces use of additional instruments.

In Vivo Corneal High-Speed, Ultra–High-Resolution Optical Coherence Tomography

PubMed Central

Christopoulos, Viki; Kagemann, Larry; Wollstein, Gadi; Ishikawa, Hiroshi; Gabriele, Michelle L.; Wojtkowski, Maciej; Srinivasan, Vivek; Fujimoto, James G.; Duker, Jay S.; Dhaliwal, Deepinder K.; Schuman, Joel S.

2007-01-01

Objective: To introduce new corneal high-speed, ultra–high-resolution optical coherence tomography (hsUHR-OCT) technology that improves the evaluation of complicated and uncomplicated cataract, corneal, and refractive surgical procedures. Design: This case series included a control subject and 9 eyes of 8 patients who had undergone phacoemulsification, Descemet membrane stripping endokeratoplasty, corneal implantation for keratoconus, and complicated and uncomplicated laser in situ keratomileusis. These eyes underwent imaging using a prototype ophthalmic hsUHR-OCT system. All the scans were compared with conventional slitlamp biomicroscopy. Results: Cross-sectional hsUHR-OCT imaging allowed in vivo differentiation of corneal layers and existing pathologic abnormalities at ultrahigh axial image resolution. These images illustrate the various incisional and refractive interfaces created with corneal procedures. Conclusions: The magnified view of the cornea using hsUHR-OCT is helpful in conceptualizing and understanding basic and complicated clinical pathologic features; hsUHR-OCT has the potential to become a powerful, noninvasive clinical corneal imaging modality that can enhance surgical management. Trial Registration: clinicaltrials.gov Identifier: NCT00343473 PMID:17698748

Clinical and electrophysiologic results after intracameral lidocaine 1% anesthesia: a prospective randomized study.

PubMed

Anders, N; Heuermann, T; Rüther, K; Hartmann, C

1999-10-01

To evaluate the efficacy and safety of intracameral lidocaine in cataract surgery compared to peribulbar anesthesia. A prospective, randomized, controlled study. A total of 200 consecutive cataract patients (200 eyes) participated. Eyes were randomly assigned to two groups: one group received 0.15 ml intracameral 1% unpreserved lidocaine combined with topical anesthesia (oxybuprocaine); the other group received 6 ml prilocaine peribulbar before phacoemulsification with sclerocorneal tunnel incision. Duration of surgery was measured; implicit time and amplitudes of the b-waves of the photopic electroretinogram (ERG) potentials (single-flash ERG and the 30-Hz flicker ERG) were recorded; frequencies of intraoperative problems, complications, intraoperative, and postoperative pain were evaluated. After lidocaine anesthesia combined with topical anesthesia, similar complications were found, longer operation time (P < 0.001), and significantly better visual acuity immediately after surgery (P < 0.001). The ERG amplitudes were not significantly reduced after 0.15-ml intracameral lidocaine half an hour after surgery (P > 0.05). Intracameral lidocaine 1% combined with topical anesthesia can be recommended as an alternative procedure to peribulbar anesthesia in cataract surgery with corneoscleral tunnel incision.

Optimization of transversal phacoemulsification settings in peristaltic mode using a new transversal ultrasound machine.

PubMed

Wright, Dannen D; Wright, Alex J; Boulter, Tyler D; Bernhisel, Ashlie A; Stagg, Brian C; Zaugg, Brian; Pettey, Jeff H; Ha, Larry; Ta, Brian T; Olson, Randall J

2017-09-01

To determine the optimum bottle height, vacuum, aspiration rate, and power settings in the peristaltic mode of the Whitestar Signature Pro machine with Ellips FX tip action (transversal). John A. Moran Eye Center Laboratories, University of Utah, Salt Lake City, Utah, USA. Experimental study. Porcine lens nuclei were hardened with formalin and cut into 2.0 mm cubes. Lens cubes were emulsified using transversal and fragment removal time (efficiency), and fragment bounces off the tip (chatter) were measured to determine optimum aspiration rate, bottle height, vacuum, and power settings in the peristaltic mode. Efficiency increased in a linear fashion with increasing bottle height and vacuum. The most efficient aspiration rate was 50 mL/min, with 60 mL/min statistically similar. Increasing power increased efficiency up to 90% with increased chatter at 100%. The most efficient values for the settings tested were bottle height at 100 cm, vacuum at 600 mm Hg, aspiration rate of 50 or 60 mL/min, and power at 90%. Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Cataract Surgery From 1918 to the Present and Future-Just Imagine!

PubMed

Olson, Randall J

2018-01-01

To review the history of cataract surgery over the past 100 years, and to offer predictions about new developments that may occur during the next 50 years. Interpretive essay. Review of historical literature and author experiences pertaining to cataract surgery, with commentary and perspective. By this time, cataract surgery has advanced to the point that Kelman's introduction of phacoemulsification and use of intraocular lenses (IOLs), both very controversial when initially introduced, have become state of the art. Outpatient surgery, minimally limited mobility, sutureless incisions, and topical anesthesia also have become key components of standard treatment. The author envisions availability of medications for nuclear sclerosis and presbyopia, expansion of lens surgery for refractive purposes with postsurgical adjustment and unprecedented precision, increased mechanization of lens removal with emphasis on uncomplicated surgery rather than refractive precision, and accommodating IOLs all becoming standard. Acknowledging and appreciating the past contributions of pioneers in cataract surgery is vital to understanding the development of today's clinical care. Clues as to the future do help give us a possible scenario worthy of such conjecture. Copyright © 2017 Elsevier Inc. All rights reserved.

Cataract, phacoemulsification and intraocular pressure: Is the anterior segment anatomy the missing piece of the puzzle?

PubMed

Masis Solano, Marisse; Lin, Shan C

2018-01-29

Cataract extraction is a safe and effective surgery that has a lowering effect on the intraocular pressure. The specific mechanisms for this effect are still unclear. A direct inflammatory effect on the trabecular meshwork, alteration of the blood aqueous barrier, changes in the ciliary body and mechanical changes of the anterior segment anatomy are the key to understand cataract surgery and it's effects on aqueous humor dynamics. Additionally, with the advent of AS OCT, changes in the anterior segment of the eye have been studied and several parameters (such as lens vault, angle opening distance and anterior chamber depth) have been identified as predictors of intraocular pressure change. In eyes with narrow angles there is a greater drop in intraocular pressure after cataract surgery and it is correlated with parameters related to anterior chamber space. It is safe to affirm that cataract surgery is an important part of the modern glaucoma treatment and evidence should be analyzed as part of a bigger picture in order to more accurately understand its clinical relevance. Copyright © 2018. Published by Elsevier Ltd.

Bilateral phacoemulsification and intraocular lens implantation in a great horned owl.

PubMed

Carter, Renee T; Murphy, Christopher J; Stuhr, Charles M; Diehl, Kathryn A

2007-02-15

A great horned owl of estimated age < 1 year that was captured by wildlife rehabilitators was evaluated because of suspected cataracts. Nuclear and incomplete cortical cataracts were evident in both eyes. Ocular ultrasonography revealed no evidence of retinal detachment, and electroretinography revealed normal retinal function. For visual rehabilitation, cataract surgery was planned and intraocular lens design was determined on the basis of values obtained from the schematic eye, which is a mathematical model representing a normal eye for a species. Cataract surgery and intraocular lens placement were performed in both eyes. After surgery, refraction was within -0.75 diopters in the right eye and -0.25 diopters in the left eye. Visual rehabilitation was evident on the basis of improved tracking and feeding behavior, and the owl was eventually released into the wild. In raptors with substantial visual compromise, euthanasia or placement in a teaching facility is a typical outcome because release of such a bird is unacceptable. Successful intraocular lens implantation for visual rehabilitation and successful release into the wild are achievable.

Dodick laser phacolysis: thermal effects.

PubMed

Alzner, E; Grabner, G

1999-06-01

To gather experimental data on whether Dodick laser phacolysis leads to corneal or scleral burns. The Eye Department, County Hospital Salzburg, Salzburg, Austria. The study was done using a pulsed neodymium:YAG (Nd:YAG) laser with a wavelength of 1064 nm; energy, 10 mJ; and duration of pulses, 14 ns. The light pulse is carried by a 400 microns quartz fiber to the laser phacolysis probe. The laser light hits a titanium target inside the tip, causing an optical breakdown and thus a shock wave. The generation of both plasma and the shock disrupt the nuclear material. The temperature at the ultrasonic phaco and laser phacolysis tip was measured under air and balanced salt solution (BSS) in a test chamber and in the anterior chambers of eye-bank eyes. Ultrasonic phacoemulsification led to a difference in temperature up to 55.3 degrees C under air, 12 degrees C in BSS, and 10.9 degrees C in the anterior chamber. There was no clinical significant heat generated by the laser phacolysis tip. This initial in vitro study demonstrates that the well-known risk of the tissue heating (i.e., phaco burn) does not occur with Dodick laser phacolysis, even when the irrigation flow is slow or discontinued.

Achieving target refraction after cataract surgery.

PubMed

Simon, Shira S; Chee, Yewlin E; Haddadin, Ramez I; Veldman, Peter B; Borboli-Gerogiannis, Sheila; Brauner, Stacey C; Chang, Kenneth K; Chen, Sherleen H; Gardiner, Matthew F; Greenstein, Scott H; Kloek, Carolyn E; Chen, Teresa C

2014-02-01

To evaluate the difference between target and actual refraction after phacoemulsification and intraocular lens implantation at an academic teaching institution's Comprehensive Ophthalmology Service. Retrospective study. We examined 1275 eye surgeries for this study. All consecutive cataract surgeries were included if they were performed by an attending or resident surgeon from January through December 2010. Postoperative refractions were compared with preoperative target refractions. Patients were excluded if they did not have a preoperative target refraction documented or if they did not have a recorded postoperative manifest refraction within 90 days. The main outcome measure was percentage of cases achieving a postoperative spherical equivalent ± 1.0 diopter (D) of target spherical equivalent. We performed 1368 cataract surgeries from January through December of 2010. Of these, 1275 (93%) had sufficient information for analysis. Of the included cases, 94% (1196 of 1275) achieved ± 1.0 D of target refraction by 90 days after cataract surgery. This paper establishes a new benchmark for a teaching hospital, where 94% of patients achieved within 1.0 D of target refraction after cataract surgery. The refractive outcomes after cataract surgery at this academic teaching institution were higher than average international benchmarks. Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Ptosis induced by topical steroid eye drops: Two cases reports.

PubMed

Zhu, Yanan; Sun, Chaohui; Zhang, Xin; Shentu, Xingchao

2017-12-01

Ptosis is a rare complication of periocular steroid use. Studies report that local injections of steroids produce ptosis. We describe the first 2 cases of ptosis because of long-term treatment with topical steroid eye drops. Two cases admitted to our hospital because of ptosis of their right eye after long-term treatment with topical steroid eye drops. Both of them had uncontrolled Posner-Schlossman syndrome. Two cases were diagnosed as steroid-related ptosis. Regulatory anti-inflammation therapy was prescribed for case 1, and after inflammation control, phacoemulsification was done for her. Six months after steroid withdrawal, the levator resection of the right eye was performed. Case 2 refused our advice of steroid reduction and ptosis surgery. After surgery, case 1 retained a symmetrical appearance during a 1-year follow-up. In the surgery, we found thin levator muscles and slack levator palpebrae superioris aponeurosis (LPSA) in the affected eye. Postoperative transmission electron microscopy revealed typical signs of apoptosis in levator muscle cells. We suggest topical application of steroids induces levator muscle apoptosis and LPSA weakness, and results in ptosis. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

Reprint of: Relationship between cataract severity and socioeconomic status.

PubMed

Wesolosky, Jason D; Rudnisky, Christopher J

2015-06-01

To determine the relationship between cataract severity and socioeconomic status (SES). Retrospective, observational case series. A total of 1350 eyes underwent phacoemulsification cataract extraction by a single surgeon using an Alcon Infiniti system. Cataract severity was measured using phaco time in seconds. SES was measured using area-level aggregate census data: median income, education, proportion of common-law couples, and employment rate. Preoperative best corrected visual acuity was obtained and converted to logarithm of the minimum angle of resolution values. For patients undergoing bilateral surgery, the generalized estimating equation was used to account for the correlation between eyes. Univariate analyses were performed using simple regression, and multivariate analyses were performed to account for variables with significant relationships (p < 0.05) on univariate testing. Sensitivity analyses were performed to assess the effect of including patient age in the controlled analyses. Multivariate analyses demonstrated that cataracts were more severe when the median income was lower (p = 0.001) and the proportion of common-law couples living in a patient's community (p = 0.012) and the unemployment rate (p = 0.002) were higher. These associations persisted even when controlling for patient age. Patients of lower SES have more severe cataracts. Copyright © 2015. Published by Elsevier Inc.

Vitiligo iridis and glaucoma: a rare sequelae of small pox.

PubMed

Kavitha, S; Patel, S R; Mohini, P; Venkatesh, R; Sengupta, S

2015-10-01

Vitiligo iridis refers to focal areas of iris atrophy as sequelae of small pox infection. We report a series of patients with unilateral vitiligo iridis, some of whom presented with secondary open-angle glaucoma. Three patients with vitiligo iridis underwent a comprehensive ophthalmic examination including intraocular pressure (IOP) measurement, slit lamp biomicroscopy, gonioscopy, and fundus evaluation. Patients' facial features were also documented and photographed. All patients were in their sixth decade. Two out the three had elevated IOP (52 mm Hg and 36 mm Hg) in the same eye as vitiligo iridis, at initial presentation. Gonioscopy showed patchy iris hyperpigmentation and fundus evaluation showed glaucomatous optic disc changes in the involved eye. One patient responded favourably to topical antiglaucoma medications, whereas the other was taken up for combined phacoemulsification-trabeculectomy with good results. The third patient had normal IOP in the involved eye. All three patients gave a history of small pox in childhood and had pitted facial scars typical of previous small pox infection. Vitiligo iridis may be associated with the secondary glaucoma as a long-term sequelae of small pox. It may be prudent to periodically follow-up such patients for development of raised IOP in the future.

How close are we? An audit of biometry of a tertiary care hospital in Karachi.

PubMed

Siddiqui, Abdul Hameed; Khan, Maria; Hussain, Marium

2018-01-01

To evaluate the accuracy of biometry in the post-op phase of cataract surgery. This study was conducted at Liaquat National Hospital, Karachi, from June 2015 to July 2016, and comprised the audit of patients who underwent cataract surgery during the period. Keratometry was done on Haag-Strait manual keratometer and A-scan was done by applanation contact method on SonoMed machine. Theoretic-T formula was used to calculate desired intraocular lens power for all kinds of axial lengths. A single surgeon operated upon the same Alcon Constellation phacoemulsification machine. Postoperative follow-up was done by monitoring auto refraction and visual acuity on days 1, 7, 30 and 90. SPSS 21 was used for data analysis.. Of 244 patients, 121(49.60%) were males and 123(50.40%) were females. There were 123(50.40%) right eyes and 121(49.60%) left eyes. Overall, 132(54.10%) achieved postoperative refraction within ±0.5 D of target and 193(79.10%) within ±1 D of target. Age, gender and laterality had no significant effect on outcomes (p>0.05 each). Postoperative refraction corresponded quite closely with global recommendations.

Creeping posterior synechiae following hyperopic iris-fixated phakic implants.

PubMed

Messina, Marco; Elalfy, Mohamed; Fares, Usama; Ghoz, Noha; Mavi, Balraj; Dua, Harminder

2016-12-01

The purpose of this study was to report on the occurrence and management of posterior synechiae (PS) in three hyperopic eyes after iris-fixated anterior chamber phakic IOL implantation. This is a case report of a 55-year-old man and a 55-year-old lady who had undergone iris-fixated anterior chamber phakic IOL implantation to correct hyperopic astigmatism (one eye) and hyperopia (both eyes), respectively. The three eyes developed creeping PS and pigment dispersion within 4-6 weeks of surgery. Synechiolysis and pupil stretching in one eye did not work as the synechiae promptly recurred. Definitive management in the form of removal of the phakic implant and phacoemulsification with lens implant was successful in restoring normal vision in all three eyes. Although implantation of phakic intraocular lenses has been reported to be very effective for the correction of moderate to high degrees of ametropia, this complication can occur in hyperopic eyes. Pigment dispersion has been reported in myopic eyes also, but PS seem to be more an issue with hyperopic eyes. Age of the patient may also be a factor. This information is important in the selection and counselling of patients.

Assessing the effects of ketorolac and acetazolamide on macular thickness by optical coherence tomography following cataract surgery.

PubMed

Turan-Vural, Ece; Halili, Elvin; Serin, Didem

2014-06-01

We aimed to evaluate the efficacy of topical ketorolac 0.5 % solution and oral acetazolamide 250 mg/day delivery during the first month after uneventful phacoemulsification surgery by measuring the macular thickness using optical coherence tomography. Our nonmasked randomized prospective study comprised 87 eyes of 80 patients. Complete follow-up was achieved on 84 eyes of 77 eligible patients. Postoperatively, the patients were divided into three groups. One group received ketorolac 0.5 %, the other group received acetazolamide 250 mg/day, and the control group was given no agent. Macular thickness and volume were measured at 1 week and 1 month after surgery by optical coherence tomography. Foveal thickness, parafoveal thickness, and perifoveal thickness were determined to be significantly elevated at postoperative 1 week and 1 month in the control group. Foveal, perifoveal, and parafoveal volumes were also significantly high at postoperative week 1 and month 1 in the control group. There was no significant difference between the ketorolac and acetazolamide groups. The correlation analysis between best-corrected visual acuity, and volume and thickness revealed a negative correlation in the acetazolamide group. Use of acetazolamide after cataract surgery is as effective as ketorolac on macular thickness and volume.

A Comparison of Three Different Thick Epinucleus Removal Techniques in Cataract Surgery.

PubMed

Hwang, Ho Sik; Lim, Byung-Su; Kim, Man Soo; Kim, Eun Chul

2017-01-01

To compare the outcomes of cataract surgery performed with three different types of the epinucleus removal techniques (safe boat, infusion/aspiration (I/A) cannulas, and phacoemulsification tip). Ninety eyes with thick adhesive epinuclei were randomly subdivided into three groups according to epinucleus removal technique: epinucleus floating (safe boat) technique, 30 patients; I/A tip, 30 patients; and phaco tip, 30 patients. Intraoperative measurements included ultrasound time (UST), mean cumulative dissipated ultrasound energy (CDE), and balanced salt solution (BSS) use. Clinical measurements were made preoperatively, and at one day, one month and two months postoperatively, including the best corrected visual acuity (BCVA), the central corneal thickness (CCT), and the endothelial cell count (ECC). Intraoperative measurements showed significantly less UST, CDE, and BSS use in the safe boat group than in the phaco tip groups (p < 0.05). The percentage of endothelial cell loss in the safe boat group was significantly lower than that in the phaco tip groups at two months post-cataract surgery (p < 0.05). The safe boat technique is a safer and more effective epinucleus removal technique than phaco tip techniques in cases with thick epinucleus.

Pseudolentogenic astigmatic effect of multifocal intraocular lenses: non-corneal ocular residual astigmatism (N-CORA) as a new parameter in astigmatic change analysis.

PubMed

Frings, Andreas; Steinberg, Johannes; Druchkiv, Vasyl; Linke, Stephan J; Katz, Toam

2017-08-01

This study was initiated to introduce the term non-corneal ocular residual astigmatism (N-CORA) as a new parameter in astigmatic change analysis after implantation of two different types of non-toric, multifocal intraocular lenses (MIOL). Seventy-two eyes from 72 consecutive patients after MIOL surgery were studied in terms of a retrospective, cross-sectional data analysis. Two types of spherical MIOL were used. Surgical technique in all patients was a 2.4-mm incision phacoemulsification, performed by one surgeon. To investigate the magnitude and axis of astigmatic changes, the true corneal astigmatism and Alpins vector method were applied. There were no statistically significant between-group differences related to the preoperative refraction or ocular residual astigmatism (ORA). After surgery, the mean refractive surgically induced astigmatism (RSIA) and the topographic SIA (TSIA) did not differ significantly between the lenses. The magnitude and orientation of ORA and N-CORA changed after surgery. There are no statistically significant differences in postoperative ORA in magnitude or axis when implanting different types of MIOL. The similarity of N-CORA between both MIOL types shows that both diffractive and refractive asymmetric MIOLs with plate haptics have the same pseudolentogenic astigmatic effect which could be presented in terms of the newly introduced parameter N-CORA.

Surface cytologic features on intraocular lenses: can increased biocompatibility have disadvantages?

PubMed

Hollick, E J; Spalton, D J; Ursell, P G

1999-07-01

To compare the anterior surface cytologic features and effect on blood-aqueous barrier of polymethyl methacrylate, silicone, and hydrogel intraocular lens (IOL) implants to give an indication of their biocompatibility. This prospective study was performed at an English-teaching hospital. Ninety eyes were randomized to receive a polymethyl methacrylate, silicone, or hydrogel implant. A standardized surgical protocol was performed by a single surgeon using phacoemulsification. Patients were seen at intervals for 1 year. Measurements of visual acuity, contrast sensitivity, and anterior chamber laser flare and cells were obtained; and an assessment of lens cytologic features using specular microscopy of the anterior IOL surface was performed. Visual acuity and contrast sensitivity were not significantly different among the 3 groups. Hydrogel IOLs were associated with fewer inflammatory cells on their surface than polymethyl methacrylate and silicone IOLs (P<.001), but with significantly more lens epithelial cells (LECs) (P<.001). Patients with hydrogel implants without LECs had greater blood-aqueous barrier breakdown than those with LECs. The hydrogel IOLs were associated with a reduced inflammatory cell reaction but had many more LECs on their anterior surface. Those IOLs associated with increased blood-aqueous barrier damage did not develop LECs. If an IOL is too biocompatible, then it may incite the growth of LECs over its surface, which could have disadvantages.

Iridoplasty of fixed-dilated pupil (Urrets-Zavalia syndrome) after deep anterior lamellar keratoplasty

PubMed Central

Ntora, Efthalia; Ziakas, Nikolaos

2017-01-01

A 38-year-old woman with advanced keratoconus initially developed Urrets-Zavalia Syndrome (UZS) in the left eye after deep anterior lamellar keratoplasty. During the uneventful surgery, a 7-mm-wide pupil unresponsive to light was noticed. On the first postoperative day, intraocular pressure (IOP) was elevated up to 45 mmHg with shallow anterior chamber (AC). A peripheral iridotomy in 2 o’clock position was conducted and a fixed combination of brinzolamide 1% and timolol 0.5% was administered topically. In the subsequent postoperative period, IOP was successfully reduced, but the patient reported severe photophobia, glare, and decreased vision. Twelve months after surgery, her best-corrected visual acuity (BCVA) was 20/200, the fixed-dilated pupil persisted, iris was atrophic, and lens opacities were detected. She was submitted for phacoemulsification cataract surgery combined with iridoplasty using the closed chamber slipping suture technique. Three months after surgery, her BCVA was 20/25, pupil diameter remained stable at 4 mm, and glare symptoms were significantly reduced. A very adequate cosmetic outcome was also achieved. Iridoplasty in postkeratoplasty patient with unilateral UZS was effective in improving patient's visual function disability and restoring residual anisocoria. This technique can be applied as a single procedure or combined with another one for the management of UZS. PMID:29118500

VR-simulation cataract surgery in non-experienced trainees: evolution of surgical skill

NASA Astrophysics Data System (ADS)

Söderberg, Per; Erngrund, Markus; Skarman, Eva; Nordh, Leif; Laurell, Carl-Gustaf

2011-03-01

Conclusion: The current data imply that the performance index as defined herein is a valid measure of the performance of a trainee using the virtual reality phacoemulsification simulator. Further, the performance index increase linearly with measurement cycles for less than five measurement cycles. To fully use the learning potential of the simulator more than four measurement cycles are required. Materials and methods: Altogether, 10 trainees were introduced to the simulator by an instructor and then performed a training program including four measurement cycles with three iterated measurements of the simulation at the end of each cycle. The simulation characteristics was standardized and defined in 14 parameters. The simulation was measured separately for the sculpting phase in 21 variables, and for the evacuation phase in 22 variables. A performance index based on all measured variables was estimated for the sculpting phase and the evacuation phase, respectively, for each measurement and the three measurements for each cycle were averaged. Finally, the performance as a function of measurement cycle was estimated for each trainee with regression, assuming a straight line. The estimated intercept and inclination coefficients, respectively, were finally averaged for all trainees. Results: The performance increased linearly with the number of measurement cycles both for the sculpting and for the evacuation phase.

Implantation of a multifocal toric intraocular lens with a surface-embedded near segment after repeated LASIK treatments.

PubMed

Khoramnia, Ramin; Auffarth, Gerd U; Rabsilber, Tanja M; Holzer, Mike P

2012-11-01

We report a 66-year-old patient who presented with increasing hyperopia, astigmatism, and presbyopia in both eyes 8 years after bilateral laser in situ keratomileusis (LASIK) and LASIK enhancement in the left eye aiming for spectacle independence. Bilateral multifocal toric Lentis Mplus intraocular lenses (IOLs) with an embedded near segment and individually customized cylinder correction were implanted uneventfully following phacoemulsification. The Haigis-L formula after previous hyperopia correction was chosen for IOL power calculation and provided reliable results. Emmetropia was targeted and achieved. Three months postoperatively, the uncorrected distance visual acuity had increased from 0.40 logMAR to 0.10 logMAR in the right eye and from 0.20 logMAR to 0.00 logMAR in the left eye. The patient gained 6 lines of uncorrected near visual acuity: 0.20 logMAR in the right eye and 0.10 logMAR in the left eye. This case shows that customized premium IOL implantation can provide accurate results even in challenging cases. The International Vision Correction Research Centre, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany, has received research grants, lecture fees, and travel reimbursement from Oculentis GmbH. Copyright © 2012 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Topical anesthesia without intracameral lidocaine in cataract surgery.

PubMed

Spiritus, A; Huygens, M; Callebaut, F

2000-01-01

To evaluate the efficacy of topical anesthesia with oxybuprocaïne 0.4% without intracameral lidocaïne as an alternative to peribulbar or retrobulbar anesthesia in cataract surgery. Fifty-eight patients (eighty-two eyes) were included in this study. All patients received topical anesthesia with oxybuprocaïne 0.4%. No intracameral lidocaïne was used at the start of the intervention. Seventy-five per cent of patients received oral sedation with lorazepam 2.5 mg. All surgery was done using a superior corneal incision and phacoemulsification followed by a foldable IOL implantation. Subjective pain was assessed at 4 intervals during surgery using a 4-point pain scale. All patients were evaluated for intraoperative eye motility and blepharospasm. Patient and surgeon satisfaction was measured with a 4-point satisfaction scale. 15% of patients experienced mild pain during phaco and 43% had mild pain during corneal suturing. No patient had severe pain during the operation. In 4% of patients, intracameral lidocaïne was used to relieve pain. The surgeon and patient satisfaction was high. No eye movements or blepharospasm were recorded in 75% and 62% of cases respectively. No serious complications occurred. Topical anesthesia is a safe and effective alternative to peribulbar and retrobulbar anesthesia in corneal cataract surgery for the experienced surgeon.

Eye healthcare services in eastern Europe: Part 1. Cataract surgery.

PubMed

Kocur, I; Resnikoff, S; Foster, A

2002-08-01

To describe cataract surgical services in 1998 in 12 eastern European countries and to identify their needs to reduce cataract blindness. All inpatient eye departments in the 12 countries received a standardised questionnaire; the data obtained were further processed at the coordinating centre in Prague. All 458 eye departments in the region were involved. The response rate was 100%, except for Bulgaria (93%) and Romania (93%). The total number of cataract surgeries per one million inhabitants in 1998 was calculated: Belarus (800), Federation of Bosnia and Herzegovina (1275), Bulgaria (1730), the Czech Republic (4210), Estonia (2530), Hungary (3530), Latvia (1860), Lithuania (1550), Trans-Dniester Moldova (1300), Poland (1475), Romania (1260), and Slovakia (2430). Cataracts were mostly operated on by the extracapsular technique. Intracapsular extractions were frequently performed in Federation of Bosnia and Herzegovina (47%), Belarus (46%), Bulgaria (18%), and Romania (14.3%). Phacoemulsification was uncommonly used in 1998, except for the Czech Republic (86%), Estonia (50%), Slovakia (38%), and Hungary (16%). An IOL was implanted in more than 90% of patients in the Czech Republic, Estonia, Hungary, Latvia, Lithuania, and Slovakia. Conditions for cataract surgery in the eastern European region differ. The main barriers to cataract surgery were state budget limitations, insufficient supply of consumables, underutilisation of operating theatres, and poor detection of patients requiring surgery.

Improvement of Uveal and Capsular Biocompatibility of Hydrophobic Acrylic Intraocular Lens by Surface Grafting with 2-Methacryloyloxyethyl Phosphorylcholine-Methacrylic Acid Copolymer

PubMed Central

Tan, Xuhua; Zhan, Jiezhao; Zhu, Yi; Cao, Ji; Wang, Lin; Liu, Sa; Wang, Yingjun; Liu, Zhenzhen; Qin, Yingyan; Wu, Mingxing; Liu, Yizhi; Ren, Li

2017-01-01

Biocompatibility of intraocular lens (IOL) is critical to vision reconstruction after cataract surgery. Foldable hydrophobic acrylic IOL is vulnerable to the adhesion of extracellular matrix proteins and cells, leading to increased incidence of postoperative inflammation and capsule opacification. To increase IOL biocompatibility, we synthesized a hydrophilic copolymer P(MPC-MAA) and grafted the copolymer onto the surface of IOL through air plasma treatment. X-ray photoelectron spectroscopy, atomic force microscopy and static water contact angle were used to characterize chemical changes, topography and hydrophilicity of the IOL surface, respectively. Quartz crystal microbalance with dissipation (QCM-D) showed that P(MPC-MAA) modified IOLs were resistant to protein adsorption. Moreover, P(MPC-MAA) modification inhibited adhesion and proliferation of lens epithelial cells (LECs) in vitro. To analyze uveal and capsular biocompatibility in vivo, we implanted the P(MPC-MAA) modified IOLs into rabbits after phacoemulsification. P(MPC-MAA) modification significantly reduced postoperative inflammation and anterior capsule opacification (ACO), and did not affect posterior capsule opacification (PCO). Collectively, our study suggests that surface modification by P(MPC-MAA) can significantly improve uveal and capsular biocompatibility of hydrophobic acrylic IOL, which could potentially benefit patients with blood-aqueous barrier damage. PMID:28084469

Relationship between cataract severity and socioeconomic status.

PubMed

Wesolosky, Jason D; Rudnisky, Christopher J

2013-12-01

To determine the relationship between cataract severity and socioeconomic status (SES). Retrospective, observational case series. A total of 1350 eyes underwent phacoemulsification cataract extraction by a single surgeon using an Alcon Infiniti system. Cataract severity was measured using phaco time in seconds. SES was measured using area-level aggregate census data: median income, education, proportion of common-law couples, and employment rate. Preoperative best corrected visual acuity was obtained and converted to logarithm of the minimum angle of resolution values. For patients undergoing bilateral surgery, the generalized estimating equation was used to account for the correlation between eyes. Univariate analyses were performed using simple regression, and multivariate analyses were performed to account for variables with significant relationships (p < 0.05) on univariate testing. Sensitivity analyses were performed to assess the effect of including patient age in the controlled analyses. Multivariate analyses demonstrated that cataracts were more severe when the median income was lower (p = 0.001) and the proportion of common-law couples living in a patient's community (p = 0.012) and the unemployment rate (p = 0.002) were higher. These associations persisted even when controlling for patient age. Patients of lower SES have more severe cataracts. Copyright © 2013 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

Analysis of Femtosecond Laser Assisted Capsulotomy Cutting Edges and Manual Capsulorhexis Using Environmental Scanning Electron Microscopy

PubMed Central

Serrao, Sebastiano; Lombardo, Giuseppe; Desiderio, Giovanni; Buratto, Lucio; Schiano-Lomoriello, Domenico; Pileri, Marco; Lombardo, Marco

2014-01-01

Purpose. To investigate the structure and irregularity of the capsulotomy cutting edges created by two femtosecond (FS) laser platforms in comparison with manual continuous circular capsulorhexis (CCC) using environmental scanning electron microscopy (eSEM). Methods. Ten anterior capsulotomies were obtained using two different FS laser cataract platforms (LenSx, n = 5, and Victus, n = 5). In addition, five manual CCC (n = 5) were obtained using a rhexis forceps. The specimens were imaged by eSEM (FEI Quanta 400, OR, USA). Objective metrics, which included the arithmetic mean deviation of the surface (Sa) and the root-mean-square deviation of the surface (Sq), were used to evaluate the irregularity of both the FS laser capsulotomies and the manual CCC cutting edges. Results. Several microirregularities were shown across the FS laser capsulotomy cutting edges. The edges of manually torn capsules were shown, by comparison of Sa and Sq values, to be smoother (P < 0.05) than the FS laser capsulotomy edges. Conclusions. Work is needed to understand whether the FS laser capsulotomy edge microirregularities, not seen in manual CCC, may act as focal points for the concentration of stress that would increase the risk of capsular tear during phacoemulsification as recently reported in the literature. PMID:25505977

Analysis of femtosecond laser assisted capsulotomy cutting edges and manual capsulorhexis using environmental scanning electron microscopy.

PubMed

Serrao, Sebastiano; Lombardo, Giuseppe; Desiderio, Giovanni; Buratto, Lucio; Schiano-Lomoriello, Domenico; Pileri, Marco; Lombardo, Marco

2014-01-01

Purpose. To investigate the structure and irregularity of the capsulotomy cutting edges created by two femtosecond (FS) laser platforms in comparison with manual continuous circular capsulorhexis (CCC) using environmental scanning electron microscopy (eSEM). Methods. Ten anterior capsulotomies were obtained using two different FS laser cataract platforms (LenSx, n = 5, and Victus, n = 5). In addition, five manual CCC (n = 5) were obtained using a rhexis forceps. The specimens were imaged by eSEM (FEI Quanta 400, OR, USA). Objective metrics, which included the arithmetic mean deviation of the surface (Sa) and the root-mean-square deviation of the surface (Sq), were used to evaluate the irregularity of both the FS laser capsulotomies and the manual CCC cutting edges. Results. Several microirregularities were shown across the FS laser capsulotomy cutting edges. The edges of manually torn capsules were shown, by comparison of Sa and Sq values, to be smoother (P < 0.05) than the FS laser capsulotomy edges. Conclusions. Work is needed to understand whether the FS laser capsulotomy edge microirregularities, not seen in manual CCC, may act as focal points for the concentration of stress that would increase the risk of capsular tear during phacoemulsification as recently reported in the literature.

Incidence and Characteristics of Cataract Surgery in Poland, during 2010-2015.

PubMed

Nowak, Michał S; Grabska-Liberek, Iwona; Michalska-Małecka, Katarzyna; Grzybowski, Andrzej; Kozioł, Milena; Niemczyk, Wojciech; Więckowska, Barbara; Szaflik, Jacek P

2018-03-02

Background: To assess the incidence and characteristic of cataract surgery in Poland from 2010 to 2015 and to interpret these findings. Patients and methods: Data from all patients who underwent cataract surgery alone or in combined procedures in Poland between January 2010 and December 2015 were evaluated. Patient data were from the national database of hospitalizations maintained by National Health Fund. Data on the population of Poland were obtained from Central Statistical Office of Poland. Results: In total, 1,218,777 cataract extractions (alone or combined with other procedures) were performed in 1,081,345 patients during 2010-2015. Overall, the incidence of cataract surgery increased from 5.22/1000 person-years in 2010 to 6.17/1000 person-years in 2015. Phacoemulsification was performed in 97.46% of cataract extractions, and 3.02% of cataract extractions were combined procedures. The rate of one-day procedures increased from 28.3% in 2010 to 43.1% in 2015. The probability of second-eye surgery 12 months after the first-eye surgery increased from 44% in 2010 to 73% in 2015 (log-rank test p < 0.0001). Conclusion: In Poland, from 2010 to 2015, the total incidence of cataract surgery, the number of people who underwent surgery, and the number of one-day cataract surgeries increased significantly.

Postoperative corneal shape changes: microincision versus small-incision coaxial cataract surgery.

PubMed

Hayashi, Ken; Yoshida, Motoaki; Hayashi, Hideyuki

2009-02-01

To compare changes in corneal topography and in regular and irregular astigmatism after coaxial clear corneal microincision cataract surgery (MICS) and after coaxial small-incision cataract surgery (SICS). Hayashi Eye Hospital, Fukuoka, Japan. Induced corneal astigmatism was determined using vector analysis. The averaged corneal shape changes and degree of irregular astigmatism were examined using videokeratography preoperatively as well as 2 days and 1, 2, 4, and 8 weeks postoperatively. One hundred twenty eyes of 60 patients scheduled for phacoemulsification were evaluated. Sixty eyes had MICS (2.00 mm), and the 60 contralateral eyes had SICS (2.65 mm). The mean induced corneal astigmatism was significantly less in the MICS group than in the SICS group (P

23G pars plana vitrectomy for vitreal floaters: prospective assessment of subjective self-reported visual impairment and surgery-related risks during the course of treatment.

PubMed

Hahn, Ursula; Krummenauer, Frank; Ludwig, Klaus

2018-06-01

Quantifying the subjective impairment due to floaters based on an indication-specific questionnaire and setting its change between prior to and 3/12 months after elective vitrectomy in relation to surgical risks. Single-arm longitudinal observational multicenter study. Sixty-four floater patients underwent 23G pars plana vitrectomy; simultaneous phacoemulsification was excluded. An overall self-rated impairment index (SRI) and sub-indices SRI were calculated on the basis of a modified Visual Quality of Life questionnaire (VQoL), which addresses general vision, glare, near-sight problems and mobility of floaters. SRI ranged from 0 to 100% (maximum impairment). Secondary endpoints included corrected visual acuity and complications. Data were collected prior to and 3 (n = 64) and 12 (n = 62) months after surgery. The median overall SRI improved (44, 12, 11%) with a statistically significant median reduction of 69% (95% confidence interval 50-89%) 3 months postop. The median sub-SRIs improved for glare (50, 17, 17%), near sight problems (50, 17, 8%), and mobility of floaters (43, 5, 0%). Sixteen eyes needed cataract surgery during follow-up (10 showed cataract already prior to vitrectomy). Eight complications were reported (6 intra-operative retinal holes, 2 post-operative retinal detachments). For the majority of floater patients, subjective impairment was profoundly reduced by vitrectomy. Benefits of surgery prevailed despite complications.

Small-Gauge Pars Plana Vitrectomy for the Management of Symptomatic Posterior Vitreous Detachment after Phacoemulsification and Multifocal Intraocular Lens Implantation: A Pilot Study from the Pan-American Collaborative Retina Study Group

PubMed Central

Navarro, Rodrigo M.; Machado, Leonardo M.; Maia, Ossires; Wu, Lihteh; Farah, Michel E.; Magalhaes, Octaviano; Arevalo, J. Fernando; Maia, Mauricio

2015-01-01

Purpose. To determine the efficacy of 23-gauge pars plana vitrectomy (PPV) for symptomatic posterior vitreous detachment (PVD) on visual acuity (VA) and quality after multifocal intraocular lenses (IOLs). Methods. In this prospective case series, patients who developed symptomatic PVD and were not satisfied with visual quality due to floaters and halos after multifocal IOL implantation underwent PPV. Examinations included LogMAR uncorrected visual acuity (UCVA), intraocular pressure, biomicroscopy, and indirect ophthalmoscopy at baseline and 1, 7, 30, and 180 days postoperatively. Ultrasonography and aberrometry were performed. The Visual Functioning Questionnaire 25 (VFQ-25) was administered preoperatively and at 30 days postoperatively. Both the postoperative UCVA and questionnaire results were compared to preoperative findings using the Wilcoxon test. Results. Sixteen eyes of 8 patients were included. VA significantly improved from 0.17 to 0.09 postoperatively (P = 0.017). All patients reported improvement of halos, glare, and floaters. VFQ-25 scores significantly improved in general vision (P = 0.023), near activities (P = 0.043), distance activities (P = 0.041), mental health (P = 0.011), role difficulties (P = 0.042), and driving (P = 0.016). Conclusion. PPV may increase UCVA and quality of vision in patients with bilateral multifocal IOLs and symptomatic PVD. Larger studies are advised. PMID:26504590

Analysis of cytoskeletal proteins in posterior capsule opacification after implantation of acrylic and hydrogel intraocular lenses.

PubMed

Matsushima, Hiroyuki; Mukai, Kouichiro; Obara, Yoshitaka; Yoshida, Shinichiro; Clark, John I

2004-01-01

To analyze selected lens cytoskeletal proteins in posterior capsule opacification (PCO) 2 weeks after intraocular lens (IOL) implantation in rabbits. Department of Ophthalmology, Dokkyo University School of Medicine, Tochigi, Japan. Eight 10-week-old albino rabbits were prepared and anesthetized for phacoemulsification and aspiration of the crystalline lens and implantation of an acrylic or a hydrogel IOL. Two weeks postoperatively, the rabbits were killed and the IOLs removed for immunohistochemistry. Deparaffinized tissue sections were processed with antibodies against alpha-smooth muscle actin (alpha-SMA) and beta-crystallin to observe the types of PCO with the 2 IOL types. The proteins in the PCO tissue and the normal lens were homogenized, centrifuged, and analyzed using SDS-polyacrylamide gel electrophoresis (SDS-PAGE) densitometric analysis and Western immunoblotting for actin and vimentin. Immunohistochemistry demonstrated a fibroblastic cell type expressing alpha-SMA and partial regeneration of epithelial cells, resulting in a lenticular structure that stained irregularly for beta-crystallin. The immunoreactivity of fibroblast-like cells to beta-crystallin appeared weaker than that of the regenerated lenticular structure. SDS-PAGE showed variability in the content of cytoskeletal proteins in the insoluble fractions of the PCO. Degradation of the cytoskeletal components was greater with the acrylic IOL than with the hydrogel IOL. Cytoskeletal proteins expressed during the formation of PCO and IOL implantation may have potential as therapeutic target proteins to improve the biocompatibility of IOLs.

The efficacy of Ahmed glaucoma valve drainage devices in cases of adult refractory glaucoma in Indian eyes

PubMed Central

Parihar, Jitendra K S; Vats, Devendra P; Maggon, Rakesh; Mathur, Vijay; Singh, Anirudh; Mishra, Sanjay K

2009-01-01

Aim: To evaluate the efficacy of Ahmed glaucoma valve (AGV) drainage devices in cases of adult refractory glaucoma in Indian eyes. Settings and Design: Retrospective interventional case series study. Materials and Methods: Fifty two eyes of 32 patients of refractory glaucoma in the age group of 35 to 60 years who underwent AGV implantation with or without concomitant procedures from January 2003 to Jan 2007 were studied. Of these, 46 eyes (88%) had undergone filtering surgery earlier whereas remaining eyes underwent primary AGV implantation following failure of maximal medical therapy. The follow up ranged between 12 months to 48 months Results: Eighteen eyes (35%) had undergone phacoemulsification with AGV implantation, penetrating keratoplasty (PK) with AGV and intraocular lens (IOL) implantation in 13 eyes (25%), AGV over preexisting IOL in eight eyes (15%). AGV implantation alone was done in six (11%) eyes. Anterior chamber (AC) reconstruction with secondary IOL and AGV was performed in the remaining eyes. The mean intra ocular pressure (IOP) decreased from 36.3 ± 15.7 mm Hg to 19.6 ± 9.2 mm Hg. Complete success as per criteria was achieved in 46 eyes (88%). None of the eyes had failure to maintain IOP control following AGV. Conclusion: The AGV resulted in effective and sustained control of IOP in cases of adult refractory glaucoma in intermediate follow up. PMID:19700871

Pupil Influence on the Visual Outcomes of a New-Generation Multifocal Toric Intraocular Lens With a Surface-Embedded Near Segment.

PubMed

Wang, Mengmeng; Corpuz, Christine Carole C; Huseynova, Tukezban; Tomita, Minoru

2016-02-01

To evaluate the influences of preoperative pupil parameters on the visual outcomes of a new-generation multifocal toric intraocular lens (IOL) model with a surface-embedded near segment. In this prospective study, patients with cataract had phacoemulsification and implantation of Lentis Mplus toric LU-313 30TY IOLs (Oculentis GmbH, Berlin, Germany). The visual and optical outcomes were measured and compared preoperatively and postoperatively. The correlations between preoperative pupil parameters (diameter and decentration) and 3-month postoperative visual outcomes were evaluated using the Spearman's rank-order correlation coefficient (Rs) for the nonparametric data. A total of 27 eyes (16 patients) were enrolled into the current study. Statistically significant improvements in visual and refractive performances were found after the implantation of Lentis Mplus toric LU-313 30TY IOLs (P < .05). Statistically significant correlations were present between preoperative pupil diameters and postoperative visual acuities (Rs > 0; P < .05). Patients with a larger pupil always have better postoperative visual acuities. Meanwhile, there was no statistically significant correlation between pupil decentration and visual acuities (P > .05). Lentis Mplus toric LU-313 30TY IOLs provided excellent visual and optical performances during the 3-month follow-up. The preoperative pupil size is an important parameter when this toric multifocal IOL model is contemplated for surgery. Copyright 2016, SLACK Incorporated.

Inhibition of surgically induced miosis and prevention of postoperative macular edema with nepafenac

PubMed Central

Cervantes-Coste, Guadalupe; Sánchez-Castro, Yuriana G; Orozco-Carroll, Mónica; Mendoza-Schuster, Erick; Velasco-Barona, Cecilio

2009-01-01

Objective: To evaluate the effectiveness of prophylactic administration of nepafenac 0.1% in maintaining mydriasis and in preventing postoperative macular edema following cataract surgery. Methods: This was a prospective, randomized, single-masked comparative study in 60 patients undergoing phacoemulsification cataract surgery. Patients were randomized to either the nepafenac or the control group. Nepafenac was administered 3 times daily 1 day before surgery and continued for 6 weeks. The control group received tobramycin-dexamethasone treatment only. Trans-operative mydriasis was measured before surgery, after nuclear emulsification, following cortex aspiration, and at the conclusion of surgery. Macular optical coherence tomography determined central foveal thickness (FT) and total macular volume (TMV) before surgery and at 2 and 6 weeks after surgery. All patients received tobramycin-dexamethasone for 2 weeks after surgery. Results: The difference in mean pupil size, at the end of surgery, between the control group (6.84 ± 0.93 mm) and the nepafenac group (7.91 ± 0.74 mm) was statistically significant (p < 0.001). There were no significant differences in FT values between the two groups at any time point; however, TMV at 2 and at 6 weeks was statistically significantly different (p < 0.001), with higher TMV in the control group. Conclusion: Prophylactic use of nepafenac was effective in reducing macular edema after cataract surgery and in maintaining trans-operative mydriasis. PMID:19668569

Eye healthcare services in eastern Europe: Part 1 Cataract surgery

PubMed Central

Kocur, I; Resnikoff, S; Foster, A

2002-01-01

Aim: To describe cataract surgical services in 1998 in 12 eastern European countries and to identify their needs to reduce cataract blindness. Methods: All inpatient eye departments in the 12 countries received a standardised questionnaire; the data obtained were further processed at the coordinating centre in Prague. Results: All 458 eye departments in the region were involved. The response rate was 100%, except for Bulgaria (93%) and Romania (93%). The total number of cataract surgeries per one million inhabitants in 1998 was calculated: Belarus (800), Federation of Bosnia and Herzegovina (1275), Bulgaria (1730), the Czech Republic (4210), Estonia (2530), Hungary (3530), Latvia (1860), Lithuania (1550), Trans-Dniester Moldova (1300), Poland (1475), Romania (1260), and Slovakia (2430). Cataracts were mostly operated on by the extracapsular technique. Intracapsular extractions were frequently performed in Federation of Bosnia and Herzegovina (47%), Belarus (46%), Bulgaria (18%), and Romania (14.3%). Phacoemulsification was uncommonly used in 1998, except for the Czech Republic (86%), Estonia (50%), Slovakia (38%), and Hungary (16%). An IOL was implanted in more than 90% of patients in the Czech Republic, Estonia, Hungary, Latvia, Lithuania, and Slovakia. Conclusions: Conditions for cataract surgery in the eastern European region differ. The main barriers to cataract surgery were state budget limitations, insufficient supply of consumables, underutilisation of operating theatres, and poor detection of patients requiring surgery. PMID:12140200

[Influence AquaLase at corneal endothelial cells].

PubMed

Jirásková, N; Rozsíval, P; Ludvíková, M; Burova, M; Nekolová, J

2009-07-01

To assess the effect of the cleaning of the posterior capsule using pulses of balanced salt solution (BSS) on the corneal endothelial cells. This pilot study involves 43 patients with bilateral cataracts having lens removal using torsional phacoemulsification (Ozil, Infiniti, Alcon) and bimanul irrigation/aspiration (I/A). Posterior capsule of the right eye of each patient was cleaned using pulses of BSS (AquaLase, Infiniti, Alcon). Surgery was performed by one of 2 surgeons (NJ, PR), both eyes of each patient was operated on by the same surgeon. Best corrected visual acuity (BCVA), endotelial cell count and pachymetry were evaluated pre- and postoperatively as well as occurence af peri- and postoperative complications. Preoperative mean pachymetry (P) was 566 +/- 45 microm in the right eye (RE) and 562 +/- 42 microm in the left eye (LE), mean endotelial cell count (ECC) 2541 +/- 317 cells/mm2 (RE) and 2567 +/- 311 cells/mm2 (LE). Three months after surgery P was 557 +/- 43 microm (RE) and 558 +/- 45 microm (LE) and ECC 2368 +/- 416 cells/mm2 (RE) and 2396 +/- 417 cells/mm2 (LE). There was no statistical difference in postoperative changes of both corneal parameters between right and left eyes. Best corrected visual acuity improved in all eyes and no peri-or postoperative complications occured. Cleaning of the posterior capsule using AquaLase is safe for corneal endothelial cells.

Long-Term Observation of Triplex Surgery for Cataract after Phakic 6H Implantation for Super High Myopia

PubMed Central

Liu, Xin; Wang, Xiaoying; Lu, Yi; Zheng, Tianyu; Zhou, Xingtao

2016-01-01

Purpose. To analyze the safety, effectiveness, and stability of triplex surgery for phakic 6H anterior chamber phakic intraocular lens explantation and phacoemulsification with in-the-bag IOL implantation for super high myopia in long-term observations. Methods. This retrospective case series evaluated 16 eyes of 10 patients who underwent triplex surgery. Best corrected visual acuity (BCVA), endothelial cell density (ECD), and associated adverse events were evaluated. Results. The mean follow-up time after the triplex surgery was 46 ± 14 months. The mean logMAR BCVA was significantly improved after triplex surgery (P = 0.047). One eye developed endophthalmitis five days postoperatively and underwent pars plana vitrectomy (PPV). Five eyes with preoperative severe endothelial cell loss developed corneal decompensation and underwent keratoplasty at a mean time of 9.4 ± 2.6 months after the triplex surgery. One eye had graft failure and underwent a second keratoplasty. The eye developed rhegmatogenous retinal detachment and underwent PPV with silicone oil 18 months later. ECD before the triplex surgery was not significantly different compared with that at last follow-up (P = 0.495) apart from these five eyes. Three eyes (18.8%) developed posterior capsule opacification. Conclusions. Triplex surgery was safe and effective for phakic 6H related complicated cataracts. Early extraction before severe ECD loss is recommended. PMID:27190642

Topical 0.1% Bromfenac Sodium for Intraoperative Miosis Prevention and Prostaglandin E2 Inhibition in Femtosecond Laser-Assisted Cataract Surgery.

PubMed

Chen, Hui; Lin, Haotian; Chen, Wan; Zhang, Bo; Xiang, Wu; Li, Jing; Chen, Weirong

2017-04-01

The purpose of this study was to evaluate the effect of topical 0.1% bromfenac sodium, a nonsteroidal anti-inflammatory drug (NSAID), on intraoperative pupil dilation maintenance and prostaglandin E 2 (PGE 2 ) inhibition during femtosecond laser-assisted cataract surgery. Sixty patients (30 each in study and control groups) were included in this study. The patients received 0.1% bromfenac ophthalmic solution or control placebo twice a day for 3 days before surgery. Pupil size was measured at the initiation of femtosecond laser pretreatment and phacoemulsification. Aqueous humor was collected at the beginning of routine cataract surgery. PGE 2 levels were measured with an enzyme-linked immunoassay. Laser flare photometry was measured preoperatively and at 1 day postoperatively. Compared with untreated patients, the change in pupil size and postoperative day 1 aqueous flare were significantly reduced throughout the operation in the patients treated with 0.1% bromfenac (P < 0.001). Mean PGE 2 concentrations were also significantly decreased by treatment with 0.1% bromfenac (P < 0.001). The reduction of the pupil area and postoperative day 1 aqueous flare were significantly correlated with PGE 2 levels (P < 0.001). NSAID treatment, when administered before femtosecond laser-assisted cataract surgery, was effective in maintaining intraoperative pupil dilation, preventing miosis, and reducing PGE 2 levels.

Effect of four different intraocular lenses on posterior capsule opacification

PubMed Central

Duman, Rahmi; Karel, Fatih; Özyol, Pelin; Ateş, Can

2015-01-01

AIM To evaluate the impact of 4 different intraocular lenses (IOLs) on posterior capsule opacification (PCO) by comparing the neodymium: yttrium-aluminum-garnet (Nd:YAG) laser capsulotomy rates. METHODS This retrospective study included 4970 eyes of 4013 cataract patients who underwent phacoemulsification and IOL implantation between January 2000 and January 2008 by the same surgeon at one clinic. Four different IOLs were assessed. The outcome parameter was the incidence of Nd:YAG laser posterior capsulotomies. RESULTS An Nd:YAG laser posterior capsulotomy was performed in 153 (3.07%) of the 4970 eyes. The mean follow-up time was 84mo for all of the IOL groups. The percentage of eyes developing PCO was significantly greater for the acrylic hydrophilic IOLs than for the hydrophobic IOLs, although eyes with acrylic hydrophilic IOLs did not require Nd:YAG laser capsulotomy as soon as eyes with acrylic hydrophobic IOLs. There was no difference between the long-term PCO rates when 1- and 3-piece acrylic hydrophobic IOLs were compared or when IOLs made of the same material but with different haptic angles were compared. CONCLUSION In this study, eyes with acrylic hydrophilic IOLs were more likely to develop PCO than those with acrylic hydrophobic IOLs. The lens design (1-piece versus 3-piece and varying haptic angles) did not affect the PCO rate. PMID:25709920

Ultrasound biomicroscopy after canaloplasty: clinical study with two different units.

PubMed

Doro, Daniele; Koerber, Norbert; Paolucci, Pierpaolo; Cimatti, Pierangela

2012-12-01

Canaloplasty is a recent non penetrating glaucoma surgical procedure where Schlemm's canal is dilated and trabecular meshwork distended by tensioning polypropylene suture. The aim of this study was to visualize the iridocorneal angle after the canaloplasty procedure by means of two different ultrasound biomicroscopy (UBM) units. Ten eyes of nine patients with primary open angle glaucoma (average age 62 years) underwent canaloplasty (six eyes) or canaloplasty combined with phacoemulsification and in-the-bag intraocular lens implantation (4 eyes). Both 50 MHz (Paradigm P45) and 80 MHz (i-UltraSound) systems were used. All procedures were performed by the same surgeon. UBM examination was performed 3 to 12 (mean 7 +/- 3.1) months after surgery. No, mild and good trabecular meshwork distension by suture tensioning was graded as 0, 1 and 2 according to the higher resolution 80 MHz images. Both ultrasound systems could show intrascleral lake and trabecular meshwork distension, which was graded as 0, 1 and 2 in 10%, 30% and 60% of eyes, respectively. Schlemm's canal could be imaged with the 80 MHz transducer only. The overall qualified success of canaloplasty (80%) was apparently correlated with suture tensioning (r=0.64). In our experience, after canaloplasty the 80 MHz but also 50 MHz technology can show trabecular meshwork distension. A greater number of eyes are needed to assess the correlation between intraocular pressure decrease and suture tensioning.

Toxic Anterior Segment Syndrome Outbreak after Cataract Surgery Triggered by Viscoelastic Substance.

PubMed

Altıntaş, AyşeGül Koçak; Ciritoğlu, Meryem Yaşar; BeyazyıldıZ, Özlem; Can, Çiğdem Ülkü; Polat, Sibel

2017-01-01

The purpose of this study is to present toxic anterior segment syndrome (TASS) outbreak at our clinic and discuss possible causes of TASS. Thirty-four eyes of 34 patients developed TASS in a consecutive 2 weeks period were included in this study. Both anterior segment and fundus examinations were performed before and after uncomplicated cataract surgery. During the follow-up period, clinical features and all possible causes were evaluated including perioperative products and processing such as sterilization technique of surgical instruments, irrigating solutions, drugs, viscoelastic substance (VES), and intraocular lens. Patients had corneal edema, anterior chamber reactions, and decreased vision. No patient had purulent secretion, chemosis, lid involvement, and pain. At first 2 postoperative days, patients treated as infectious endophthalmitis by topical and oral antibiotics and then TASS was suspected, and patients treated completely with topical steroids. Suspected cause for TASS was VES substance, 2% sodium hyaluronate which had newly been used as VES product in phacoemulsification surgery. No new case has occurred after stopped usage of this VES product. As far as we know, this is the largest report of TASS outbreak in the shortest period from the same clinic caused by VES. Suboptimal products of surgical materials can be the cause of TASS. Close monitoring of each surgical step and elimination of causative agent can prevent the outbreaks of TASS.

Corneal indentation in the early management of acute angle closure.

PubMed

Masselos, Katherine; Bank, Allan; Francis, Ian C; Stapleton, Fiona

2009-01-01

To describe in detail corneal indentation (CI) in the management of a series of patients treated for acute angle closure (AAC). Retrospective, consecutive, noncomparative case series. Seven consecutive patients (8 eyes) referred to the authors with the diagnosis of AAC. Patients presented to the Prince of Wales Hospital, Randwick, or to the private practices of the authors. Seven patients (8 eyes) underwent CI as part of their early management for AAC. Reduction in intraocular pressure (IOP), symptoms of AAC and pain relief. Of the 7 patients, complete data were available for 6. The IOP was significantly reduced (P<0.05) and 3 of 4 patients with severe acute pain reported early resolution of pain after CI. The average reduction in IOP was 20.9 mmHg (range +1 to -45). All patients subsequently underwent definitive management with laser peripheral iridotomies or lensectomy using phacoemulsification. Three patients treated acutely with CI without any medical agents had a mean IOP reduction of 21 mmHg (range, 20-23) after indentation. Corneal indentation is a rapid, portable, and effective method of reducing elevated IOP in the setting of AAC. It can be performed with instrumentation that is readily at hand and allows for rapid pain relief. This reduction in IOP improves corneal clarity and permits further definitive management of the patient with AAC. The authors have no proprietary or commercial interest in any materials discussed in this article.

Choroidal neovascularization in highly myopic eyes after cataract surgery.

PubMed

Hayashi, Kengo; Ohno-Matsui, Kyoko; Futagami, Soh; Ohno, Seiji; Tokoro, Takashi; Mochizuki, Manabu

2006-01-01

To determine the incidence and characteristics of choroidal neovascularization (CNV) in patients with high myopia (>or=8 diopters) who underwent cataract surgery in the Department of Ophthalmology, Tokyo Medical and Dental University, or the Ohno Eye Clinic, Tokyo, between September 1991 and March 2000. The medical records of 35 patients (48 eyes) who underwent cataract surgery with phacoemulsification and intraocular lens implantation were studied retrospectively. The development of CNV over a 4-year follow-up period, and its characteristics were determined. All of the eyes had received a comprehensive ophthalmological examination, including best-corrected visual acuity measurements, anterior segment biomicroscopy, and a dilated fundus examination by stereoscopic observation. CNV was found in six eyes (12.5%) of six patients. The mean interval between cataract surgery and the development of CNV was 34+/-17 months (range, 12-48 months). The CNV was subfoveal in all cases. The mean logarithm of the minimum angle of resolution (logMAR) after cataract surgery and before the appearance of CNV was 0.23+/-0.24, and 0.93+/-0.41 after the CNV appeared. This decrease was statistically significant (P=0.0008, paired Student t test). Subfoveal CNV developed more frequently in eyes when the fellow eye showed evidence of CNV preoperatively (40.0%) than in eyes when the fellow eye exhibited no evidence of CNV (9.3%). CNV developed in 12.5% of patients with high myopia after cataract surgery. CNV tended to develop more frequently when the fellow eye had CNV. Copyright (c) Japanese Ophthalmological Society 2006.

Cataracts induced by neodymium-yttrium-aluminium-garnet laser lysis of vitreous floaters.

PubMed

Koo, Ellen H; Haddock, Luis J; Bhardwaj, Namita; Fortun, Jorge A

2017-06-01

Neodymium-yttrium-aluminium-garnet (Nd:YAG) laser vitreolysis has been proposed as a treatment modality for symptomatic vitreous floaters. The purpose of this paper is to report two cases of cataracts associated with posterior capsular compromise, induced by Nd:YAG laser vitreolysis for symptomatic vitreous floaters. Case series. Two patients who underwent ND:YAG laser vitreolysis for symptomatic floaters, presented with decline in visual acuity in the treated eye after the laser procedure. At the slit-lamp biomicroscope, each patient was found to have a posterior subcapsular cataract in the treated eye, with obvious loss of integrity of the posterior capsule. These two patients underwent cataract extraction by the same surgeon via phacoemulsification. Both eyes were found to have a defect in the posterior capsule intraoperatively. In both cases, a three-piece acrylic intraocular lens implant was placed in the sulcus, achieving optic capture. The best-corrected visual acuity (BCVA) was 20/20 in both patients, at 1 month following the surgery. At 2 months, one patient had a BCVA of 20/15. The second patient maintained a BCVA of 20/20 at 3 months. Secondary cataract formation accompanied by loss of integrity of the posterior capsule is a potential complication of Nd:YAG laser vitreolysis for symptomatic floaters. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Spring-action Apparatus for Fixation of Eyeball (SAFE): a novel, cost-effective yet simple device for ophthalmic wet-lab training.

PubMed

Ramakrishnan, Seema; Baskaran, Prabu; Fazal, Romana; Sulaiman, Syed Mohammad; Krishnan, Tiruvengada; Venkatesh, Rengaraj

2016-10-01

Achieving a formed and firm eyeball which is stably fixed in a holding device is a major challenge of surgical wet-lab training. Our innovation, the 'Spring-action Apparatus for Fixation of Eyeball (SAFE)' is a robust, simple and economical device to solve this problem. It consists of a hollow iron cylinder to which a spring-action syringe is attached. The spring-action syringe generates vacuum and enables reliable fixation of a human or animal cadaveric eye on the iron cylinder. The rise in intraocular pressure due to vacuum fixation can be varied as per need or nature of surgery being practised. A mask-fixed version of this device is also designed to train surgeons for appropriate hand positioning. An experienced surgeon performed various surgeries including manual small incision cataract surgery (MSICS), phacoemulsification, laser in situ keratomileusis (LASIK), femtosecond LASIK docking, Descemet's stripping endothelial keratoplasty, deep anterior lamellar keratoplasty, penetrating keratoplasty and trabeculectomy on this device, while a trainee surgeon practised MSICS and wound suturing. Skill-appropriate comfort level was much higher with SAFE than with conventional globe holders for both surgeons. Due to its stability, pressure adjustability, portability, cost-efficiency and simplicity, we recommend SAFE as the basic equipment for every wet lab. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

The journey to femtosecond laser-assisted cataract surgery: new beginnings or a false dawn?

PubMed Central

Trikha, S; Turnbull, A M J; Morris, R J; Anderson, D F; Hossain, P

2013-01-01

Femtosecond laser-assisted cataract surgery (FLACS) represents a potential paradigm shift in cataract surgery, but it is not without controversy. Advocates of the technology herald FLACS as a revolution that promises superior outcomes and an improved safety profile for patients. Conversely, detractors point to the large financial costs involved and claim that similar results are achievable with conventional small-incision phacoemulsification. This review provides a balanced and comprehensive account of the development of FLACS since its inception. It explains the physiology and mechanics underlying the technology, and critically reviews the outcomes and implications of initial studies. The benefits and limitations of using femtosecond laser accuracy to create corneal incisions, anterior capsulotomy, and lens fragmentation are explored, with reference to the main platforms, which currently offer FLACS. Economic considerations are discussed, in addition to the practicalities associated with the implementation of FLACS in a healthcare setting. The influence on surgical training and skills is considered and possible future applications of the technology introduced. While in its infancy, FLACS sets out the exciting possibility of a new level of precision in cataract surgery. However, further work in the form of large scale, phase 3 randomised controlled trials are required to demonstrate whether its theoretical benefits are significant in practice and worthy of the necessary huge financial investment and system overhaul. Whether it gains widespread acceptance is likely to be influenced by a complex interplay of scientific and socio-economic factors in years to come. PMID:23370418

Evaluation of biometry and corneal astigmatism in cataract surgery patients from Central China.

PubMed

Yu, Ji-Guo; Zhong, Jie; Mei, Zhong-Ming; Zhao, Fang; Tao, Na; Xiang, Yi

2017-04-26

To evaluate the distribution of biometric parameters and corneal astigmatism using the IOLMaster device before phacoemulsification in cataract patients in Central China. Consecutive cataract patients were recruited at the Central Hospital of Wuhan between January 2015 and June 2016. Ocular axial length (AL), keratometry values, anterior chamber depth (ACD) and horizontal corneal diameter (white to white [WTW]) of each cataract-affected eye were measured with the IOLMaster device. The study evaluated 3209 eyes of 2821 cataract patients. The mean AL, ACD, and WTW were 24.38 ± 2.47 mm, 3.15 ± 0.48 mm, and 11.63 ± 0.43 mm, respectively. Corneal astigmatism of 0.51-1.00 diopters (D) was the most common range of values (34.96%). A total of 10.56% patients exhibited a corneal astigmatism greater than 2.0 D. The flat and steep keratometry values gradually increased with age. The mean ACD and WTW showed increasing trends as the AL increased (P < 0.001). When the AL was shorter than 26.0 mm, the keratometry decreased as AL increased. The against-the-rule (ATR) astigmatism proportion increased with age and the with-the-rule (WTR) astigmatism proportion decreased with age. The profile of ocular biometric data and corneal astigmatism may help ophthalmologists improve their surgical procedures and make an appropriate IOL choice to gain a high quality of postoperative vision.

[Analysis of cataract surgical rate and its influencing factors in Shanghai, China].

PubMed

Zhu, Ming-ming; Zhu, Jian-feng; Zou, Hai-dong; He, Xian-gui; Zhao, Rong; Lu, Li-na

2013-12-17

To explore the cataract surgical rate (CSR) of Shanghai from 2006 to 2012 and examine its influencing factors. As of 2003, a cataract surgery registration form had been filled by physicians after every cataract surgery in Shanghai. The local eye disease prevention team then entered the relevant information into the Shanghai Cataract Operations Database. Based upon this database, CSR of Shanghai was calculated. And the number of cataract surgeries was compared between Shanghai urban and suburban districts as well as among different medical institutions. The overall CSR in Shanghai increased from 1741 in 2006 to 2313 in 2012. In 2012, CSR in urban districts reached 6013 while it stood at 460 and 584 in inner and outer suburb districts respectively. The number of hospitals performing cataract surgery in urban districts was much more than that in suburbs. And the average number of cataract surgeries per hospital per year in suburbs was only one third of that (748 cases) in urban areas. The number of cataract surgeries at in private hospitals increased rapidly during the past 7 years. The number of 1921 cases was nearly twice as many as that at tertiary hospitals in 2012. Phacoemulsification surgery was the most popular surgical choice for cataract removal, accounting for 98.40% of total cataract surgeries in 2012. Until 2012, CSR in Shanghai dropped below the target of World Health Organization (WHO). A low level of CSR in suburbs is a major influencing factor for the overall level of CSR in Shanghai.

Introduction of Lens-angle Reconstruction Surgery in Rabbit Eyes

PubMed Central

Kim, Min Hee; Hwang, Ho Sik; Park, Kyoung Jin; Hwang, Je Hyung

2014-01-01

Purpose In this study, we examined the stability of the lens-angle supporter (LAS) for accommodation restoration by comparing intraocular lens (IOL) location, after-cataract and ciliary body damage after cataract surgery in rabbits. Methods Eight rabbits were divided into experimental and control groups of four rabbits each. Phacoemulsification and irrigation and aspiration were performed in all rabbits. This was followed by an LAS and IOL insertion in the four experimental rabbits. In the four control rabbits, only an IOL insertion was performed. Six months after the surgery, the location of the IOL, the conditions of the lens capsule and ciliary body were evaluated using a slitl-amp examination and Miyake-Apple view. Results For the experimental group, the ultrasound biomicroscope results showed normal LAS and IOL positioning in all four cases. According to the slitlamp examination and Miyake-Apple view, the IOL was positioned at the center, with less after-cataract and damage to the ciliary body. For the control group, ultrasound biomicroscope results indicated a higher IOL position than normal, as well as a single case of IOL decentering. According to the slit-lamp examination and Miyake-Apple view, the IOL was decentered with more severe after-cataract and ciliary body damage. Conclusions The LAS has the potential to maintain a stable IOL position while producing less after-cataract when used in lens-angle reconstruction for correction of presbyopia. Moreover, LAS implantation incurs less damage to the ciliary body. PMID:25435752

Intraocular and systemic levels of vascular endothelial growth factor in advanced cases of retinopathy of prematurity

PubMed Central

Velez-Montoya, Raul; Clapp, Carmen; Rivera, Jose Carlos; Garcia-Aguirre, Gerardo; Morales-Cantón, Virgilio; Fromow-Guerra, Jans; Guerrero-Naranjo, Jose Luis; Quiroz-Mercado, Hugo

2010-01-01

Purpose: To measure vitreous, aqueous, subretinal fluid and plasma levels of vascular endothelial growth factor in late stages of retinopathy of prematurity. Methods: Interventional study. We enrolled patients with clinical diagnoses of bilateral stage V retinopathy of prematurity, confirmed by b-scan ultrasound and programmed for vitrectomy. During surgery we took samples from blood, aqueous, vitreous, and subretinal fluids. The vascular endothelial growth factor concentration in each sample was measured by ELISA reaction. A control sample of aqueous, vitreous and blood was taken from patients with congenital cataract programmed for phacoemulsification. For statistical analysis, a Mann–Whitney and a Wilcoxon W test was done with a significant P value of 0.05. Results: We took samples of 16 consecutive patients who met the inclusion criteria. The vascular endothelial growth factor levels in the study group were: aqueous, 76.81 ± 61.89 pg/mL; vitreous, 118.53 ± 65.87 pg/mL; subretinal fluid, 1636.58 ± 356.47 pg/mL; and plasma, 74.64 ± 43.94 pg/mL. There was a statistical difference between the study and the control group (P < 0.001) in the aqueous and vitreous samples. Conclusion: Stage 5 retinopathy of prematurity has elevated intraocular levels of vascular endothelial growth factor, which remains high despite severe retinal lesion. There was no statistical difference in plasma levels of the molecule between the control and study group. PMID:20856587

[Early macular edema after phacoemulsification and suspected overdose of cefuroxime: report of six cases].

PubMed

Le Dû, B; Pierre-Kahn, V

2014-03-01

Antibiotic prophylaxis by intracameral cefuroxime injection, 1mg/0.1 mL after cataract surgery is increasing in popularity. Several cases of early postoperative macular edema have recently been reported after cefuroxime injection, most of them due to accidental cefuroxime overdose. We report six additional cases of macular involvement after cataract surgery, with intracameral cefuroxime injection imputed to cause retinal toxicity. Formal proof of cefuroxime overdose has never been possible, due to rapid wash-out in a few hours and the diagnosis of the macular edema the day after surgery or within a few days. Thus, this strong suspicion is based on clinical, pharmacokinetic, tomographic and retinographic criteria. In our series of six cases, the first four patients involved the same surgeon in the same hospital, and two of them on the same day. For the sixth case, the diagnosis was made retrospectively and based on history and medium-term tomographic characteristics. All the patients underwent optical coherence tomography (OCT) relatively early. As early as day one after surgery, there is macular edema predominantly in the outer retinal layers associated with serous retinal detachment, similar to the cases described in the literature. In the late stage, three patients had functional impairment related to photoreceptor damage on OCT. Three cases are described with additional retinal imaging (angiography, autofluorescence) to better characterize this macular toxicity associated with cefuroxime. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Changes in corneal shape after suture cutting using the argon laser for postoperative astigmatism following cataract extraction.

PubMed

Hayashi, K; Nakao, F; Hayashi, F

1993-03-01

We studied the changes in corneal shape after suture cutting with an argon laser to reduce corneal astigmatism following cataract extraction. Sixty-two patients who exhibited high with-the-rule astigmatism (> 3 diopters [D]) following extracapsular lens extraction had argon laser suture cutting. The patients were classified into three groups: Group A comprised 30 patients whose sutures were cut two to three months after planned extracapsular cataract extraction (p-ECCE); Group B consisted of eight patients who had the same treatment five to nine months after p-ECCE; Group C comprised 24 patients who had the treatment one to two months after phacoemulsification (PE). The dioptric reduction of corneal astigmatism (the percent reduction of astigmatism) was 1.83 +/- 0.98 D (37.4 +/- 18.3%) in Group A, 3.20 +/- 2.35 D (55.6 +/- 34.4%) in Group B, and 2.08 +/- 1.20 D (41.4 +/- 20.4%) in Group C. There was no statistical significance in the dioptric reduction and the percent reduction among Groups A, B, and C. This suggests that the wound size and time of cutting are not directly correlated to the effect of argon laser suture cutting. To examine the relationship between the effect and changes in corneal shape from suture cutting, we divided the patients into two subgroups; one was Subgroup (+) in which the percent reduction of astigmatism was above 25%; the other was Subgroup (-) in which the percent reduction was below 25%.(ABSTRACT TRUNCATED AT 250 WORDS)

Infectious crystalline keratopathy caused by Cladosporium sp. after penetrating keratoplasty: a case report

PubMed Central

Stock, Ricardo Alexandre; Bonamigo, Elcio Luiz; Cadore, Emeline; Oechsler, Rafael Allan

2016-01-01

Background Infectious crystalline keratopathy is a rare, progressive infection characterized by the insidious progression of branches and crystalline corneal opacities with minimal or no inflammation. This case report describes the evolution of an infectious crystalline keratopathy caused by Cladosporium sp., which developed after tectonic keratoplasty in a patient with a history of ocular trauma. Case presentation A 40-year-old Brazilian male was the victim of firework-induced trauma to the left eye, which resulted in a corneal laceration that could not be sutured as well as a severe traumatic cataract. The patient underwent penetrating keratoplasty and phacoemulsification. During postoperative follow-up, another therapeutic keratoplasty was required because unresponsive infectious keratitis was observed. The infiltrate’s characteristics were suggestive of infectious crystalline keratopathy; in particular, the infiltrate was insidious and progressive, and grayish-white branches appeared in the anterior corneal stroma. As different therapies were administered, inflammatory reactions ranging from mild to severe were observed. The infection was unresponsive to typical antifungal drugs. This lack of response most likely occurred due to steroid treatment and the diffuse corneal spread of an atypical microorganism, which was subsequently identified in culture as Cladosporium sp. After the second therapeutic keratoplasty, the patient’s eye integrity was successfully reestablished. Conclusion This study likely provides the first report describing a case of infectious crystalline keratopathy caused by Cladosporium sp. This case emphasizes the clinical characteristics and outcome of this type of keratitis. PMID:27621671

Corneal edema and permanent blue discoloration of a silicone intraocular lens by methylene blue.

PubMed

Stevens, Scott; Werner, Liliana; Mamalis, Nick

2007-01-01

To report a silicone intraocular lens (IOL) stained blue by inadvertent intraoperative use of methylene blue instead of trypan blue and the results of experimental staining of various lens materials with different concentrations of the same dye. A "blue dye" was used to enhance visualization during capsulorhexis in a patient undergoing phacoemulsification with implantation of a three-piece silicone lens. Postoperatively, the patient presented with corneal edema and a discolored IOL. Various IOL materials were experimentally stained using methylene blue. Sixteen lenses (4 silicone, 4 hydrophobic acrylic, 4 hydrophilic acrylic, and 4 polymethylmethacrylate) were immersed in 0.5 mL of methylene blue at concentrations of 1%, 0.1%, 0.01%, and 0.001%. These lenses were grossly and microscopically evaluated for discoloration 6 and 24 hours after immersion. The corneal edema resolved within 1 month after the initial surgical procedure. After explantation, gross and microscopic analyses of the explanted silicone lens revealed that its surface and internal substance had been permanently stained blue. In the experimental study, all of the lenses except the polymethylmethacrylate lenses were permanently stained by methylene blue. The hydrophilic acrylic lenses showed the most intense blue staining in all dye concentrations. This is the first clinicopathological report of IOL discoloration due to intraocular use of methylene blue. This and other tissue dyes may be commonly found among surgical supplies in the operating room and due diligence is necessary to avoid mistaking these dyes for those commonly used during ocular surgery.

The effects of Nd:YAG laser posterior capsulotomy on macular thickness, intraocular pressure, and visual acuity.

PubMed

Ari, Seyhmus; Cingü, Abdullah Kürsat; Sahin, Alparslan; Çinar, Yasin; Çaça, Ihsan

2012-01-01

To evaluate how different energy levels of Nd:YAG laser posterior capsulotomy affect best-corrected visual acuity (BCVA), intraocular pressure (IOP), and macular thickness of patients with posterior capsule opacification. Thirty eyes of 30 patients with posterior capsule opacification following phacoemulsification were enrolled in the study. Patients were classified according to total energy used during Nd:YAG laser capsulotomy (≤ 80 mJ = group I, > 80 mJ = group II). Mean total energy levels were 58 ± 18 mJ (range: 14 to 80 mJ) in group I and 117 ± 36 mJ (range: 84 to 200 mJ) in group II. BCVA at 1 week preoperatively and 1 and 3 months postoperatively was significantly better compared to preoperative BCVA in both groups (P < .001). In group I, IOP increased 1 week postoperatively (P = .007) and declined to preoperative levels at 1 month. In group II, IOP increased 1 week postoperatively (P = .001) and did not return to preoperative levels during 3 months of follow-up (P = .04). Both groups had increased macular thickness compared to preoperative levels, but group II measurements were significantly higher 1 week and 1 month postoperatively compared to group I (P = .004 and .03, respectively). Increased IOP and macular thickness are inevitable after Nd:YAG laser capsulotomy, but the severity and duration are less when a total energy level less than 80 mJ is used. Copyright 2012, SLACK Incorporated.

Results in Combined Cataract Surgery With Prosthetic Iris Implantation in Patients With Previous Iridocyclectomy for Iris Melanoma.

PubMed

Snyder, Michael E; Osher, Robert H; Wladecki, Trisha M; Perez, Mauricio A; Augsburger, James J; Corrêa, Zélia

2017-03-01

To present visual and functional results following implantation of iris prosthesis combined with cataract surgery in eyes with previous iridocyclectomy for iris melanoma or presumed iris melanoma. Retrospective noncomparative case series. Sixteen patients (16 eyes) with iris defects after iridocyclectomy for iris melanoma in 15 cases and iris adenoma in 1 case underwent prosthetic iris device implantation surgery. Prosthetic iris implantation was combined with phacoemulsification and intraocular lens (IOL) implantation. The visual acuity, subjective glare and photophobia reduction, anatomic outcome, and complications were reviewed. Best-corrected visual acuity was improved in 13 eyes (81.25%), remained stable in 2 eyes (12.25%), and decreased in 1 eye (6.25%). Photophobia and glare improved in every case except for 1 (93.75%). Notably, after surgery 12 patients (75.00%) reported no photophobia and 10 patients (62.50%) reported no glare. The median postoperative follow-up was 29.5 months, with a minimum of 5 months and a maximum of 189 months. All iris devices were in the correct position, and all eyes achieved the desired anatomic result. The IOL optic edges were covered in all areas by either residual iris or opaque portions of a prosthetic iris device. In patients who have undergone previous iridocyclectomy for presumed iris melanoma, combined cataract surgery and iris prosthesis placement, with or without iris reconstruction, can lead to visual improvement as well as reduction of both glare and photophobia. Copyright © 2016 Elsevier Inc. All rights reserved.

Effects of topical diquafosol pretreatment on intraoperative corneal wetting.

PubMed

Miyake, Goichiro; Ota, Ichiro; Miyake, Kensaku; Zako, Masahiro; Iwaki, Masayoshi

2014-10-01

To examine the effects of pretreatment with diquafosol 3.0% ophthalmic solution on corneal surface wetting during cataract surgery with intraocular lens (IOL) implantation in cases of senile cataract. Shohzankai Medical Foundation, Miyake Eye Hospital, Nagoya, Japan. Prospective randomized single-masked comparative study. Phacoemulsification and IOL implantation were performed in eyes with senile cataract. After a 2-week washout period, patients were randomly assigned to receive 1 drop of diquafosol 3.0% ophthalmic solution or artificial tears 6 times daily for 4 weeks before surgery. The main outcome measure, termed the corneal wetting property, was the time between when a clear image of the operating microscope light source appeared just after the corneal surface was irrigated with a balanced salt solution and the time at which that image began to blur. The study enrolled 51 patients (76 eyes). The mean time to corneal wetting was 50.1 seconds ± 10.8 (SD) in the diquafosol group and 45.3 ± 9.2 seconds in the artificial tears group. The difference between the 2 groups was statistically significant (P<.029). Four-week pretreatment with diquafosol 3.0% ophthalmic solution in patients with senile cataract scheduled for cataract surgery with IOL implantation was effective in enhancing the intraoperative corneal surface wetting property, which suggests improved optical clarity during surgery. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Aqueous Humor Penetration and Biological Activity of Moxifloxacin 0.5% Ophthalmic Solution Alone or with Dexamethasone 0.1.

PubMed

Gomes, Rachel L R; Viana, Rodrigo Galvão; Melo, Luiz Alberto S; Cruz, Alessandro Carvalho; Suenaga, Eunice Mayumi; Kenyon, Kenneth R; Campos, Mauro

2017-03-01

To compare aqueous humor concentrations of topically applied moxifloxacin 0.5% ophthalmic solution alone or in combination with dexamethasone 0.1% and to correlate these concentrations with the minimum inhibitory concentrations (MICs) for common endophthalmitis-causing organisms. Sixty-eight patients undergoing routine phacoemulsification with intraocular lens implantation received either moxifloxacin 0.5% alone or moxifloxacin 0.5% combined with dexamethasone. For both groups, 1 drop of the test solution was instilled 4 times daily 1 day preoperatively and 1 drop 1 h preoperatively. An aqueous humor sample obtained immediately before paracentesis was submitted to high-performance liquid chromatography-tandem mass spectrometry to determine the moxifloxacin concentration. The mean concentrations of moxifloxacin were 986.6 ng/mL in the moxifloxacin with dexamethasone group and 741.3 ng/mL in the moxifloxacin group (P = 0.13). Moxifloxacin concentrations of all samples exceeded the MICs for Staphylococcus epidermidis, S. aureus, and Streptococcus pneumoniae. All samples in the moxifloxacin with dexamethasone group and 94% in the moxifloxacin group achieved the MIC for Enterococcus species. For quinolone-resistant S. aureus, the MIC was achieved in 29% in the moxifloxacin with dexamethasone group and 9% in the moxifloxacin group (P = 0.06). Aqueous humor moxifloxacin concentrations were higher when topically administrated in combination with dexamethasone compared to the moxifloxacin alone. However, this difference was not statistically significant. Nevertheless, the MICs of the most common pathogens associated with endophthalmitis were exceeded in both study groups.

Ab interno trabeculectomy: ultrastructural evidence and early tissue response in a human eye.

PubMed

Ferrari, Ettore; Ortolani, Fulvia; Petrelli, Lucia; Contin, Magali; Pognuz, Derri Roman; Marchini, Maurizio; Bandello, Francesco

2007-10-01

To report the results of ultrastructural analysis of the postoperative effects of ab interno trabeculectomy in a human eye. Department of Ophthalmology, Palmanova Hospital, Palmanova, Udine, Italy. A 60-year-old woman with cataract and glaucoma had enucleation for a choroidal melanoma 10 days after ab interno trabeculectomy combined with phacoemulsification. A second ab interno trabeculectomy was performed after enucleation to evaluate the outcomes of the previous trabeculectomy. Light and transmission electron microscopy analyses were performed on samples excised from areas (1) not subjected to a procedure (control samples), (2) that had ab interno trabeculectomy before enucleation, and (3) that had ab interno trabeculectomy immediately after enucleation. Control samples showed normal trabecular features. Semithin sections of all ab interno trabeculectomy samples showed full-thickness removal of trabeculum segments, with Schlemm's canal lumen opening into the anterior chamber and apparent preservation of the adjacent structures. On ultrathin sections of samples that had ab interno trabeculectomy before enucleation, the endothelium lining the outer wall of Schlemm's canal and other angle components showed intact ultrastructural features. In trabecular beams that were not removed, the extracellular matrix appeared to have maintained its fine texture and was free of activated fibroblasts or leucocyte infiltrates. Observations confirm that ab interno trabeculectomy causes direct communication between Schlemm's canal lumen and the anterior chamber in vivo and immediately after enucleation during the early postoperative period. The absence of an evident inflammatory reaction in the examined case should be considered with caution because of possible tumor-induced immune suppression.

Effect of high pressurization versus normal pressurization on changes in intraocular pressure immediately after clear corneal cataract surgery.

PubMed

Hayashi, Ken; Yoshida, Motoaki; Manabe, Shin-Ichi; Yoshimura, Koichi

2014-01-01

To compare changes in intraocular pressure (IOP) immediately after clear corneal incision (CCI) cataract surgery between eyes in which IOP was adjusted to a high or normal range at the conclusion of surgery. Hayashi Eye Hospital, Fukuoka, Japan. Comparative case series. Either eye of patients scheduled for phacoemulsification was randomized to 1 of 2 groups as follows: eyes that were to be adjusted to (1) high IOP (22 to 40 mm Hg) or (2) normal IOP (10 to 21 mm Hg). The IOP was measured using a rebound tonometer preoperatively; at the conclusion of surgery; and 15, 30, 60, 120, and 180 minutes and 24 hours postoperatively. The Seidel test and anterior segment optical coherence tomography (AS-OCT) were performed. The mean IOP at the conclusion of surgery was 31.3 mm Hg in the high IOP group and 17.1 mm Hg in the normal IOP group. The IOP decreased to approximately 15 mm Hg by 15 minutes and did not change until 60 minutes in either group. The mean IOP did not differ significantly between groups throughout the observation period (P ≥.0634). Hypotony of 5 mm Hg or less was not detected in any eye. The Seidel test was negative and based on AS-OCT, the wound was closed at 60 minutes in all eyes. After adjusting IOP to a high or normal range, the IOP normalized within 15 minutes postoperatively and was stable for 24 hours. The wound was closed within 60 minutes postoperatively. Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Subjective Visual Performance and Objective Optical Quality With Intraocular Lens Glistening and Surface Light Scattering.

PubMed

Luo, Furong; Bao, Xuan; Qin, Yingyan; Hou, Min; Wu, Mingxing

2018-06-01

To evaluate the long-term effect of glistenings and surface light scattering of intraocular lenses (IOLs) on visual and optical performance after cataract surgery. Pseudophakic eyes that underwent standard phacoemulsification and two types of hydrophobic acrylic spherical IOL implantation without complications for at least 5 years were included in this retrospective study. Participants were divided into the glistenings, surface light scattering, and control groups according to the current condition of the IOLs. Then participants received a follow-up examination including uncorrected and corrected distance visual acuity (UDVA and CDVA), contrast sensitivity, straylight, and intraocular higher order aberrations, as well as point spread function (PSF) and modulation transfer function (MTF). A total of 140 eyes were included in the study. UDVA, CDVA, and glare sensitivity were not significantly different among the three groups (P > .05). However, compared with the control group, the IOLs of the glistenings and surface light scattering groups were associated with significantly lower contrast sensitivity under no glare conditions. Furthermore, eye with glistenings exhibited the highest straylight value (P < .05), whereas no difference was found between the surface light scattering and control groups. In contrast to the control group, the spherical aberration increased and the mean values of PSF and MTF decreased in the glistenings and surface light scattering groups. Both glistenings and surface light scattering tend to impair subjective visual performance, such as contrast sensitivity, and potentially affect objective optical quality, including straylight, spherical aberration, PSF, and MTF. [J Refract Surg. 2018;34(6):372-378.]. Copyright 2018, SLACK Incorporated.

Longterm follow-up of pars plana vitrectomy for vitreous floaters: complications, outcomes and patient satisfaction.

PubMed

Schulz-Key, Steffen; Carlsson, Jan-Olof; Crafoord, Sven

2011-03-01

Floaters caused by degenerative or postoperative changes in the vitreous can interfere with all aspects of visual functioning. The aim of this study is to report the longterm outcome of pars plana vitrectomy (PPV) for persistent vitreous opacities. In a retrospective, non-randomized, interventional case study we reviewed all cases of vitreous floaters that were vitrectomized at our department between 1997 and 2006. Patient complaints and satisfaction were assessed by a questionnaire administered at the end of follow-up. Seventy-three consecutive cases were included (61 patients). Mean Snellen best corrected visual acuity (BCVA) before surgery was 0.81. Overall, 85% of patients complained of severe or very severe difficulty caused by floaters. A total of 42% of eyes were pseudophakic, four of which were operated with combined PPV and phacoemulsification. Mean follow-up time was 37 months. Of the phakic eyes, 60% were operated for cataract during follow-up. One retinal detachment (RD) occurred immediately postoperatively (1.3%) and another four eyes developed RD during longterm follow-up 24-44 months after PPV (5.5% of cases). Postoperative BCVA remained mostly unchanged. Overall, 88% of patients were satisfied with the results of the operation. Some patients make considerable complaints as a result of vitreous opacities and their distress does not correlate with visual acuity. Vitrectomy is a safe and effective procedure with which to help these patients. Patients should be informed about the risk of cataract progression, unexpected inflammatory reaction and an increased risk for RD several years after PPV (5.5%). © 2009 The Authors. Journal compilation © 2009 Acta Ophthalmol.

Safety Profile of Stromal Hydration of Clear Corneal Incisions with Cefuroxime in the Mouse Model.

PubMed

Moosajee, Mariya; Tracey-White, Dhani; Harbottle, Richard P; Ferguson, Veronica

2016-09-01

The use of sutureless clear corneal incisions (CCIs) for phacoemulsification is an established surgical technique, but the dynamic morphology of the wound and poor construction can lead to an increased risk of postoperative endophthalmitis. Stromal hydration with balanced salt solution (BSS) can improve the self-sealing status. Intracameral cefuroxime has reduced endophthalmitis rates. This study investigates the safety profile of stromal hydration with cefuroxime, as sequestering antibiotic at the wound may potentially provide added protection against infection. MF-1 mice underwent bilateral CCI, followed by stromal hydration with 5 μL of 10 mg/mL cefuroxime, cefuroxime-texas red conjugate (for detection using confocal microscopy), or BSS. Corneas were harvested from 1 h to 12 weeks postoperatively; gross morphology, histology, and apoptotic cell death levels were investigated to determine the safety profile. Bactericidal activity of cefuroxime was assayed using homogenized whole cornea following stromal hydration at 1 h, 24 h, and day 7 against gram-negative Escherichia coli. Cefuroxime stromal hydration did not alter corneal morphology, with no evidence of corneal scarring or vascularization. Corneal histology and levels of apoptosis were minimal and comparable to the BSS groups up to 12 weeks. Confocal microscopy detected cefuroxime-texas red up to 1 week surrounding the corneal wound. Whole corneal tissue homogenates displayed bactericidal activity up to 24 h postoperatively. Stromal hydration of CCI with cefuroxime is safe in mouse corneas. A reservoir of antibiotic at the wound can potentially act as a barrier of defense against infection following cataract and associated ocular surgery.

Final incision size after cataract surgery with toric intraocular lens implantation using 2 techniques.

PubMed

Guarnieri, Adriano; Moreno-Montañés, Javier; Sabater, Alfonso L; Gosende-Chico, Inmaculada; Bonet-Farriol, Elvira

2013-11-01

To analyze the changes in incision sizes after implantation of a toric intraocular lens (IOL) using 2 methods. Department of Ophthalmology, Clínica Universidad de Navarra, Pamplona, Spain. Prospective case series. Coaxial phacoemulsification and IOL implantation through a 2.2 mm clear corneal incision using a cartridge injector were performed. Wound-assisted or cartridge-insertion techniques were used to implant the IOLs. The results were analyzed according to IOL spherical and cylindrical powers. Corneal hysteresis (CH) and the corneal resistance factor (CRF) were measured and evaluated based on the changes in incision size. Incision size increased in 30 (41.7%) of 72 eyes in the wound-assisted group and 71 (98.6%) of 72 eyes in the cartridge-insertion group. The mean incision size after IOL implantation was 2.27 mm ± 0.06 (SD) and 2.37 ± 0.05 mm, respectively (P<.01). The final incision size and IOL spherical power in the wound-assisted technique group (P=.02) and the cartridge-insertion technique group (P=.03) were correlated significantly; IOL toricity was not (P=.19 and P=.28, respectively). The CH and CRF values were not correlated with the final incision size. The final incision size and the changes in incision size after IOL implantation were greater with the cartridge-insertion technique than with the wound-assisted technique. The increase was related to IOL spherical power in both groups but not to IOL toricity. Corneal biomechanical properties were not correlated with the final incision size. Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

[Quantitative evaluation of acrylic and silicone intraocular lenses with a sharp optic edge design].

PubMed

Rabsilber, T M; Reuland, A J; Entz, B B; Holzer, M P; Limberger, I J; Auffarth, G U

2006-01-01

At the Department of Ophthalmology, Heidelberg, Germany, posterior capsule opacification (PCO) of a silicone and an acrylic intraocular lens (IOL) with a sharp optic edge design was evaluated. In a prospective study either the AMO ClariFlex silicone IOL or the Sensar AR40e hydrophobic acrylic IOL were implanted in 47 patients following uneventful phacoemulsification. Mean patient age was 76.2+/-7.8 (ClariFlex) and 73.4+/-12.9 years (AR40e), respectively. The mean follow-up time was 19.7+/-5.34 in the ClariFlex and 21.9+/-1.89 months in the AR40e group. PCO development was evaluated postoperatively using the EPCO 2000 analysis software (scale 0-4). Areas of interest were the total IOL optic, the central 3-mm zone as well as the capsulorhexis. In both groups, all patients achieved a BCVA of 20/32 (AR40e) and 20/25 (ClariFlex), respectively. There was a very low incidence of PCO development with a mean EPCO score of 0.07+/-0.2 (ClariFlex and 0.15+/-0.2 (AR40e). Within the 3-mm zone and the capsulorhexis, there was a tendency for even lower EPCO scores in both groups. We calculated a statistically significant difference for the two lens materials for all investigated IOL areas (Wilcoxon's test, p<0.05). Both IOLs with a sharp edge design showed good functional results, a stable position in the capsular bag as well as a low incidence of PCO development. However, the silicone IOL showed statistically significantly lower PCO scores.

Effect of cataract surgery on retinal nerve fiber layer thickness parameters using scanning laser polarimetry (GDxVCC).

PubMed

Dada, Tanuj; Behera, Geeta; Agarwal, Anand; Kumar, Sanjeev; Sihota, Ramanjit; Panda, Anita

2010-01-01

To study the effect of cataract extraction on the retinal nerve fiber layer (RNFL) thickness, and assessment by scanning laser polarimetry (SLP), with variable corneal compensation (GDx VCC), at the glaucoma service of a tertiary care center in North India. Thirty-two eyes of 32 subjects were enrolled in the study. The subjects underwent RNFL analysis by SLP (GDx VCC) before undergoing phacoemulsification cataract extraction with intraocular lens (IOL) implantation (Acrysof SA 60 AT) four weeks following cataract surgery. The RNFL thickness parameters evaluated both before and after surgery included temporal, superior, nasal, inferior, temporal (TSNIT) average, superior average, inferior average, and nerve fiber index (NFI). The mean age of subjects was 57.6 +/- 11.7 years (18 males, 14 females). Mean TSNIT average thickness (microm) pre- and post-cataract surgery was 49.2 +/- 14.1 and 56.5 +/- 7.6 ( P = 0.001). There was a statistically significant increase in RNFL thickness parameters (TSNIT average, superior average, and inferior average) and decrease in NFI post-cataract surgery as compared to the baseline values. Mean NFI pre- and post-cataract surgery was 41.3 +/- 15.3 and 21.6 +/- 11.8 ( P = 0.001). Measurement of RNFL thickness parameters by scanning laser polarimetry is significantly altered following cataract surgery. Post the cataract surgery, a new baseline needs to be established for assessing the longitudinal follow-up of a glaucoma patient. The presence of cataract may lead to an underestimation of the RNFL thickness, and this should be taken into account when analyzing progression in a glaucoma patient.

Photoreceptor Outer Segment on Internal Limiting Membrane after Macular Hole Surgery: Implications for Pathogenesis.

PubMed

Grinton, Michael E; Sandinha, Maria T; Steel, David H W

2015-01-01

This report presents a case, which highlights key principles in the pathophysiology of macular holes. It has been hypothesized that anteroposterior (AP) and tangential vitreous traction on the fovea are the primary underlying factors causing macular holes [Nischal and Pearson; in Kanski and Bowling: Clinical Ophthalmology: A Systemic Approach, 2011, pp 629-631]. Spectral domain optical coherence tomography (OCT) has subsequently corroborated this theory in part but shown that AP vitreofoveal traction is the more common scenario [Steel and Lotery: Eye 2013;27:1-21]. This study was conducted as a single case report. A 63-year old female presented to her optician with blurred and distorted vision in her left eye. OCT showed a macular hole with a minimum linear diameter of 370 µm, with persistent broad vitreofoveal attachment on both sides of the hole edges. The patient underwent combined left phacoemulsification and pars plana vitrectomy, internal limiting membrane (ILM) peel and gas injection. The ILM was examined by electron microscopy and showed the presence of a cone outer segment on the retinal side. Post-operative OCT at 11 weeks showed a closed hole with recovery of the foveal contour and good vision. Our case shows the presence of a photoreceptor outer segment on the retinal side of the ILM and reinforces the importance of tangential traction in the development of some macula holes. The case highlights the theory of transmission of inner retinal forces to the photoreceptors via Müller cells and how a full thickness macular hole defect can occur in the absence of AP vitreomacular traction.

The Results of Toric Intraocular Lens Implantation in Patients With Cataract and High Astigmatism After Penetrating Keratoplasty.

PubMed

Müftüoğlu, İlkay Klç; Akova, Yonca Aydn; Egrilmez, Sait; Yilmaz, Suzan Guven

2016-03-01

To evaluate the results of toric intraocular lens (IOL) implantation in patients with cataract and postpenetrating keratoplasty astigmatism. Seven eyes of 7 patients with cataract and more than 3.5 diopters (D) astigmatism following penetrating keratoplasty were included in this retrospective case series study. All of the eyes underwent phacoemulsification and Acrysof toric IOL (t5-t9) implantation at least 6 months later than the complete suture removal. Corrected visual acuity (CVA), manifest astigmatism, the keratometry measurements, and complications were assessed. The mean preoperative CVA significantly increased (0.7±0.3 [range: 0.3-1.3] logMAR to 0.1±0.04 [range: 0.05-0.15] logMAR; P<0.05) at mean 8.71±4.11 months after the surgery. The mean preoperative corneal astigmatism and the average manifest refractive astigmatism at the last visit were 5.4±0.9 D (range: 4.25-7 D) and 1.6±0.6 D (range: 0.5-2.5 D), respectively. The mean attempted cylinder correction at spectacle plane was 4.3±0.9 D (range: 2.4-4.7 D) whereas the mean cylinder correction was 4.6±0.5 D (range: 3.9-5.9 D), showing a slightly tendency for overcorrection. All eyes (100%) were within 1 D of predicted residual astigmatism. No complication occurred during the follow-up. Toric IOL implantation seems to be an effective, predictable, and safe procedure in patients with cataract formation and high astigmatism after penetrating keratoplasty.

A comparison of preservative-free diclofenac and preserved diclofenac eye drops after cataract surgery in patients with diabetic retinopathy.

PubMed

Yasuda, Kanako; Miyazawa, Akiko; Shimura, Masahiko

2012-06-01

The aim of this study was to compare the anti-inflammatory efficacy of preservative-free and preserved 0.1% diclofenac eye drops for the management of postoperative inflammation after cataract surgery in patients with nonproliferative diabetic retinopathy and in normal controls. Forty-two diabetic patients and 50 normal control patients who underwent small-incision phacoemulsification cataract surgery bilaterally received topical preservative-free diclofenac in 1 eye and preserved diclofenac in the other eye. The corrected distance visual acuity (CDVA) as determined by a logarithm of the minimum angle of resolution (logMAR) chart, intraocular pressure (IOP), foveal thickness (FT) using optical coherence tomography (OCT), and the anterior chamber flare (ACF) score measured with a laser flare cell meter were monitored for 12 weeks after surgery. In the eyes with diabetic retinopathy, there were no significant differences in CDVA, IOP, FT, and ACF score between the right and left eyes at the initial exam. After cataract surgery, changes in CDVA, IOP, and FT were not influenced by the preservative in the diclofenac eye drops. In contrast, the ACF score in the eyes treated with preserved diclofenac showed slower recovery from postoperative inflammation than the eyes treated with preservative-free diclofenac. In the normal control eyes, similar but milder changes were observed in each of the clinical parameters. Because preservative suppressed the anti-inflammatory efficacy of topical diclofenac after cataract surgery, preservative-free diclofenac may have an improved safety profile during postoperative treatment, especially in patients with diabetic retinopathy.

Accommodation-Amplitudes following an Accommodative Lens Refilling Procedure — an in vivo Update

PubMed Central

Nishi, Okihiro; Nishi, Yutaro; Chang, S.; Nishi, Kayo

2014-01-01

Purpose To investigate whether a newly developed lens refilling procedure can provide some accommodation in monkey eyes and to evaluate the difference in accommodation with different degrees of capsular bag refilling. Setting Jinshikai Medical Foundation, Nishi Eye Hospital, Osaka, Japan. Design Experimental monkey study. Methods Following a central 3–4 mm continuous curvilinear capsulorhexis, phacoemulsification was performed in the usual manner. A novel accommodative membrane intraocular lens for sealing capsular opening was implanted into the capsular bag. Silicone polymers were injected beneath the intraocular lens into the capsular bag through the delivery hole. In three study groups, each with six monkey eyes, the lens capsule was refilled with 0.08 ml corresponding to 65% bag volume, 0.1 ml corresponding to 80% bag volume, and 0.125 ml of silicone polymers corresponding to 100% bag volume, respectively. To calculate the accommodation-amplitudes achieved, automated refractometry was performed before and 1 hour after the topical 4% pilocarpine application before and four weeks after surgery. Results The refilling technique was successful in all monkeys without polymer leakage. Accommodation-amplitudes attained were 2.56 ± 0.74 dioptries (D), 2.42 ± 1.00D, and 2.71 ± 0.63D, respectively, 4 weeks after surgery in the three study groups. Conclusions Using the technique, some accommodation could be obtained in the young monkey eyes. Leakage of the injectable silicone polymer and anterior capsular opacification at least in the visual axis could be avoided. The results suggest that this lens refilling procedure warrants further studies for a possible clinical application. PMID:24461501

Overview of Therapeutic Ultrasound Applications and Safety Considerations

PubMed Central

Miller, Douglas; Smith, Nadine; Bailey, Michael; Czarnota, Gregory; Hynynen, Kullervo; Makin, Inder

2013-01-01

Summary Applications of ultrasound in medicine for therapeutic purposes have been an accepted and beneficial use of ultrasonic biological effects for many years. Low power ultrasound of about 1 MHz frequency has been widely applied since the 1950s for physical therapy in conditions such as tendinitis or bursitis. In the 1980s, high pressure-amplitude shockwaves came into use for mechanically resolving kidney stones, and “lithotripsy” rapidly replaced surgery as the most frequent treatment choice. The use of ultrasonic energy for therapy continues to expand, and approved applications now include uterine fibroid ablation, cataract removal (phacoemulsification), surgical tissue cutting and hemostasis, transdermal drug delivery, and bone fracture healing, among others. Undesirable bioeffects can occur including burns for thermal-based therapies and significant hemorrhage for mechanical-based therapies (e. g. lithotripsy). In all these therapeutic applications for bioeffects of ultrasound, standardization, ultrasound dosimetry, benefits assurance and side-effects risk minimization must be carefully considered in order to insure an optimal benefit to risk ratio for the patient. Therapeutic ultrasound typically has well-defined benefits and risks, and therefore presents a tractable safety problem to the clinician. However, safety information can be scattered, confusing or subject to commercial conflict of interest. Of paramount importance for managing this problem is the communication of practical safety information by authoritative groups, such as the AIUM, to the medical ultrasound community. In this overview, the Bioeffects Committee outlines the wide range of therapeutic ultrasound methods, which are in clinical use or under study, and provides general guidance for assuring therapeutic ultrasound safety. PMID:22441920

Intraocular pressure and pulsatile ocular blood flow after retrobulbar and peribulbar anaesthesia

PubMed Central

Watkins, R.; Beigi, B.; Yates, M.; Chang, B.; Linardos, E.

2001-01-01

AIMS—This study investigated the effect of peribulbar and retrobulbar local anaesthesia on intraocular pressure (IOP) and pulsatile ocular blood flow (POBF), as such anaesthetic techniques may adversely affect these parameters.
METHODS—20 eyes of 20 patients who were to undergo phacoemulsification cataract surgery were prospectively randomised to receive peribulbar or retrobulbar anaesthesia. The OBF tonometer (OBF Labs, Wiltshire, UK) was used to simultaneously measure IOP and POBF before anaesthesia and 1 minute and 10 minutes after anaesthesia. Between group comparisons of age, baseline IOP, and baseline POBF were performed using the non-parametric Mann-Whitney test. Within group comparisons of IOP and POBF measured preanaesthesia and post-anaesthesia were performed using the non-parametric Wilcoxon signed ranks test for both groups.
RESULTS—There was no statistically significant IOP increase post-anaesthesia in either group. In the group receiving peribulbar anaesthesia, there was a significant reduction in POBF initially post-anaesthesia which recovered after 10 minutes. In the group receiving retrobulbar anaesthesia, there was a persistent statistically significant reduction in POBF.
CONCLUSIONS—Retrobulbar and peribulbar injections have little effect on IOP. Ocular compression is not needed for IOP reduction when using local anaesthesia for cataract surgery. Conversely, POBF falls, at least for a short time, when anaesthesia for ophthalmic surgery is administered via a retrobulbar route or a peribulbar route. This reduction may be mediated by pharmacologically altered orbital vascular tone. It may be safer to use other anaesthetic techniques in patients with ocular vascular compromise.

 PMID:11423451

High resolution OCT quantitative analysis of the space between the IOL and the posterior capsule during the early cataract postoperative period.

PubMed

Tao, Aizhu; Lu, Ping; Li, Jin; Shao, Yilei; Wang, Jianhua; Shen, Meixiao; Zhao, Yinying; Lu, Fan

2013-10-25

We quantitatively characterized the space between the IOL and the posterior capsule (IOL-PC space) during the early postphacoemulsification period, using high resolution optical coherence tomography (OCT). We recruited 30 eyes of 30 patients who underwent phacoemulsification and randomly divided them into two groups. Acrysof Natural IQ IOLs were implanted in one group (n = 15), and Adapt-AO IOLs were implanted into the other (n = 15). A custom-built OCT instrument was used to image the IOL-PC space at 1 day, 1 week, and 1 month after surgery. Slit-lamp examination and auto refraction were performed at each visit. The IOL-PC spaces in the IQ group were 0.72 ± 0.35, 0.40 ± 0.24, and 0.23 ± 0.16 mm(2) at 1 day, 1 week, and 1 month after surgery, respectively. At each of these times, the values for the AO group were significantly smaller (P < 0.001). Compared to 1 day after surgery, significant changes in the ACDs and refractive errors occurred up to 1 month postoperatively in the IQ group; however, changes in the ACD and refractive error were significant only at 1 week in the AO group. The decreases in IOL-PC space and in ACD during the early postoperative period were associated with a myopic shift. It appeared that the different IOL designs had a role in closure of the IOL-PC space. High resolution OCT was suitable for quantitative analysis of IOL-PC space. (ClinicalTrials.gov number, NCT01605812.).

A case of Weill-Marchesani syndrome with inversion of chromosome 15.

PubMed

Chung, Jae Lim; Kim, Sun Woong; Kim, Ji Hyun; Kim, Tae-Im; Lee, Hyung Keun; Kim, Eung Kweon

2007-12-01

To present a case of Weill-Marchesani syndrome with corneal endothelial dysfunction due to anterior dislocation of a spherophakic lens and corneolenticular contact. A 17-year-old woman presented with high myopia and progressive visual disturbance. She was of short stature and had brachydactyly. Her initial Snellen best corrected visual acuity (BCVA) was 20/50 (-sph 20.50 -cyl 3.00 Ax 180) in her right eye and 20/40 (-sph 16.00 -cyl 6.00 Ax 30) in her left eye. Slit lamp examination revealed a dislocated spherophakic lens touching corenal endothelium. A microspherophakic lens, hypoplastic ciliary body, and elongated zonules were confirmed on rotating Scheimpflug camera (Pentacam) and on ultrasound biomicroscopy. Specular microscopy showed corneal endothealial dysfunction. Systemic evaluation was performed, and chromosomal study showed 46, XX, inv (15) (q13qter). The patient was diagnosed with Weill-Marchesani syndrome. Due to impending corneal decompensation, phacoemulsification and suture fixation of the intraocular lens were performed. The operation and postoperative course were uneventful. Three months postoperatively, the visual acuity was 20/30 (OD) and 20/40 (OS) without correction, and BCVA was 20/20 (+sph 0.50 -cyl 2.00 Ax 160 : OD) and 20/25 (+sph 1.50 -cyl 3.00 Ax 30 : OS). During the follow-up period, increased corneal endothelial counts, hexagonality, and decreased corneal thickness were achieved. In Weill-Marchesani syndrome with a chromosomal anomaly, a dislocated spherophakic lens may cause severe corneal endothelial dysfunction due to corneolenticular contact, and prompt lensectomy is important to prevent such complications.

Trends in cataract surgical rate and resource utilisation in Egypt.

PubMed

Elbieh, Islam; Bascaran, Covadonga; Blanchet, Karl; Foster, Allen

2018-06-08

To describe cataract services in Egypt and explore resources and practices in public and private sectors. The study was conducted between June and August 2015. All facilities in the country providing cataract services were contacted to obtain information on surgeries performed in 2014. Hospitals performing eye surgery in Quena, Sharkia, and Fayoum regions were visited and a questionnaire on resources for cataract surgery was completed. Cataract surgery was offered in the public sector by 64 government and 16 university teaching hospitals and in the private sector by 101 hospitals. Over 90% of all facilities in the country contacted participated in the study. In 2014, the national cataract surgical rate (CSR) was 3674 varying in governorates from 7579 in Ismailia to 402 in Suez. The private sector performed 70% of cataract surgeries. Analysis of three regions showed an 11.7% increase in cataract output between 2010 and 2014. The average number of cataract surgeries per unit in 2014 was 2272 in private, 1633 in university, and 824 in government hospitals. Private hospitals had 60% of human resources for eye care. Phacoemulsification was the surgical technique in 85.6% of private, 72.1% of university, and 41% of government hospitals. Reasons explaining the differences in output between public and private sectors were the lack of trainers, supervisors, and incentives. The private sector provides most of the cataract services in Egypt, resulting in inadequate services for the poor. There is a 15-fold variation in CSR between the best and least served regions. The public sector could increase cataract output by improving training, supervision, and incentives.

Management of moderate and severe corneal astigmatism with AcrySof® toric intraocular lens implantation - Our experience.

PubMed

Farooqui, Javed Hussain; Koul, Archana; Dutta, Ranjan; Shroff, Noshir Minoo

2015-01-01

Visual performance following toric intraocular lens implantation for cataract with moderate and severe astigmatism. Cataract services, Shroff Eye Centre, New Delhi, India. Case series. This prospective study included 64 eyes of 40 patients with more than 1.50 dioptre (D) of pre-existing corneal astigmatism undergoing phacoemulsification with implantation of the AcrySof® toric IntraOcular Lens (IOL). The unaided visual acuity (UCVA), best corrected visual acuity (BCVA), residual refractive sphere and refractive cylinders were evaluated. Toric IOL axis and alignment error was measured by slit lamp method and Adobe Photoshop (version 7) method. Patient satisfaction was evaluated using a satisfaction questionnaire at 3 months. The mean residual refractive astigmatism was 0.57 D at the final follow-up of 3 months. Mean alignment error was 3.44 degrees (SD = 2.60) by slit lamp method and 3.88 degrees (SD = 2.86) by Photoshop method. Forty-six (71.9%) eyes showed misalignment of 5 degrees or less, and 60 (93.8%) eyes showed misalignment of 10 degrees or less. The mean log MAR UCVA at 1st post-op day was 0.172 (SD = 0.02), on 7th post-op day was 0.138 (SD = 0.11), and on 30th post-op day was 0.081 (SD = 0.11). The mean log MAR BCVA at three months was -0.04 (SD = 0.76). We believe that implantation of AcrySof® toric IOL is an effective, safe and predictable method to correct high amounts of corneal astigmatism during cataract surgery.

Antibiotic prophylaxis practice patterns for cataract surgery in India - Results from an online survey.

PubMed

Kelkar, Aditya S; Chang, David F; Kelkar, Jai A; Mehta, Hetal M; Lahane, Tatyarao; Parekh, Ragini

2017-12-01

The aim of this study is to assess the current antibiotic prophylaxis practice patterns for cataract surgery in India. This was a questionnaire-based E-survey carried out at a tertiary eye care center in India. An E-mail invitation to complete an online 20 point questionnaire survey was sent to all members of the All India Ophthalmological Society with valid E-mail addresses using a digital E-mail service. Duplicate entries were prevented. Out of 1228 total respondents (8.2%) who completed the survey 38% reported using routine intracameral (IC) antibiotic prophylaxis. Another 7% place antibiotics in the irrigating solution. Of those using IC antibiotic prophylaxis, 91% adopted this practice within the past 2 years; 92% are using moxifloxacin with 56% using a commercially available moxifloxacin formulation. Those predominantly performing phacoemulsification (43% vs. 25% performing mostly manual small incision cataract surgery, P < 0.001) and more than 500 cataract surgeries annually (45% vs. 33%, P < 0.001) reported greater use of IC moxifloxacin. Self-reported endophthalmitis rates were statistically significantly greater in those not using IC antibiotics (0.045% vs. 0.036, P = 0.04). Although a majority of respondents believe that IC antibiotics are an important option (54%) and that it is important to have a commercially available solution (68%), many believe that other antibiotic prophylaxis methods are sufficient (31%). IC antibiotic prophylaxis for cataract surgery has sharply increased in India. In contrast to the West, intraocular moxifloxacin, which is commercially available in India, is preferred by the vast majority of users.

Cost-effectiveness analysis should continually assess competing health care options especially in high volume environments like cataract surgery.

PubMed

Khan, Ashiya; Amitava, Abadan Khan; Rizvi, Syed Ali Raza; Siddiqui, Ziya; Kumari, Namita; Grover, Shivani

2015-06-01

Cost-effectiveness analysis should continually assess competing health care options especially in high volume environments like cataract surgery. To compare the cost effectiveness of phacoemulsification (PE) versus manual small-incision cataract surgery (MSICS). Prospective randomized controlled trial. Tertiary care hospital setting. A total of 52 consenting patients with age-related cataracts, were prospectively recruited, and block randomized to PE or MSICS group. Preoperative and postoperative LogMAR visual acuity (VA), visual function-14 (VF-14) score and their quality-adjusted life years (QALYs) were obtained, and the change in their values calculated. These were divided by the total cost incurred in the surgery to calculate and compare the cost effectiveness and cost utility. Surgery duration was also compared. Two group comparison with Student's t-test. Significance set at P < 0.05; 95% confidence interval (CI) quoted where appropriate. Both the MSICS and PE groups achieved comparative outcomes in terms of change (difference in mean [95% CI]) in LogMAR VA (0.03 [-0.05-0.11]), VF-14 score (7.92 [-1.03-16.86]) and QALYs (1.14 [-0.89-3.16]). However, with significantly lower costs (INR 3228 [2700-3756]), MSICS was more cost effective, with superior cost utility value. MSICS was also significantly quicker (10.58 min [6.85-14.30]) than PE. MSICS provides comparable visual and QALY improvement, yet takes less time, and is significantly more cost-effective, compared with PE. Greater push and penetration of MSICS, by the government, is justifiably warranted in our country.

[Phacoemulsification: advantages of a consultation the day after surgery?].

PubMed

Pajot, O; Mazit, C; Jallet, G; Ebran, J-M; Cochereau, I

2010-03-01

Cataract surgery is the most frequent surgery in France. The D1 consultation limits the extension of ambulatory care to patients who can return on their own the day after sugery. We assessed the usefulness of this systematic D1 consultation in terms of therapeutic modifications. MATERIAL AND MéTHODE: Retrospective study of patients who underwent cataract surgery in a teaching hospital from february to july 2006. The major parameter was the modification of postsurgical treatment after the D1 consultation. Of the 380 operated eyes studied, the patients included 145 men and 235 women, the mean age was 73.8 years (range, 43-92), 86% underwent conventional hospitalization, 70% had been operated by a senior surgeon, and 66% had no suture. At the D1 visit, 11 modifications (2.9%) were recorded: one case of athalamia, one Seidel-positive test, four cases of high IOP (>30mmHg), and five severe inflammations of the anterior segment. All the treatment changes were reported in the group of hospitalized patients, none were reported in the ambulatory patients. Of the 380 eyes studied, only one required sutures at D1, the other treatment changes were minor. The low output of the D1 visit raises the problem of its relevance in terms of public health. In most of the English-speaking and Scandinavian countries, patients have only one postoperative visit at 1 month. Patients could receive written and oral recommendations and a hotline number to contact the surgical team, which could allow the D1 visit to be discontinued for standard patients with uncomplicated surgery.

Comparison of actual vacuum pressures at the end of 3 phacoemulsification tips in swine eyes.

PubMed

Park, Sang Hoon; Choi, Chul Young; Kim, Joon Mo; Chang, Hae Ran; Kim, Jae Yong; Kim, Myoung Joon; Tchah, Hungwon; Kim, Jae Chan

2009-05-01

To compare the actual vacuum pressure at the end of an aspiration bypass system (ABS) phaco tip and a conventional tip in conditions similar to those during human cataract surgery. Kangbuk Samsung Hospital, Seoul, Korea. A 4.0 mm diameter rubber eraser ball was inserted in a phacoemulsified swine eye and engaged to a phaco tip. With a vacuum pressure of 300 mm Hg, the eraser ball was pulled in the opposite direction with the phaco tip. The pulling power separating the eraser ball from the phaco tip was measured using the volume of water dripped into a container connected to the eraser ball. Measurements were taken with an Infiniti ABS tip and 2 conventional tips: Sovereign (conventional tip S) and Infiniti (conventional tip I). Measurements were taken alternatively at random in the same eye. The mean pulling power was 17.35 mL +/- 5.01 (SD) with conventional tip S and 16.85 +/- 4.45 mL with conventional tip I. The mean pulling power of the ABS tip was 13.35 +/- 4.32 mL, which was a mean 20.8% lower than that of conventional tip I (P = .016) and 23.1% lower than that of conventional tip S (P = .010). The actual vacuum pressure of the phaco tip was significantly influenced by the presence of the ABS hole. To compensate for the decrease in actual vacuum pressure, surgeons should be aware of the characteristics of the ABS tip being used and change the standard settings accordingly.

Thermal comparison of Infiniti OZil and Signature Ellips phacoemulsification systems.

PubMed

Schmutz, Joseph S; Olson, Randall J

2010-05-01

To determine thermal characteristics of Signature Ellips (Abbott Medical Optics) and Infiniti OZil (Alcon, Inc.) transverse ultrasound and compare both with longitudinal ultrasound in clinically relevant scenarios. Laboratory investigation. Temperature increase over baseline after 60 seconds was measured in water at positions in 90-degree increments around the sleeve near the proximal needle shaft in an artificial chamber for Ellips and OZil on continuous ultrasound with aspiration blocked and unblocked. This was also done with Signature using longitudinal ultrasound, with and without micropulse (6 ms on, 12 ms off), with aspiration blocked and unblocked, and at the OZil sleeve tip on continuous transverse mode with aspiration unblocked. OZil (8.1 +/- 0.3 C) had greater temperature increase than Ellips (5.2 +/- 0.3 C; P < .0001) with aspiration unblocked and blocked (29.3 +/- 1.0 C vs 12.2 +/- 0.7 C; P < .0001). OZil had uneven distribution of heat around the shaft (30.1 +/- 0.5 C vs 28.5 +/- 0.6 C; P < .0001), whereas Ellips did not (P = .57). OZil was cooler at the tip (6.6 +/- 0.2 C; P < .0001). Friction in a cadaver eye incision only increased these numbers by 10% (OZil, irrigation blocked). Metal stress probably creates heat at the proximal needle junction for both transverse methods. Heat generation differences between OZil and Ellips result from the manner in which they create needle motion. Incision burns may occur, especially for OZil, under nonpulsed settings during fragment removal with occlusion when reaching across the anterior chamber such that the proximal needle shaft came near the wound. Copyright 2010 Elsevier Inc. All rights reserved.

Mortality after endophthalmitis following contemporary phacoemulsification cataract surgery.

PubMed

Crosby, Niall; Polkinghorne, Philip J; Kim, Bia; McGhee, Charles; Welch, Sarah; Riley, Andrew

2018-04-24

To determine if endophthalmitis following cataract surgery is linked to increased mortality. Increased mortality has been linked to patients with cataract and cataract surgery. We tested the hypothesis that post-cataract endophthalmitis has a greater risk of death than pseudophakes who do not develop this complication. Case-control study conducted in a tertiary public hospital. The study group comprised 50 consecutive patients with post-cataract endophthalmitis, and these were matched with selected controls. Patients with endophthalmitis following cataract surgery were identified from a prospective electronic surgical database. Subsequently, it was determined if the patient was deceased at the time of sequestration (September 2015), and the date of death was recorded. A previously described population who had undergone cataract surgery in the same facility was selected as a control group, and the population was case-matched in terms age, gender, presence or absence of diabetes and/or hypertension. The median survival rates were determined for the control group and the patients with post-cataract endophthalmitis. Fifty patients were identified as undergoing endophthalmitis post-cataract surgery, and 48 (n = 48) met inclusion criteria (mean age 72 years ±12 SD with 30:18 F:M); 17% were diabetic, and 50% had systemic hypertension. No statistically significant difference in median survival between the study and control cases was identified (100 months (95% confidence interval 86-114) vs. 106 months (95% confidence interval 66-146), respectively, P = 0.756). Post-cataract endophthalmitis was not associated with an increased rate of mortality in this study. © 2018 Royal Australian and New Zealand College of Ophthalmologists.

Risk factors for postoperative intraretinal cystoid changes after peeling of idiopathic epiretinal membranes among patients randomized for balanced salt solution and air-tamponade.

PubMed

Leisser, Christoph; Hirnschall, Nino; Hackl, Christoph; Döller, Birgit; Varsits, Ralph; Ullrich, Marlies; Kefer, Katharina; Karl, Rigal; Findl, Oliver

2018-02-20

Epiretinal membranes (ERM) are macular disorders leading to loss of vision and metamorphopsia. Vitrectomy with membrane peeling displays the gold standard of care. Aim of this study was to assess risk factors for postoperative intraretinal cystoid changes in a study population randomized for balanced salt solution and air-tamponade at the end of surgery. A prospective randomized study, including 69 eyes with idiopathic ERM. Standard 23-gauge three-port pars plana vitrectomy with membrane peeling, using intraoperative optical coherence tomography (OCT), was performed. Randomization for BSS and air-tamponade was performed prior to surgery. Best-corrected visual acuity improved from 32.9 letters to 45.1 letters 3 months after surgery. Presence of preoperative intraretinal cystoid changes was found to be the only risk factor for presence of postoperative intraretinal cystoid changes 3 months after surgery (p = 0.01; odds ratio: 8.0). Other possible risk factors such as combined phacoemulsification with 23G-ppv and membrane peeling (p = 0.16; odds ratio: 2.4), intraoperative subfoveal hyporeflective zones (p = 0.23; odds ratio: 2.6), age over 70 years (p = 0.29; odds ratio: 0.5) and air-tamponade (p = 0.59; odds ratio: 1.5) were not found to be significant. There is strong evidence that preoperative intraretinal cystoid changes lead to smaller benefit from surgery. © 2018 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

[Outcome of cataract surgery in patients with pigmentary retinal degeneration].

PubMed

Grześk, Magdalena; Kałuzny, Józef; Malukiewicz-Wiśniewska, Grazyna

2007-01-01

To evaluate the results of cataract surgery in patients with RP because retinitis pigmentosa is one of the disease entities that belongs to tapeto-retinal degenerations. The occurrence of RP appearance is 1:4000 to 1:3000. Twenty patients with RP (7 women and 13 men, 33 eyes), who underwent cataract surgery were examined retrospectively. Average age in our group was 46.6 years. Visual acuity, intraocular pressure, slip lamp examination, fundus examination, cataract morphology, visual field were taken before surgery and on discharge, on the basis of medical documentation. Control examination was taken, on average, eighty one months after cataract surgery. Nine eyes were operated by phacoemulsification, 24 eyes by means of extracapsular cataract extraction. In the same way control group of 18 patients who underwent cataract surgery without RP (33 eyes) was examined. In RP group in 63.6% patients on discharge from the hospital and in 60.6% patients during the control examination, improvement of visual acuity was revealed. Deterioration was noted in 18.2% of patients on discharge from hospital and in 24.2% of patients during the control examination. In the control group improvement of visual acuity was revealed in 90.9% of patients on discharge and in 97% patients during the control examination, whereas deterioration of visual acuity occurred in 6.1% patients on discharge and in 3% patients during the check examination. In patients with retinitis pigmentosa cataract occurs earlier then in the control group. Cataract surgery for relatively minor opacities is beneficial in patients with RP, and causes improvement of visual acuity in most of eyes undergoing surgery.

Correlation between anterior chamber characteristics and laser flare photometry immediately after femtosecond laser treatment before phacoemulsification

PubMed Central

Pahlitzsch, M; Torun, N; Pahlitzsch, M L; Klamann, M K J; Gonnermann, J; Bertelmann, E; Pahlitzsch, T

2016-01-01

Purpose To assess the anterior chamber (AC) characteristics and its correlation to laser flare photometry immediately after femtosecond laser-assisted capsulotomy and photodisruption. Patients and methods The study included 97 cataract eyes (n=97, mean age 68.6 years) undergoing femtosecond laser-assisted cataract surgery (FLACS). Three cohorts were analysed relating to the flare photometry directly post femtosecond laser treatment (flare <100 n=28, 69.6±7 years; flare 100–249 n=47, 67.7±8 years; flare >249 photon counts per ms cohort n=22, 68.5±10 years). Flare photometry (KOWA FM-700), corneal topography (Oculus Pentacam, Germany: AC depth, volume, angle, pachymetry), axial length, pupil diameter, and endothelial cells were assessed before FLACS, immediately after femtosecond laser treatment and 1 day postoperative (LenSx Alcon, USA). Statistical data were analysed by SPSS v19.0, Inc. Results The AC depth, AC volume, AC angle, central and thinnest corneal thickness showed a significant difference between flare <100 vs flare 100–249 10 min post femtosecond laser procedure (P=0.002, P=0.023, P=0.007, P=0.003, P=0.011, respectively). The AC depth, AC volume, and AC angle were significantly larger (P=0.001, P=0.007, P=0.003, respectively) in the flare <100 vs flare >249 cohort 10 min post femtosecond laser treatment. Conclusions A flat AC, low AC volume, and a narrow AC angle were parameters associated with higher intraocular inflammation. These criteria could be used for patient selection in FLACS to reduce postoperative intraocular inflammation. PMID:27229702

Correlation between anterior chamber characteristics and laser flare photometry immediately after femtosecond laser treatment before phacoemulsification.

PubMed

Pahlitzsch, M; Torun, N; Pahlitzsch, M L; Klamann, M K J; Gonnermann, J; Bertelmann, E; Pahlitzsch, T

2016-08-01

PurposeTo assess the anterior chamber (AC) characteristics and its correlation to laser flare photometry immediately after femtosecond laser-assisted capsulotomy and photodisruption.Patients and methodsThe study included 97 cataract eyes (n=97, mean age 68.6 years) undergoing femtosecond laser-assisted cataract surgery (FLACS). Three cohorts were analysed relating to the flare photometry directly post femtosecond laser treatment (flare <100 n=28, 69.6±7 years; flare 100-249 n=47, 67.7±8 years; flare >249 photon counts per ms cohort n=22, 68.5±10 years). Flare photometry (KOWA FM-700), corneal topography (Oculus Pentacam, Germany: AC depth, volume, angle, pachymetry), axial length, pupil diameter, and endothelial cells were assessed before FLACS, immediately after femtosecond laser treatment and 1 day postoperative (LenSx Alcon, USA). Statistical data were analysed by SPSS v19.0, Inc.ResultsThe AC depth, AC volume, AC angle, central and thinnest corneal thickness showed a significant difference between flare <100 vs flare 100-249 10 min post femtosecond laser procedure (P=0.002, P=0.023, P=0.007, P=0.003, P=0.011, respectively). The AC depth, AC volume, and AC angle were significantly larger (P=0.001, P=0.007, P=0.003, respectively) in the flare <100 vs flare >249 cohort 10 min post femtosecond laser treatment.ConclusionsA flat AC, low AC volume, and a narrow AC angle were parameters associated with higher intraocular inflammation. These criteria could be used for patient selection in FLACS to reduce postoperative intraocular inflammation.

A 2D correlation Raman spectroscopy analysis of a human cataractous lens

NASA Astrophysics Data System (ADS)

Sacharz, Julia; Wesełucha-Birczyńska, Aleksandra; Paluszkiewicz, Czesława; Chaniecki, Piotr; Błażewicz, Marta

2016-11-01

This work is a continuation of our study of a cataractous human eye lens removed after phacoemulsification surgery. There are clear differences in the lens colors that allowed for distinguishing two opaque phases in the obtained biological material: the white- and yellow-phase. The Raman spectroscopy and 2D correlation spectroscopy method were used to trace a pathologically altered human cataract lens at a molecular level. Although the Raman spectra of these two phases are relatively similar, taking advantage of 2D correlation, and considering time as an external perturbation, the synchronous and asynchronous spectra were obtained showing completely different patterns. Prominent synchronous auto-peaks appear at 3340, 2920, 1736, 1665 and 1083 cm-1 for the white-, and at 2929 and 1670 cm-1 for the yellow phase. The white phase is characterized by intensive asynchronous peaks at -(2936, 3360), -(1650, 1674) and +(1620,1678). The modifications in the water contained in the white phase structure are ahead of the changes in the protein (CH3-groups), furthermore changes in β-conformation are asynchronous with respect to the α-structure. The yellow phase demonstrates asynchronous peaks: +(2857, 2928), +(1645,1673), +(1663, 1679), and +(1672,1707). These illustrate concomitant modifications in the β- and unordered conformation. Both forms of cataractous human eye lens, white- and yellow-phases, are degenerate forms of the eye lens proteins, both are arranged in a different way. The main differences are observed for the amide I, methyl, methylene and Osbnd H vibrational band region. The effect of Asp, Glu and Tyr amino acids in cataractous lens transformations was observed.

Nepafenac 0.1% versus fluorometholone 0.1% for preventing cystoid macular edema after cataract surgery.

PubMed

Miyake, Kensaku; Ota, Ichiro; Miyake, Goichiro; Numaga, Jiro

2011-09-01

To compare a topical nonsteroidal antiinflammatory drug (nepafenac 0.1%) and a topical steroidal antiinflammatory drug (fluorometholone 0.1% ) in preventing cystoid macular edema (CME) and blood-aqueous barrier (BAB) disruption after small-incision cataract extraction with foldable intraocular lens (IOL) implantation. Shohzankai Medical Foundation, Miyake Eye Hospital, Nagoya, Japan. Randomized double-masked single-center clinical trial. Patients were randomized to receive nepafenac 0.1% eyedrops or fluorometholone 0.1% eyedrops for 5 weeks after phacoemulsification with foldable IOL implantation. The incidence and severity of CME were evaluated by fluorescein angiography, retinal foveal thickness on optical coherence tomography, and BAB disruption on laser flare-cell photometry. Thirty patients received nepafenac and 29 patients, fluorometholone. Five weeks postoperatively, the incidence of fluorescein angiographic CME was significantly lower in the nepafenac group (14.3%) than in the fluorometholone group (81.5%) (P<.0001). The fovea was thinner in the nepafenac group than in the fluorometholone group at 2 weeks (P=.0266) and 5 weeks (P=.0055). At 1, 2, and 5 weeks, anterior chamber flare was significantly less in the nepafenac group than in the fluorometholone group (P<.0001, P<.0001, and P=.0304, respectively). The visual acuity recovery from baseline was significantly greater in the nepafenac group (80.0%) than in the fluorometholone group (55.2%) (P=.0395). There were no serious side effects in either group. Nepafenac was more effective than fluorometholone in preventing angiographic CME and BAB disruption, and results indicate nepafenac leads to more rapid visual recovery. Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Ablation of lens epithelial cells with a laser photolysis system: Histopathology, ultrastructure, and immunochemistry

PubMed Central

Mamalis, Nick; Grossniklaus, Hans E.; Waring, George O.; Werner, Liliana; Brubaker, Jacob; Davis, Don; Espandar, Ladan; Walker, Rudolf; Thyzel, Reinhardt

2010-01-01

PURPOSE To evaluate efficacy of a neodymium:YAG (Nd:YAG) laser photolysis system in removing lens epithelial cells (LECs) and characterize the effect of the laser on laminin and fibronectin involved in LEC adhesion and migration. METHODS Cadaver eyes were evaluated using the Miyake technique. The lenses were removed with phacoemulsification. The modified Nd:YAG laser was used to clean the LECs from the capsule. Only the fornix was cleaned in some eyes and the anterior subcapsular area in other eyes. Some areas were not treated and acted as controls. Standard irrigation/aspiration (I/A) removal of LECs was performed in additional eyes. The eyes were analyzed using light microscopy and immunohistochemical staining. RESULTS Histopathologic evaluation showed that the laser removed the LECs from the anterior lens capsule and from the fornix. Immunohistochemical staining showed fibronectin and laminin staining in the untreated areas that was absent in the treated areas. Standard I/A removal of the LECs showed absence of cells but persistent laminin and fibronectin. Electron microscopy showed epithelial cells in untreated areas with an absence of the LECs and debris in treated areas. CONCLUSIONS The laser photolysis system removed LECs from the anterior lens capsule and capsule fornix. Along with the cells, laminin, fibronectin, and cell debris remained in the untreated areas but were removed by the treatment. This treatment may be useful in preventing posterior capsule opacification. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes. PMID:20494774

Intracameral dexamethasone reduces inflammation on the first postoperative day after cataract surgery in eyes with and without glaucoma.

PubMed

Chang, Diane T W; Herceg, Michael C; Bilonick, Richard A; Camejo, Larissa; Schuman, Joel S; Noecker, Robert J

2009-01-01

To evaluate whether dexamethasone injected intracamerally at the conclusion of surgery can safely and effectively reduce postoperative inflammation and improve surgical outcomes in eyes with and without glaucoma. Retrospective chart review of 176 consecutive eyes from 146 patients receiving uncomplicated phacoemulsification (PE) (n = 118 total, 82 with glaucoma), glaucoma drainage device (GDD) (n = 35), combined PE/GDD (n = 11) and combined PE/endoscopic cyclophotocoagulation (n = 12). Ninety-one eyes from 76 patients were injected with 0.4 mg dexamethasone intracamerally at the conclusion of surgery. All eyes received standard postoperative prednisolone and ketorolac eyedrops. Outcomes were measured for four to eight weeks by subjective complaints, visual acuity (VA), slit-lamp biomicroscopy, intraocular pressure (IOP) and postoperative complications. Dexamethasone significantly reduced the odds of having an increased anterior chamber (AC) cell score after PE (p = 0.0013). Mean AC cell score +/- SD in nonglaucomatous eyes was 1.3 +/- 0.8 in control and 0.8 +/- 0.7 with dexamethasone; scores in glaucomatous eyes were 1.3 +/- 0.7 in control and 0.9 +/- 0.8 with dexamethasone. Treated nonglaucomatous eyes had significantly fewer subjective complaints after PE (22.2% vs 64.7% in control; p = 0.0083). Dexamethasone had no significant effects on VA, corneal changes, IOP one day and one month after surgery, or long-term complications. Intracameral dexamethasone given at the end of cataract surgery significantly reduces postoperative AC cells in eyes with and without glaucoma, and improves subjective reports of recovery in nonglaucomatous eyes. There were no statistically significant risks of IOP elevation or other complications in glaucomatous eyes.

Comparative outcomes of femtosecond laser-assisted cataract surgery and manual phacoemusification: a six-month follow-up.

PubMed

Yu, Yinhui; Chen, Xinyi; Hua, Huixia; Wu, Menghan; Lai, Kairan; Yao, Ke

2016-08-01

To explore efficacy and safety outcomes in patients undergoing femtosecond laser-assisted cataract surgery (FLACS) versus manual phacoemulsification cataract surgery (PCS). Prospective consecutive nonrandomized comparative cohort study. A total of 124 eyes from 106 patients (70 in FLACS and 54 in PCS). Comparison of FLACS with PCS over 6 months. Macular central subfield thickness (CST), cube volume (CV), cube average thickness (CAT), endothelial cell density (ECD), central corneal thickness (CCT) and photon count value (PCV). CST, CV and CAT increased postoperatively, which did not return to preoperative levels by 6 months. The values were similar between groups throughout the follow-up, and comparison of changes from baseline also showed no significant difference. Preoperative ECD showed significant difference, which decreased postoperatively and remained stable during follow-up, being lowest at 1 month. FLACS had greater endothelial cell loss than PCS, which was not significant. CCT in both groups increased, reaching maximum on day one and tended to decrease thereafter. No significant differences were found regarding postoperative values and the mean increase. In both groups, mean PCV increased from preoperatively to day one, week one and month one. Flare values in FLACS were lower than PCS, reaching statistical significance at 6 months (P = 0.001). However, the differences in changes of PCV were not significantly different at any visit. Both FLACS and PCS achieved similar safety and efficacy outcomes for performing cataract surgery. Flare values in eyes with FLACS were lower than those with PCS at 6 months postoperatively. © 2015 Royal Australian and New Zealand College of Ophthalmologists.

Variations in retinal nerve fiber layer measurements on optical coherence tomography after implantation of trifocal intraocular lens.

PubMed

García-Bella, Javier; Martínez de la Casa, José M; Talavero González, Paula; Fernández-Vigo, José I; Valcarce Rial, Laura; García-Feijóo, Julián

2018-01-01

To establish the changes produced after implantation of a trifocal intraocular lens (IOL) on retinal nerve fiber layer measurements performed with Fourier-domain optical coherence tomography (OCT). This prospective study included 100 eyes of 50 patients with bilateral cataract in surgical range, no other associated ocular involvement, refractive errors between +5 and -5 spherical diopters, and less than 1.5 D of corneal astigmatism. The eyes were operated by phacoemulsification with implantation of 2 different trifocal IOLs (FineVision and AT LISA tri 839MP) in randomized equal groups. Cirrus OCT and Spectralis OCT were performed before surgery and 3 months later. Both analyzed the thickness of the nerve fiber layer and thickness divided by quadrants (6 in case of Spectralis and 4 in case of Cirrus HD). The mean age of patients was 67.5 ± 5.8 years. The global nerve fiber layer thickness measured with Spectralis OCT was 96.77 μm before surgery and 99.55 μm after. With Cirrus OCT, the global thickness was 85.29 μm before surgery and 89.77 μm after. Statistically significant differences in global thickness measurements between preimplantation and postimplantation of the IOL were found with both OCT in the 2 groups. Statistically significant differences were also found in temporal and superior quadrants. The implantation of a diffractive trifocal IOL alters the results of the optic nerve fiber layer on Fourier-domain OCT in these patients, which should be taken into account in the posterior study of these patients.

[Preliminary investigation on the safety and efficacy of Trabectome].

PubMed

Huang, Ping; Wang, Huaizhou; Wu, Huijuan; Sun, Yanran; Wang, Minshu; Cui, Ying; Qiu, Weiqiang; Yang, Yiquan; Ren, Zeqin; Zhang, Chun; Wang, Ningli

2015-02-01

To evaluate the safety and efficacy of ab interno trabeculectomy (Trabectome) surgery in Chinese open angle glaucoma patients. Prospective non-comparative case series study. A total of 41 cases (34 primary open angle glaucoma patients, 3 developmental glaucoma patients and 4 pigmentary glaucoma patients) were included in the study. All the cases underwent Trabectome, including 9 cases combined with phacoemulsification cataract extraction. Major outcomes include intraocular pressure (IOP), number of glaucoma medications, secondary glaucoma surgery and postoperative complications. Criteria for successful operation were defined as IOP ≤ 21 mmHg (1 mmHg = 0.133 kPa), at least 20% IOP reduction in any two consecutive visits after 3 months with or without IOP-lowering drugs and no additional glaucoma surgery. IOP and number of glaucoma medications were compared to baseline using Wilcoxon signed-rank test with Bonferroni correction. Kaplan-Meier analysis was performed to analyze the success rate of surgery. In the all 41 patients, 21 cases (51.2%) were followed up for up to 12 months. IOP was reduced from (22.5 ± 8.1) mmHg to (17.6 ± 6.4) mmHg (P = 0.02), meanwhile number of glaucoma medications was reduced from 2.0 ± 0.9 to 1.2 ± 0.9 (P = 0.02) at 12 months. The success rate at one year was 85% and 4 cases required additional glaucoma surgery. Trabectome has many advantages, such as shorter surgery time, simple post-operative care, less intraoperative and postoperative complications and clear IOP-lowering effect. But it slong-term efficacy is still need a large sample, long-term follow-up to verify.

Combined surgery versus cataract surgery alone for eyes with cataract and glaucoma

PubMed Central

Zhang, Mingjuan Lisa; Hirunyachote, Phenpan; Jampel, Henry

2016-01-01

Background Cataract and glaucoma are leading causes of blindness worldwide, and their co-existence is common in elderly people. Glaucoma surgery can accelerate cataract progression, and performing both surgeries may increase the rate of postoperative complications and compromise the success of either surgery. However, cataract surgery may independently lower intraocular pressure (IOP), which may allow for greater IOP control among patients with co-existing cataract and glaucoma. The decision between undergoing combined glaucoma and cataract surgery versus cataract surgery alone is complex. Therefore, it is important to compare the effectiveness of these two interventions to aid clinicians and patients in choosing the better treatment approach. Objectives To assess the relative effectiveness and safety of combined surgery versus cataract surgery (phacoemulsification) alone for co-existing cataract and glaucoma. The secondary objectives include cost analyses for different surgical techniques for co-existing cataract and glaucoma. Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2014, Issue 10), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to October 2014), EMBASE (January 1980 to October 2014), PubMed (January 1948 to October 2014), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to October 2014), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 3 October 2014. We checked the reference lists of the included trials to identify further relevant trials. We used the Science Citation Index to search for references to publications that cited the studies included in the review. We also contacted investigators and experts in the field to identify additional trials. Selection criteria We included randomized controlled trials (RCTs) of participants who had open-angle, pseudoexfoliative, or pigmentary glaucoma and age-related cataract. The comparison of interest was combined cataract surgery (phacoemulsification) and any type of glaucoma surgery versus cataract surgery (phacoemulsification) alone. Data collection and analysis Two review authors independently assessed study eligibility, collected data, and judged risk of bias for included studies. We used standard methodological procedures expected by the Cochrane Collaboration. Main results We included nine RCTs, with a total of 655 participants (657 eyes), and follow-up periods ranging from 12 to 30 months. Seven trials were conducted in Europe, one in Canada and South Africa, and one in the United States. We graded the overall quality of the evidence as low due to observed inconsistency in study results, imprecision in effect estimates, and risks of bias in the included studies. Glaucoma surgery type varied among the studies: three studies used trabeculectomy, three studies used iStent® implants, one study used trabeculotomy, and two studies used trabecular aspiration. All of these studies found a statistically significant greater decrease in mean IOP postoperatively in the combined surgery group compared with cataract surgery alone; the mean difference (MD) was -1.62 mmHg (95% confidence interval (CI) -2.61 to -0.64; 489 eyes) among six studies with data at one year follow-up. No study reported the proportion of participants with a reduction in the number of medications used after surgery, but two studies found the mean number of medications used postoperatively at one year was about one less in the combined surgery group than the cataract surgery alone group (MD -0.69, 95% CI -1.28 to -0.10; 301 eyes). Five studies showed that participants in the combined surgery group were about 50% less likely compared with the cataract surgery alone group to use one or more IOP-lowering medications one year postoperatively (risk ratio (RR) 0.47, 95% CI 0.28 to 0.80; 453 eyes). None of the studies reported the mean change in visual acuity or visual fields. However, six studies reported no significant differences in visual acuity and two studies reported no significant differences in visual fields between the two intervention groups postoperatively (data not analyzable). The effect of combined surgery versus cataract surgery alone on the need for reoperation to control IOP at one year was uncertain (RR 1.13, 95% CI 0.15 to 8.25; 382 eyes). Also uncertain was whether eyes in the combined surgery group required more interventions for surgical complications than those in the cataract surgery alone group (RR 1.06, 95% CI 0.34 to 3.35; 382 eyes). No study reported any vision-related quality of life data or cost outcome. Complications were reported at 12 months (two studies), 12 to 18 months (one study), and two years (four studies) after surgery. Due to the small number of events reported across studies and treatment groups, the difference between groups was uncertain for all reported adverse events. Authors' conclusions There is low quality evidence that combined cataract and glaucoma surgery may result in better IOP control at one year compared with cataract surgery alone. The evidence was uncertain in terms of complications from the surgeries. Furthermore, this Cochrane review has highlighted the lack of data regarding important measures of the patient experience, such as visual field tests, quality of life measurements, and economic outcomes after surgery, and long-term outcomes (five years or more). Additional high-quality RCTs measuring clinically meaningful and patient-important outcomes are required to provide evidence to support treatment recommendations. PMID:26171900

Effect of steepest-meridian clear corneal incision for reducing preexisting corneal astigmatism using a meridian-marking method or surgeon's intuition.

PubMed

Hayashi, Ken; Yoshida, Motoaki; Yoshimura, Koichi

2014-12-01

To compare the effect of steepest-meridian clear corneal incisions (CCIs) for reducing preexisting corneal astigmatism between a meridian-marking method and a surgeon's-intuition method. Hayashi Eye Hospital, Fukuoka, Japan. Randomized controlled trials. Eyes scheduled for phacoemulsification were randomized to 1 of 2 groups: a 2.65 mm steepest-meridian CCI using the meridian-marking method or a 2.65 mm steepest-meridian CCI using the surgeon's intuition. Regular and irregular corneal astigmatism, surgically induced astigmatism (SIA) vector, refractive status, higher-order aberrations (HOAs), uncorrected (UDVA) and corrected (CDVA) distance visual acuities, and physical meridian misalignment of the steepest-meridian CCI measured using anterior segment optical coherence tomography were evaluated preoperatively and 1 month and 3 months postoperatively. The mean meridian misalignment of the steepest-meridian CCIs was significantly smaller in the meridian-marking group (4.4 degrees ± 2.8 [SD]) than in the surgeon's-intuition group (8.6 ± 4.4 degrees) (P ≤.0001). Regular and irregular corneal astigmatism and corneal HOAs did not change significantly postoperatively in either group. No significant difference was found in regular or irregular corneal astigmatism, refractive cylinder, manifest spherical equivalent value, SIA, HOAs, UDVA, or CDVA between the meridian-marking group and the surgeon's-intuition group throughout the follow-up. The physical meridian misalignment of steepest-meridian CCI was significantly smaller with the meridian-marking method than with the surgeon's-intuition method; however, the effect of the difference was not large enough to decrease remaining astigmatism and HOAs or to improve the UDVA. Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Changes in shape and astigmatism of total, anterior, and posterior cornea after long versus short clear corneal incision cataract surgery.

PubMed

Hayashi, Ken; Yoshida, Motoaki; Hirata, Akira; Yoshimura, Koichi

2018-01-01

To compare changes in the shape and astigmatism of the total, anterior, and posterior cornea between eyes with long-length clear corneal incisions (CCIs) and eyes with short-length CCIs in cataract surgery. Hayashi Eye Hospital, Fukuoka, Japan. Prospective case series. Both eyes of patients having phacoemulsification with temporal CCIs were randomized to have a long-length (≥1.75 mm) or short-length (<1.75 mm) CCI. Corneal astigmatic changes were decomposed to vertical/horizontal (Jackson cross-cylinder, axes at 180 degrees and 90 degrees [J0]) and oblique changes (Jackson cross-cylinder, axes at 45 degrees and 135 degrees [J45]) using power vector analysis. Corneal shape changes were assessed using the average of the difference map on videokeratography 2 days and 2, 4, and 8 weeks postoperatively. The mean J0 and J45 values of the total cornea in the 120 eyes evaluated were significantly greater in the long CCI group than in the short CCI group at all follow-ups (P ≤ .0290). The videokeratography showed a wedge-shaped flattening in the total and anterior cornea and a steepening in the posterior cornea around the CCI 2 days postoperatively in both groups. This wound-related flattening of the total and anterior cornea rapidly reduced but persisted until 8 weeks, whereas the steepening of the posterior cornea disappeared within 4 weeks. These changes extended closer to the central cornea in the long CCI group than in the short CCI group. Corneal astigmatic changes were significantly greater after long CCI than after short CCI. The wound-related shape changes occurred immediately postoperatively but rapidly diminished. Copyright © 2018 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Intraocular pressure elevation after cataract surgery and its prevention by oral acetazolamide in eyes with pseudoexfoliation syndrome.

PubMed

Hayashi, Ken; Yoshida, Motoaki; Sato, Tatsuhiko; Manabe, Shin-Ichi; Yoshimura, Koichi

2018-02-01

To examine whether intraocular pressure (IOP) increases immediately after cataract surgery in eyes with pseudoexfoliation (PXF) syndrome and to assess whether orally administered acetazolamide can prevent the IOP elevation. Hayashi Eye Hospital, Fukuoka, Japan. Prospective case series. Patients with PXF syndrome scheduled for phacoemulsification were randomly assigned to 1 of 3 groups: (1) oral acetazolamide administered 1 hour preoperatively (preoperative administration group), (2) administered 3 hours postoperatively (postoperative administration group), and (3) not administered (no administration group). The IOP was measured using a rebound tonometer 1 hour preoperatively, upon completion of surgery, and at 1, 3, 5, 7, and 24 hours postoperatively. The study comprised 96 patients (96 eyes). The mean IOP increased at 3, 5, and 7 hours postoperatively in all groups. At 1 hour and 3 hours postoperatively, the IOP was significantly lower in the preoperative administration group than in the postoperative group and no administration group (P ≤ .001). At 5, 7, and 24 hours postoperatively, the IOP was significantly lower in the preoperative group and postoperative administration group than in the no administration group (P ≤. 045). An IOP spike higher than 25 mm Hg occurred less frequently in the preoperative administration group than in the postoperative administration group and the no administration group (P = .038). Intraocular pressure increased at 3, 5, and 7 hours after cataract surgery in eyes with PXF syndrome. Oral acetazolamide administered 1 hour preoperatively reduced the IOP elevation throughout the 24-hour follow-up; acetazolamide administered 3 hours postoperatively reduced the elevation at 5 hours postoperatively and thereafter. Copyright © 2018 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Changes in corneal astigmatism during 20 years after cataract surgery.

PubMed

Hayashi, Ken; Manabe, Shin-Ichi; Hirata, Akira; Yoshimura, Koichi

2017-05-01

To examine how corneal astigmatism changes with age over 20 years after cataract surgery and to assess whether the changes differ from those in eyes that did not have surgery. Hayashi Eye Hospital, Fukuoka, Japan. Retrospective case study. Using an autokeratometer, corneal astigmatism was measured preoperatively, at baseline (the day the surgically induced astigmatism stabilized), and 10 years and 20 years after baseline. The change in corneal astigmatism between baseline and 10 years, 10 years and 20 years, and baseline and 20 years was determined using power vector analysis and compared between the time intervals and between groups. The study assessed 74 eyes that had phacoemulsification with a horizontal scleral incision more than 21 years ago (surgery group) and 68 eyes that did not have surgery (no-surgery group). The mean vertical/horizontal change in corneal astigmatism (J0) between baseline and 20 years was -0.64 diopter (D) in the surgery group and -0.49 D in the no-surgery group. The oblique change (J45) was -0.03 D in the surgery group and 0.07 D in the no-surgery group. Using multivariate comparison, the mean J0 and J45 values were not significantly different between baseline and 10 years or between 10 years and 20 years in both groups (P ≥ .2350). The J0 and J45 values were not significantly different between the 2 groups at any time interval (P ≥ .1331). Corneal astigmatism continues to change toward against-the-rule astigmatism over 20 years after cataract surgery. This change was similar in eyes that did not have surgery. Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Comparative evaluation of toric intraocular lens alignment and visual quality with image-guided surgery and conventional three-step manual marking.

PubMed

Titiyal, Jeewan S; Kaur, Manpreet; Jose, Cijin P; Falera, Ruchita; Kinkar, Ashutosh; Bageshwar, Lalit Ms

2018-01-01

To compare toric intraocular lens (IOL) alignment assisted by image-guided surgery or manual marking methods and its impact on visual quality. This prospective comparative study enrolled 80 eyes with cataract and astigmatism ≥1.5 D to undergo phacoemulsification with toric IOL alignment by manual marking method using bubble marker (group I, n=40) or Callisto eye and Z align (group II, n=40). Postoperatively, accuracy of alignment and visual quality was assessed with a ray tracing aberrometer. Primary outcome measure was deviation from the target axis of implantation. Secondary outcome measures were visual quality and acuity. Follow-up was performed on postoperative days (PODs) 1 and 30. Deviation from the target axis of implantation was significantly less in group II on PODs 1 and 30 (group I: 5.5°±3.3°, group II: 3.6°±2.6°; p =0.005). Postoperative refractive cylinder was -0.89±0.35 D in group I and -0.64±0.36 D in group II ( p =0.003). Visual acuity was comparable between both the groups. Visual quality measured in terms of Strehl ratio ( p <0.05) and modulation transfer function (MTF) ( p <0.05) was significantly better in the image-guided surgery group. Significant negative correlation was observed between deviation from target axis and visual quality parameters (Strehl ratio and MTF) ( p <0.05). Image-guided surgery allows precise alignment of toric IOL without need for reference marking. It is associated with superior visual quality which correlates with the precision of IOL alignment.

Nd:YAG vitreolysis and pars plana vitrectomy: surgical treatment for vitreous floaters.

PubMed

Delaney, Y M; Oyinloye, A; Benjamin, L

2002-01-01

To determine the efficacy of Nd:YAG vitreolysis and pars plana vitrectomy in the treatment of vitreous floaters. This is a single centre retrospective study of 31 patients (42 eyes) who underwent 54 procedures, Nd:YAG vitreolysis or pars plana vitrectomy, for the treatment of vitreous floaters between January 1992 and December 2000. Main outcome measures were percentage symptomatic improvement following treatment and incidence of post-operative complications. Statistical analysis was performed using the Fisher exact test. Posterior vitreous detachment was the primary cause of floaters in all 42 eyes with co-existing vitreous veils in three eyes and asteroid hyalosis in two eyes. Thirty-nine of 42 eyes received Nd:YAG vitreolysis. Thirty-eight percent found Nd:YAG vitreolysis moderately improved their symptoms while 61.5% found no improvement. After an average of 14.7 months follow-up no post-operative complications were recorded. Fifteen eyes underwent a pars plana vitrectomy, one with combined phacoemulsification and posterior chamber implantation and 11 following unsuccessful laser vitreolysis. Pars plana vitrectomy resulted in full resolution of symptoms in 93.3% of eyes. One patient developed a post-operative retinal detachment which was successfully treated leaving the patient with 6/5 VA. Patients' symptoms from vitreous floaters are often underestimated resulting in no intervention. This paper shows Nd:YAG vitreolysis to be a safe but only moderately effective primary treatment conferring clinical benefit in one third of patients. Pars plana vitrectomy, while offering superior results, should be reserved for patients who remain markedly symptomatic following vitreolysis, until future studies further clarify its role in the treatment of patients with floaters and posterior vitreous detachment.

ELISA-Confirmed Bilateral Ocular Toxocariasis with Different Features.

PubMed

Lee, Tae Hee; Ji, Yong Sok; Lee, Seung Hyun

2015-08-01

To report a rare case of bilateral ocular toxocariasis with a different clinical presentation in each eye. A 56-year-old man presented with severe ocular pain and acute visual loss in the right eye (RE). His best-corrected visual acuity was hand motion in the RE and 20/30 in the left eye (LE). Slit-lamp examination showed a severe anterior chamber reaction in the RE and a moderate anterior chamber reaction in the LE. The fundus of the LE showed a posterior hemorrhagic granuloma with vascular sheathing whereas the fundus of the RE was not visible because of severe vitreous opacification. Blood laboratory testing disclosed hyperproduction of IgE but no eosinophilia. Serum enzyme-linked immunosorbent assay testing was positive for Toxocara canis IgG (1:38). Toxocara antibody was also detected in the aqueous humor from both eyes (RE, 1:321; LE, 1:254). The patient was treated with topical and oral steroids along with oral albendazole. Additionally, phacoemulsification, a therapeutic vitrectomy, and vitreous cultures were performed in the RE. During the vitrectomy, the fundus of the RE showed diffuse retinal vascular obstruction with sheathing. Toxocara antibodies were detected in the vitreous fluid from the RE (1:679). A laser barrier was placed around the granuloma in the LE. After 1 month of steroid therapy, a tapering schedule was started. At 6 months postoperatively, the fundi of both eyes were stable. The final best-corrected visual acuity was 8/20 in the RE and 20/20 in the LE. A rare case of bilateral ocular toxocariasis is reported with a different clinical presentation in each eye that was diagnosed using enzyme-linked immunosorbent assay analysis of intraocular fluids. Both eyes were successfully treated medically with a vitrectomy eventually being required in the RE.

A randomized, masked comparison of topical ketorolac 0.4% plus steroid vs steroid alone in low-risk cataract surgery patients.

PubMed

Wittpenn, John R; Silverstein, Steven; Heier, Jeffrey; Kenyon, Kenneth R; Hunkeler, John D; Earl, Melissa

2008-10-01

To evaluate whether adding perioperative topical ketorolac tromethamine 0.4% improves cataract surgery outcomes relative to topical steroids alone in patients without known risk factors for cystoid macular edema (CME). Prospective, randomized, investigator-masked, multicenter clinical trial. Patients scheduled to undergo phacoemulsification and with no recognized CME risks (diabetic retinopathy, retinal vascular disease, or macular abnormality) were randomized to receive either prednisolone acetate 1% 4 times daily (QID) alone (steroid group; n = 278) or prednisolone 1% QID plus ketorolac 0.4% QID (ketorolac/steroid group; n = 268) for approximately four weeks postoperatively. In the ketorolac/steroid group, patients also received topical ketorolac 0.4% QID for three days preoperatively. In both groups, patients received four doses of ketorolac 0.4% one hour before surgery. Patients with capsular disruption or vitreous loss intraoperatively were exited from the study. Outcome measures included CME incidence, retinal thickness as measured by optical coherence tomography (OCT), best-corrected visual acuity, and contrast sensitivity. No patients in the ketorolac/steroid group and five patients in the steroid group had clinically apparent CME (P = .032). Based on OCT, no ketorolac/steroid patient had definite or probable CME, compared with six steroid patients (2.4%; P = .018). In the ketorolac/steroid group, mean retinal thickening was less (3.9 microm vs 9.6 microm; P = .003), and fewer patients had retinal thickening of more than 10 microm as compared with the steroid group (26% vs 51%; P < .001). This study suggests that adding perioperative ketorolac to postoperative prednisolone significantly reduces the incidences of CME and macular thickening in cataract surgery patients already at low risk for this condition.

Toxic anterior segment syndrome caused by autoclave reservoir wall biofilms and their residual toxins.

PubMed

Sorenson, Andrew L; Sorenson, Robert L; Evans, David J

2016-11-01

To identify etiology of toxic anterior segment syndrome (TASS) after uneventful phacoemulsification. EyeMD Laser and Surgery Center, Oakland, California. Retrospective case series. Patient charts with TASS were reviewed. Reservoirs of 2 autoclaves associated with these cases were cultured for bacterial contamination. Cultures were performed on 23 other autoclave reservoirs at surgery centers in the local area. The main outcome measures were the incidence of TASS and prevalence of bacterial biofilm contamination of autoclave reservoirs. From 2010 to 2013, 11 935 consecutive cataract surgeries were performed at 1 center by multiple surgeons with no reported TASS. Between January 1, 2014, and January 15, 2015, 10 cases of TASS occurred out of 3003 cataract surgeries; these patients' charts were reviewed. Cultures of 2 Statim autoclave reservoir walls grew Bacillus species, Williamsia species, Mycobacterium mucogenicum, and Candida parapsilosis. Scanning electron microscopy of reservoir wall sections showed prominent biofilm. The 2 autoclaves were replaced in January 2015. Subsequently, 2875 cataract surgeries were performed with no reported TASS (P < .001, χ 2 test). Eighteen of 23 additional regional autoclaves were also contaminated with bacterial biofilms. Toxic anterior segment syndrome was strongly associated with bacterial biofilm contamination of autoclave reservoirs. An etiological mechanism might involve transport of heat-stable bacterial cell antigens in the steam with deposition on surgical instrumentation. Data suggest widespread prevalence of bacterial biofilms on fluid-reservoir walls, despite adherence to manufacturer guidelines for cleaning and maintenance. Prevention or elimination of autoclave fluid-reservoir biofilms might reduce the risk for postoperative TASS. None of the authors has a financial or proprietary interest in any material or method mentioned. Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Effect of cataract surgery on retinal nerve fiber layer thickness parameters using scanning laser polarimetry (GDxVCC)

PubMed Central

Dada, Tanuj; Behera, Geeta; Agarwal, Anand; Kumar, Sanjeev; Sihota, Ramanjit; Panda, Anita

2010-01-01

Purpose: To study the effect of cataract extraction on the retinal nerve fiber layer (RNFL) thickness, and assessment by scanning laser polarimetry (SLP), with variable corneal compensation (GDx VCC), at the glaucoma service of a tertiary care center in North India. Materials and Methods: Thirty-two eyes of 32 subjects were enrolled in the study. The subjects underwent RNFL analysis by SLP (GDx VCC) before undergoing phacoemulsification cataract extraction with intraocular lens (IOL) implantation (Acrysof SA 60 AT) four weeks following cataract surgery. The RNFL thickness parameters evaluated both before and after surgery included temporal, superior, nasal, inferior, temporal (TSNIT) average, superior average, inferior average, and nerve fiber index (NFI). Results: The mean age of subjects was 57.6 ± 11.7 years (18 males, 14 females). Mean TSNIT average thickness (μm) pre- and post-cataract surgery was 49.2 ± 14.1 and 56.5 ± 7.6 (P = 0.001). There was a statistically significant increase in RNFL thickness parameters (TSNIT average, superior average, and inferior average) and decrease in NFI post-cataract surgery as compared to the baseline values. Mean NFI pre- and post-cataract surgery was 41.3 ± 15.3 and 21.6 ± 11.8 (P = 0.001). Conclusions: Measurement of RNFL thickness parameters by scanning laser polarimetry is significantly altered following cataract surgery. Post the cataract surgery, a new baseline needs to be established for assessing the longitudinal follow-up of a glaucoma patient. The presence of cataract may lead to an underestimation of the RNFL thickness, and this should be taken into account when analyzing progression in a glaucoma patient. PMID:20689193

Toric Intraocular Lens for Astigmatism Correction in Cataract Patients.

PubMed

Razmjoo, Hassan; Ghoreishi, Mohammad; Milasi, Azadeh Mohammadi; Peyman, Alireza; Jafarzadeh, Zahra; Mohammadinia, Mohadeseh; Kobra, Nasrollahi

2017-01-01

To assess the clinical consequences of AcrySof toric intraocular lens (IOL) and Hoya toric IOL implantation to correct preexisting corneal astigmatism in patients undergoing cataract surgery. In this study, we examined 55 eyes of 45 patients with at least 1.00 D corneal astigmatism who were scheduled for cataract surgery. After phacoemulsification, toric IOL was inserted and axis was aligned. We observed the patients, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), keratometry, manifest refraction, and IOL axis alignment 6 months after surgery. After 6 months, the UDVA was 0.17 ± 0.17 logMAR in the AcrySof group and 0.17 ± 0.18 logMar in the Hoya group. More than 78% of eyes in the AcrySof group and 80% of eyes in the Hoya toric IOL achieved a UDVA of 20/40 or better. In the AcrySof group, the mean preoperative corneal astigmatism was 2.73 ± 0.92 D. The mean postoperative refractive astigmatism was 0.84 ± 0.63 D. In the Hoya group, the preoperative corneal astigmatism was 2.58 ± 0.76 D and the postoperative refractive astigmatism was 0.87 ± 0.66 D ( P < 0.05). The mean AcrySof IOL axis rotation was 1.88° ± 3.05°. In the Hoya group, the mean axis rotation was 1.53° ± 3.66°. All changes in visual and refractive data before and after surgery were statistically significant ( P < 0.05). There was no significant difference between the two groups regarding refractive and visual outcome after surgery ( P > 0.05 for all). Implantation of AcrySof toric IOL and Hoya toric IOL was an effective way to correct preexisting corneal astigmatism in cataract surgery.

Implantation of a customized toric intraocular lens for correction of post-keratoplasty astigmatism

PubMed Central

Srinivasan, S; Ting, D S J; Lyall, D A M

2013-01-01

Purpose To report visual and refractive outcomes, and endothelial cell loss following primary and secondary ‘piggyback' toric intraocular lens (IOL) implantation in patients with high post-penetrating keratoplasty (PK) astigmatism. Methods Prospective case series. Nine eyes of nine patients with post-PK astigmatism were consecutively recruited for implantation of a customized toric IOL. Six underwent simultaneous phacoemulsification (PE) and three pseudophakic eyes had a secondary ‘piggyback' toric IOL implanted in the ciliary sulcus. Mean follow-up time was 17.2±7.7 months. Pre- and post-operative uncorrected (UDVA) and best-corrected (BDVA) distance visual acuities and refractive errors were collected for comparison. Cartesian astigmatic vectors were calculated to identify a change in the magnitude of astigmatism pre- compared to postoperatively. Pre- and post-operative endothelial cell counts were also collected for analysis. Results UDVA (logMAR) improved from 1.13±0.51 preoperatively to 0.48±0.24 postoperatively (P-value=0.003). There was no significant change in BDVA (P-value=0.905) from 0.31±0.27 to 0.26±0.19. Corneal astigmatism preoperatively was 6.57±4.40 diopters (D). Post-operative refractive cylinder was 0.83±1.09 D compared to 3.89±4.01 D preoperatively (P=0.039). Analysis of astigmatic Cartesian x and y coordinates found a significant reduction postoperatively compared to preoperatively (P=0.005 and P=0.002), respectively. Mean endothelial cell loss was 9.9%. Conclusion: Implantation of a customized primary or secondary ‘piggyback' toric IOL serves as an effective modality in treating patients with high post-PK astigmatism. PMID:23348728

Comparison of toric intraocular lenses and peripheral corneal relaxing incisions to treat astigmatism during cataract surgery.

PubMed

Mingo-Botín, David; Muñoz-Negrete, Francisco José; Won Kim, Hae Ryung; Morcillo-Laiz, Rafael; Rebolleda, Gema; Oblanca, Noelia

2010-10-01

To evaluate and compare toric intraocular lens (IOL) implantation and spherical IOL implantation with peripheral corneal relaxing incisions to manage astigmatism during phacoemulsification. Ophthalmology Service, Hospital Ramón y Cajal, Madrid, Spain. Prospective randomized comparative case series. Eyes with cataract and corneal astigmatism (1.00 to 3.00 diopters [D]) had toric IOL implantation or peripheral corneal relaxing incisions. Outcome measures were visual outcomes, slitlamp assessment, digital toric IOL axis determination, spectacle need, and patient satisfaction. Three months postoperatively, the mean uncorrected distance visual acuity (UDVA) was 0.13 ± 0.10 (SD) in the toric IOL group and 0.19 ± 0.12 in the relaxing incisions group; the UDVA was better than 0.20 in 75% of eyes and 60% of eyes, respectively. Refractive cylinder decreased significantly in both groups, with a mean residual refractive astigmatism of 0.61 ± 0.41 D in the toric IOL group and 1.32 ± 0.60 D in the relaxing incisions group (P<.01). The mean toric IOL rotation was 3.65 ± 2.96 degrees, with no significant differences between slitlamp and digital photograph measurements. There was a trend toward better mesopic contrast sensitivity with glare in the toric IOL group. There were no differences in VF-14 or patient satisfaction results; 15% of patients in the toric IOL group and 45% in the relaxing-incision group required distance spectacles postoperatively. Although refractive astigmatism decreased in both groups, toric IOL implantation was more effective and predictable, resulting in greater spectacle independence. Copyright © 2010 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Wound stability and surgically induced corneal astigmatism after transconjunctival single-plane sclerocorneal incision cataract surgery.

PubMed

Hayashi, Ken; Ogawa, Soichiro; Yoshida, Motoaki; Yoshimura, Koichi

2017-01-01

To compare intraocular pressure (IOP) immediately after cataract surgery, and surgically induced corneal astigmatism (SIA) and corneal shape changes between eyes with transconjunctival single-plane sclerocorneal incisions (TSSIs) and eyes with clear corneal incisions (CCIs). Bilateral eyes of 64 patients undergoing phacoemulsification were randomized to undergo 2.4-mm temporal TSSI or CCI. IOP was measured preoperatively, and in the immediate postoperative periods. SIA was determined using vector analysis, and corneal shape changes and irregular astigmatism were evaluated using a videokeratography preoperatively, and in the early postoperative periods. Wound hydration was performed in 23 eyes (35.9 %) of the TSSI group and in 60 (93.8 %) of the CCI group (P < 0.0001). Mean IOP was significantly higher in the TSSI group than in the CCI group at 30, 60, and 120 min postoperatively (P ≤ 0.0179). SIA tended to be smaller in the TSSI group than the CCI group, but the difference was not significant. The higher order irregular astigmatism was smaller in the TSSI group than in the CCI group at 2 days (P = 0.0312). The videokeratography revealed a wound-related flattening postoperatively in both groups; this change disappeared within 4 weeks in the TSSI group, whereas it persisted until 12 weeks in the CCI group. IOP was significantly higher immediately after TSSI than after CCI and required less wound hydration, suggesting better stability with TSSI. Higher order irregular astigmatism and wound-related corneal flattening were smaller after TSSI than after CCI in the early periods, suggesting that fewer corneal shape changes with TSSI.

Influence of posterior corneal astigmatism on postoperative refractive astigmatism in pseudophakic eyes after cataract surgery.

PubMed

Sano, Maki; Hiraoka, Takahiro; Ueno, Yuta; Itagaki, Hideo; Ogami, Tomohiro; Oshika, Tetsuro

2016-12-01

To examine the influence of posterior corneal astigmatism on postoperative refractive astigmatism in pseudophakic eyes after cataract surgery. The study enrolled 64 pseudophakic eyes of 50 patients (71.8 ± 9.9 years old, mean ± standard deviation) who had undergone phacoemulsification with non-toric IOL implantation. Refractive astigmatism was measured using an auto ref-keratometer with a 0.01- diopter (D) scale. Two types of corneal astigmatism were calculated using anterior segment optical coherence tomography; keratometric and total corneal astigmatism. Keratometric astigmatism was obtained based on anterior corneal curvature alone and total corneal astigmatism was calculated using both anterior and posterior corneal curvatures. The difference between refractive and corneal astigmatism was computed as the vector difference using 1) refractive and keratometric astigmatism and 2) refractive and total corneal astigmatism. The mean refractive, keratometric, and total corneal astigmatism was 0.92 ± 0.48 D, 0.87 ± 0.44 D, and 0.94 ± 0.46 D, respectively. The difference between refractive and keratometric astigmatism (0.70 ± 0.40 D, mean vector of 0.30 D axis 164°) was significantly larger than the difference between refractive and total corneal astigmatism (0.63 ± 0.38 D, mean vector of 0.12 D axis 137°) (P = .019). The difference between refractive and total corneal astigmatism, calculated using both anterior and posterior corneal curvatures, was significantly smaller than the difference between refractive and keratometric astigmatism using anterior corneal astigmatism alone, implying that the latter overestimates the true postoperative refractive astigmatism and can cause cylindrical inaccuracy after cataract surgery.

Comparison of astigmatism correction using either peripheral corneal relaxing incisions or toric intraocular lenses.

PubMed

Muftuoglu, Ilkay Kilic; Aydin Akova, Yonca; Aksoy, Sibel; Unsal, Erkan

2016-01-01

To compare the efficacy and short-term stability of toric intraocular lenses (tIOL) and peripheral cornea relaxing incisions (PCRI) during phacoemulsification. Patients with preexisting corneal astigmatism had cataract surgery either with tIOL (AcrySof Toric) (39 eyes of 35 patients) or standard intraocular lens (AcrySof) + PCRIs (38 eyes of 33 patients). Patients were retrospectively evaluated for manifest refraction, corneal topography, and uncorrected and corrected visual acuities preoperatively and at postoperative 1 and 6 months. The Alpins vectorial method was used to analyze the target induced astigmatism (TIA) and surgically induced astigmatism (SIA), magnitude of error (the difference between the magnitude of SIA and TIA) (ME), and correction index. Mean preoperative corneal astigmatism was 2.21 ± 1.32 D in the tIOL group and 2.24 ± 0.96 D in the PCRI group; the difference was not significant. The decrease in astigmatism was significant in both groups at last follow-up (64% tIOL group, 32% PCRI group, p<0.01, Wilcoxon signed rank test). The mean remaining refractive astigmatism was significantly higher in the PCRI group than in the tIOL group at 1-month (1.42 ± 1.22, 0.89 ± 0.68, respectively) and 6-month follow-ups (1.75 ± 1.37 D, 0.92 ± 0.72, respectively) (p<0.01). The mean ME was significantly lower (-0.35 versus -0.88) with a higher correction index (0.96 versus 0.56) in the tIOL group at 6 months postoperatively. Both tIOL implantation and using PCRI were effective methods to reduce preoperative astigmatism at the time of the cataract surgery. However, tIOLs provided better remaining astigmatism with a more stable refraction than PCRI.

Economic considerations related to choice of intraocular lens (IOL) and posterior capsule opacification frequency - a comparison of three different IOLs.

PubMed

Cullin, Felix; Busch, Tobias; Lundström, Mats

2014-03-01

To evaluate the posterior capsule opacification (PCO) rates in three different modern standard intraocular lenses (IOL) and analyse the related cost. Retrospective study of medical records from 1527 patients who underwent uneventful cataract surgery by phacoemulsification with posterior chamber implantation of either AcrySof SN60 (n = 375), Akreos Adapt (n = 350) or Tecnis Acryl IOL (n = 801). All surgeries were performed by the same surgeon using the same surgical technique and equipment. Primary end-point was neodymium:yttrium-aluminium-garnet (Nd:YAG) capsulotomy for visual impairment secondary to PCO. Cost of IOL material and Nd:YAG capsulotomy for PCO was then evaluated and compared between the IOLs. Mean follow-up was 41.5 months, and the only statistically significant variable of developing PCO was IOL type and individual follow-up time. Nd:YAG capsulotomy was performed in 7.47% in the AcrySof group, 17.71% in the Akreos group and 3.75% in the Tecnis group. Average cost for Nd:YAG capsulotomy per surgery was €18.75 in the AcrySof SN60 group, €44.25 in the Akreos Adapt group and €9.25 in the Tecnis Acryl group. The combined cost of cataract surgery and PCO treatment was €9.81 higher in for the Akreos Adapt group than the other two combined. This retrospective study shows that the risk of PCO and Nd:YAG capsulotomy is significantly higher in hydrophilic Akreos IOL compared with both AcrySof and Tecnis hydrophobic IOLs. The increased risk of PCO in the hydrophilic IOL is related to higher total average costs for cataract surgery. © 2012 The Authors. Acta Ophthalmologica © 2012 Acta Ophthalmologica Scandinavica Foundation.

Adhesion of lens capsule to intraocular lenses of polymethylmethacrylate, silicone, and acrylic foldable materials: an experimental study

PubMed Central

Oshika, T.; Nagata, T.; Ishii, Y.

1998-01-01

AIMS—To investigate the adhesion characteristics of several intraocular lenses (IOLs) to the simulated and rabbit lens capsule.
METHODS—Adhesive force to bovine collagen sheets was measured in water with polymethylmethacrylate (PMMA), three piece silicone, and acrylic foldable IOLs. In rabbit eyes, phacoemulsification and IOL implantation were performed. Three weeks later, adhesion between the anterior/posterior capsules and IOL optic was tested, and the capsule was examined histologically.
RESULTS—The mean adhesive force to the collagen sheet was 1697 (SD 286) mg for acrylic foldable, 583 (49) mg for PMMA, and 0 mg for silicone IOLs (p=0.0003, Kruskal-Wallis test). Scores (0-5) of adhesion between rabbit anterior capsule and IOL optic were 4.50 (0.55) for acrylic foldable, 3.20 (0.84) for PMMA, and 0.40 (0.55) for silicone IOLs (p=0.004). Scores between rabbit posterior capsule and IOL optic displayed a similar tendency; 4.50 (0.84) for acrylic foldable, 3.00 (1.00) for PMMA, and 0.40 (0.55) for silicone IOLs (p=0.021). Histological observation indicated that the edge of IOL optic suppressed the migration of lens epithelial cells towards the centre of the posterior capsule. This inhibitory effect was most pronounced with acrylic foldable IOL and least with silicone IOL.
CONCLUSIONS—The acrylic foldable IOL adhered to the lens capsule more than the PMMA IOL, and the silicone IOL showed no adhesiveness. These differences seem to play a role in preventing lens epithelial cells from migrating and forming posterior capsule opacification.

 Keywords: intraocular lens; lens capsule; posterior capsule opacification; adhesion PMID:9713064

THE ADVANTAGES OF FEMTOSECOND LASER-ASSISTED CATARACT SURGERY

PubMed Central

Gavris, M Monica; Belicioiu, Roxana; Olteanu, Ioana; Horge, Ioan

2015-01-01

Purpose: To present the advantages of performing femtosecond laser-assisted (Alcon-LenSx Inc.) cataract surgery. Methods: Cataract surgery was performed with the LenSx femtosecond laser (Alcon-LenSx Inc.) in 50 eyes of 50 patients. The laser was programmed to perform a 4,9-4,5 mm capsulorhexis, a 2,3 mm main corneal incision, two 1,3 mm side-port incisions and either a hybrid-pattern or a cylinder-pattern fragmentation of the nucleus. The evaluated parameters were the capsulotomy, the corneal wounds and the nucleus fragmentation. Phacoemulsification of the nucleus and aspiration of the cortex were performed with the Alcon Centurion Vision System and monofocal, toric and multifocal IOLs were successfully implanted. Results: A continuous, central, curvilinear capsulorhexis was performed in 48 cases, 96% (free-floating capsulotomy). In 2 cases, micro-adhesions were reported and detached with the Utrata forceps. Femtolaser capsulotomy resulted in a complete overlap of the anterior capsule over the IOL optics in all cases. Horizontal decentration was found in 2 cases, 4% and vertical decentration in 1 case, 2%. The main corneal incision was self-sealing in 49 cases, 98%. Sutures were used in 1 case, 2%. The hybrid pattern of nucleus fragmentation was used in 42 cases, 84% and the cylindrical pattern in 8 cases, 16%. The fragmentation was incomplete in one case of white cataract and in one case of traumatic cataract. Conclusions: The main advantages of femtolaser cataract surgery are standardized corneal incisions, perfectly centered, round capsulorhexis, and lens nucleus fragmentation even in eyes with hard cataracts. The laser precision is due to the real time OCT software programs, which cover the whole anterior segment, up to the posterior lens capsule. PMID:27373114

Comparative evaluation of toric intraocular lens alignment and visual quality with image-guided surgery and conventional three-step manual marking

PubMed Central

Titiyal, Jeewan S; Kaur, Manpreet; Jose, Cijin P; Falera, Ruchita; Kinkar, Ashutosh; Bageshwar, Lalit MS

2018-01-01

Purpose To compare toric intraocular lens (IOL) alignment assisted by image-guided surgery or manual marking methods and its impact on visual quality. Patients and methods This prospective comparative study enrolled 80 eyes with cataract and astigmatism ≥1.5 D to undergo phacoemulsification with toric IOL alignment by manual marking method using bubble marker (group I, n=40) or Callisto eye and Z align (group II, n=40). Postoperatively, accuracy of alignment and visual quality was assessed with a ray tracing aberrometer. Primary outcome measure was deviation from the target axis of implantation. Secondary outcome measures were visual quality and acuity. Follow-up was performed on postoperative days (PODs) 1 and 30. Results Deviation from the target axis of implantation was significantly less in group II on PODs 1 and 30 (group I: 5.5°±3.3°, group II: 3.6°±2.6°; p=0.005). Postoperative refractive cylinder was −0.89±0.35 D in group I and −0.64±0.36 D in group II (p=0.003). Visual acuity was comparable between both the groups. Visual quality measured in terms of Strehl ratio (p<0.05) and modulation transfer function (MTF) (p<0.05) was significantly better in the image-guided surgery group. Significant negative correlation was observed between deviation from target axis and visual quality parameters (Strehl ratio and MTF) (p<0.05). Conclusion Image-guided surgery allows precise alignment of toric IOL without need for reference marking. It is associated with superior visual quality which correlates with the precision of IOL alignment. PMID:29731603

Effect of glaucoma tube shunt parameters on cornea endothelial cells in patients with Ahmed valve implants.

PubMed

Koo, Euna B; Hou, Jing; Han, Ying; Keenan, Jeremy D; Stamper, Robert L; Jeng, Bennie H

2015-01-01

The aim of this study was to assess the effect of various tube parameters on corneal endothelial cell density (ECD) after insertion of Ahmed valves. Thirty-nine eyes of 33 patients with previous superotemporal (ST) Ahmed valve implantation and 20 eyes of 13 participants with previous uncomplicated phacoemulsification and intraocular lens implantation but no history of glaucoma surgery were evaluated. Various tube parameters were measured with anterior segment optical coherence tomography. ST, central, and inferonasal (IN) ECD and pachymetry were measured. Endothelial cell loss and corneal thickness in the ST cornea was compared with those in the IN cornea. The mean age of the operated patients was 58 ± 22 years, and the mean time since glaucoma surgery was 2.5 ± 2.6 years. Thirty-two of the 39 study eyes were pseudophakic. The ECD was significantly lower in the ST endothelium than in the IN endothelium in eyes with glaucoma tube surgery (P < 0.001), although this relative reduction in ST ECD was not greater than that seen in pseudophakic control eyes (P = 0.16). In univariate analysis, tube angle relative to the cornea and distance from the tip of the tube to the cornea were significant risk factors for decreased ST endothelial cell loss when assessed relative to the IN ECD (P = 0.01 and P = 0.02, respectively). In multivariate analysis, only the distance of the tube tip to the cornea remained significantly associated with ST endothelial cell loss. Although this was a retrospective study with inherent limitations, tubes that are closer to the cornea seem to lead to increased loss of adjacent endothelial cells.

Phacoemulsification combined with a new ab interno gel stent to treat open-angle glaucoma: Pilot study.

PubMed

Sheybani, Arsham; Lenzhofer, Markus; Hohensinn, Melchior; Reitsamer, Herbert; Ahmed, Iqbal Ike K

2015-09-01

To study the effect on intraocular pressure (IOP) of implanting a new gelatin stent at the time of cataract surgery in the treatment of open-angle glaucoma (OAG). Multicenter university and private-practice settings. Nonrandomized prospective clinical trial. The implantation of 2 models of a gelatin stent (Xen140 and Xen63) was performed at the time of cataract surgery without mitomycin-C. Complete success was defined as a postoperative IOP of less than 18 mm Hg and more than a 20% reduction in IOP at 12 months without glaucoma medication. Failure was defined as loss of light perception vision or worse, a need for additional glaucoma surgery, or less than a 20% reduction in the IOP from baseline. The study included 37 eyes of 37 patients. The mean preoperative IOP was 22.4 mm Hg ± 4.2 (SD) on 2.5 ± 1.4 medication classes. Twelve months postoperatively, the mean IOP was reduced to 15.4 ± 3.0 mm Hg on 0.9 ± 1.0 medication classes (P < .0001). This resulted in a qualified success of 85.3% and a complete success rate off medications of 47.1%. There were no failures. Cataract surgery combined with implantation of the gelatin stent resulted in a significant reduction in IOP in eyes with OAG. Dr. Sheybani has received travel reimbursement from Aquesys, Inc. Dr. Ahmed is a paid consultant to Aquesys, Inc. No other author has a financial or proprietary interest in any material or method mentioned. Copyright © 2015 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

A retrospective study on the incidence of post-cataract surgery Descemet's membrane detachment and outcome of air descemetopexy.

PubMed

Odayappan, Annamalai; Shivananda, Narayana; Ramakrishnan, Seema; Krishnan, Tiruvengada; Nachiappan, Sivagami; Krishnamurthy, Smitha

2018-02-01

To study the anatomic and functional outcome of air descemetopexy in postcataract surgery Descemet's membrane detachment (DMD). Retrospective study. Setting: Institutional. Records of 112 patients who underwent air descemetopexy for postcataract surgery sight-threatening DMD at Aravind Eye Hospital, Pondicherry, between January 2013 and December 2015 were studied. Anatomical outcome refers to reattachment of the Descemet's membrane (DM). Functional outcome was given by the best-corrected visual acuity. The mean age was 66.47±8.46 (SD) years, the male to female ratio was 45:67. The incidence of DMD was more in extracapsular cataract extraction (0.26%) and manual small incision cataract surgery (0.11%) than phacoemulsification (0.04%) (p=0.005 and p<0.0001). DMD was more common among surgical trainees (0.17%) than consultants (0.07%) (p≤0.0001). After primary air descemetopexy, 78 (71%) out of the 110 patients had DM reattachment. The complications noted after descemetopexy include persistent DMD (21.8%), corneal decompensation (7.3%), appositional angle closure (18%), pupillary block with air (2.7%) and uveitis (2.7%). Age, sex and timing of intervention did not influence the reattachment rate. Fifteen patients underwent repeat air descemetopexy for persistent DMD among whom nine (60%) had successful reattachment. Almost 75% of patients had vision better than 6/18 1 month after anatomically successful descemetopexy. Air descemetopexy is a safe and efficient modality of treatment of DMD and should be tried even in patients with severe DMD before planning a major surgery like endothelial keratoplasty. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Outcomes of cataract surgery in eyes with a low corneal endothelial cell density.

PubMed

Yamazoe, Katsuya; Yamaguchi, Takefumi; Hotta, Kazuki; Satake, Yoshiyuki; Konomi, Kenji; Den, Seika; Shimazaki, Jun

2011-12-01

To evaluate the surgical outcomes of cataract surgery in eyes with a low preoperative corneal endothelial cell density (ECD) and analyze factors affecting the prognosis. Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan. Noncomparative case series. Eyes with a preoperative ECD of less than 1000 cells/mm(2) that had cataract surgery between 2006 and 2010 were identified. Standard phacoemulsification with intraocular lenses was performed using the soft-shell technique. The rate of endothelial cell loss, incidence of bullous keratopathy, and risk factors were retrospectively assessed. Sixty-one eyes (53 patients) with a low preoperative ECD were identified. Preoperative diagnoses or factors regarded as causing endothelial cell loss included Fuchs dystrophy (20 eyes), laser iridotomy (16 eyes), keratoplasty (10 eyes), traumatic injury (3 eyes), trabeculectomy (3 eyes), corneal endotheliitis (2 eyes), and other (7 eyes). The corrected distance visual acuity improved from 0.59 ± 0.49 logMAR preoperatively to 0.32 ± 0.48 logMAR postoperatively (P<.001). The mean ECD was 693 ± 172 cells/mm(2) and 611 ± 203 cells/mm(2), respectively (P=.001). The mean rate of endothelial cell loss was 11.5% ± 23.4%. Greater ECD loss was associated with a shorter axial length (AL) (<23.0 mm) and diabetes mellitus. Bullous keratopathy developed in 9 eyes (14.8%) and was associated with posterior capsule rupture. The results suggest that modern techniques for cataract surgery provide excellent visual rehabilitation in many patients with a low preoperative ECD. Shorter AL, diabetes mellitus, and posterior capsule rupture were risk factors for greater ECD loss and bullous keratopathy. Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

[Optical quality after 2.2mm microincisional cataract surgery with bimanual I/A in 154 eyes].

PubMed

Dot, C; El Chehab, H; Agard, E; Russo, A; Ract-Madoux, G; Dussart, C

2013-12-01

A prospective study to analyze the effects of 2.2mm microincisional coaxial phacoemulsification with bimanual irrigation/aspiration on the optical quality of the cornea and whole eye. We compare two groups. Group A: 102 consecutive eyes undergoing this three-incision procedure and implanted with an Alcon® SN60WF IQ aspheric intraocular lens. Astigmatism, corneal and total asphericity, as well as H/B ratio were measured by OPD scann II, Nidek®, Japan, preoperatively (Day 0), 15 days postoperatively (Day 15) and 1 month postoperatively (M1). Group B: 52 eyes with corneal astigmatism greater than 1.25D, undergoing the same procedure but implanted with a Toric IOL (Alcon® Toric IQ SN6AT), followed in the same manner but with additional follow-up at 1 year. Corneal surgically induced astigmatism (SIA) was essentially neutral: 0.065D ± 0.86 at Day 30 in group A, and 0.06D ± 0.34 at 1 month and -0.008D ± 0.4 at 12 months in group B. Corneal topographic astigmatism underwent a mean axis shift of 29.95° ± 27.6 in group A compared to 5.3° ± 3.7 in Group B, and remained stable at 1 year. Corneal asphericity did not change significantly between Day 0 and 30 in either group. H/B ratio increased significantly in both groups, with a gain of 22 % to 24 % after surgery. This three-incision procedure does not degrade the optical quality of the cornea. Postoperative shift in the axis of astigmatism is only an issue in cases of low or asymmetric astigmatism and must be kept in mind for low-power toric IOL implantation. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Management of moderate and severe corneal astigmatism with AcrySof® toric intraocular lens implantation – Our experience

PubMed Central

Farooqui, Javed Hussain; Koul, Archana; Dutta, Ranjan; Shroff, Noshir Minoo

2015-01-01

Purpose Visual performance following toric intraocular lens implantation for cataract with moderate and severe astigmatism. Setting Cataract services, Shroff Eye Centre, New Delhi, India. Design Case series. Method This prospective study included 64 eyes of 40 patients with more than 1.50 dioptre (D) of pre-existing corneal astigmatism undergoing phacoemulsification with implantation of the AcrySof® toric IntraOcular Lens (IOL). The unaided visual acuity (UCVA), best corrected visual acuity (BCVA), residual refractive sphere and refractive cylinders were evaluated. Toric IOL axis and alignment error was measured by slit lamp method and Adobe Photoshop (version 7) method. Patient satisfaction was evaluated using a satisfaction questionnaire at 3 months. Results The mean residual refractive astigmatism was 0.57 D at the final follow-up of 3 months. Mean alignment error was 3.44 degrees (SD = 2.60) by slit lamp method and 3.88 degrees (SD = 2.86) by Photoshop method. Forty-six (71.9%) eyes showed misalignment of 5 degrees or less, and 60 (93.8%) eyes showed misalignment of 10 degrees or less. The mean log MAR UCVA at 1st post-op day was 0.172 (SD = 0.02), on 7th post-op day was 0.138 (SD = 0.11), and on 30th post-op day was 0.081 (SD = 0.11). The mean log MAR BCVA at three months was −0.04 (SD = 0.76). Conclusion We believe that implantation of AcrySof® toric IOL is an effective, safe and predictable method to correct high amounts of corneal astigmatism during cataract surgery. PMID:26586976

Evaluation of rotation and visual outcomes after implantation of monofocal and multifocal toric intraocular lenses.

PubMed

Garzón, Nuria; Poyales, Francisco; de Zárate, Begoña Ortíz; Ruiz-García, Jose Luis; Quiroga, Juan Antonio

2015-02-01

To evaluate rotational stability and its influence on postoperative visual acuity of different monofocal and multifocal toric intraocular lenses (IOLs). A prospective interventional study was designed. Ninety-one patients with a mean age of 71.65 ± 11.82 years were implanted with toric IOLs after phacoemulsification. Three monofocal toric IOLs (the Lentis LT [Oculentis, Berlin, Germany], enVista [Bausch & Lomb, Rochester, NY], and AcrySof IQ [Alcon Laboratories, Inc., Fort Worth, TX]) and one multifocal toric IOL (AcrySof IQ ReSTOR; Alcon Laboratories, Inc.) were implanted. Preoperative and postoperative images were taken to calculate the misalignment due to the marking method. To evaluate rotation in the different follow-up visits, another photograph was taken 1 hour and 1, 7 and 30 days postoperatively. Refraction, uncorrected distance visual acuity (UDVA), and corrected distance visual acuity were measured 30 days postoperatively. Postoperative UDVA was 0.1 logMAR or better in 64.6% of eyes implanted with monofocal IOLs and 46.4% of eyes implanted with multifocal IOLs. The enVista toric IOL showed the best UDVA compared to the other monofocal IOLs, with 81% of eyes with 0.1 logMAR or better. The mean misalignment in the total group studied was 0.07° ± 0.60°; 69.6% of monofocal IOLs and 67.9% of multifocal IOLs showed less than 5° of rotation. A correlation was found between postoperative UDVA and rotation in the monofocal and multifocal IOLs implanted (r = 0.439 [P < .011] and = 0.787 [P = .001], respectively). At 1 month postoperatively, UDVA was slightly more affected by IOL rotation in multifocal than monofocal toric IOLs. The marking method was also effective. Copyright 2015, SLACK Incorporated.

Reliability of a Single Light Source Purkinjemeter in Pseudophakic Eyes.

PubMed

Janunts, Edgar; Chashchina, Ekaterina; Seitz, Berthold; Schaeffel, Frank; Langenbucher, Achim

2015-08-01

To study the reliability of Purkinje image analysis for assessment of intraocular lens tilt and decentration in pseudophakic eyes. The study comprised 64 eyes of 39 patients. All eyes underwent phacoemulsification with intraocular lens implanted in the capsular bag. Lens decentration and tilt were measured multiple times by an infrared Purkinjemeter. A total of 396 measurements were performed 1 week and 1 month postoperatively. Lens tilt (Tx, Ty) and decentration (Dx, Dy) in horizontal and vertical directions, respectively, were calculated by dedicated software based on regression analysis for each measurement using only four images, and afterward, the data were averaged (mean values, MV) for repeated sequence of measurements. New software was designed by us for recalculating lens misalignment parameters offline, using a complete set of Purkinje images obtained through the repeated measurements (9 to 15 Purkinje images) (recalculated values, MV'). MV and MV' were compared using SPSS statistical software package. MV and MV' were found to be highly correlated for the Tx and Ty parameters (R2 > 0.9; p < 0.001), moderately correlated for the Dx parameter (R2 > 0.7; p < 0.001), and weakly correlated for the Dy parameter (R2 = 0.23; p < 0.05). Reliability was high (Cronbach α > 0.9) for all measured parameters. Standard deviation values were 0.86 ± 0.69 degrees, 0.72 ± 0.65 degrees, 0.04 ± 0.05 mm, and 0.23 ± 0.34 mm for Tx, Ty, Dx, and Dy, respectively. The Purkinjemeter demonstrated high reliability and reproducibility for lens misalignment parameters. To further improve reliability, we recommend capturing at least six Purkinje images instead of three.

A study of initial therapy for glaucoma in southern India: India Glaucoma Outcomes and Treatment (INGOT) Study.

PubMed

Congdon, Nathan G; Krishnadas, R; Friedman, David S; Goggins, William; Ramakrishnan, R; Kader, M A; Gilbert, Donna; Tielsch, James; Quigley, Harry A

2012-06-01

To compare initial glaucoma therapy with medications and trabeculectomy in southern India. Patients aged ≥ 30 years newly diagnosed with glaucoma were randomized to trabeculectomy with 5-fluorouracil or medical therapy. Subjects with best-corrected vision <6/18 due to cataract underwent phacoemulsification (phaco/intraocular lens, IOL). Intraocular pressure (IOP), vision and visual function were assessed at 12 months. Patients assigned to medications and surgery received the expected therapy in 86% (172/199) and 64% (126/199) of cases, respectively. Forty patients (20%) assigned to surgery refused any treatment and 33 (17%) received medications. Among 199 patients randomized to medications, 52 (26.1%) underwent phaco/IOL, as did 89/199 (43.7%) of patients randomized to trabeculectomy. Baseline parameters of the two groups did not differ, nor did 1-year follow-up rates (medication 65%, trabeculectomy 58%, P = 0.15). Final IOP was lower with randomization to trabeculectomy (16.3 ± 5.1 mmHg) than medication (18.8 ± 6.7 mmHg, P < 0.0001). In regression models, randomization to trabeculectomy (P < 0.0001) was associated with lower IOP, and simultaneous trabeculectomy and cataract surgery was associated with higher IOP (P = 0.008) than trabeculectomy alone. Subjects receiving Phaco/IOL had significantly better final acuity (P < 0.0001) and visual function (P = 0.035), despite concurrent glaucoma treatment. Final visual acuity was worse in those receiving trabeculectomy in addition to cataract surgery, but this was of borderline significance (P = 0.06). Trabeculectomy lowered IOP significantly more than medical treatment, but with slightly greater loss of visual acuity. Combined phaco/IOL and trabeculectomy improved visual acuity with substantial IOP lowering.

Clinical outcome and higher order aberrations after bilateral implantation of an extended depth of focus intraocular lens.

PubMed

Pilger, Daniel; Homburg, David; Brockmann, Tobias; Torun, Necip; Bertelmann, Eckart; von Sonnleithner, Christoph

2018-04-01

The purpose of this study was to assess the clinical outcome after a bilateral implantation of an extended depth of focus intraocular lens in comparison to a monofocal intraocular lens. Department of Ophthalmology, Charité-Medical University Berlin, Germany. A total of 60 eyes of 30 patients were enrolled in this prospective, single-center study. The cataract patients underwent phacoemulsification with bilateral implantation of a TECNIS ® Symfony (Abbott Medical Optics, Santa Ana, CA, USA, 15 patients) or a TECNIS Monofocal ZCB00 (Abbott Medical Optics, Santa Ana, CA, USA, 15 patients). Postoperative evaluations were performed after 1 and 3 months, including visual acuities at far, intermediate, and near distance. Mesopic, scotopic vision, and contrast sensitivity were investigated. Aberrometry was performed using an iTrace aberrometer with a pupil scan size of 5.0 mm. After 3 months, the TECNIS Symfony group reached an uncorrected visual acuity at far distance of -0.02 logMAR compared to -0.06 logMAR in the TECNIS Monofocal group ( p = 0.03). Regarding the uncorrected vision at intermediate and near distance the following values were obtained: intermediate visual acuity -0.13 versus 0.0 logMAR (TECNIS Symfony vs TECNIS Monofocal, p = 0.001) and near visual acuity 0.11 versus 0.26 logMAR (TECNIS Symfony vs TECNIS Monofocal, p = 0.001). Low-contrast visual acuities were 0.27 versus 0.20 logMar (TECNIS Symfony vs TECNIS Monofocal, p = 0.023). The TECNIS Symfony intraocular lens can be considered an appropriate alternative to multifocal intraocular lenses because of good visual results at far, intermediate, and near distance as well as in low-contrast vision.

Use of the Posterior/Anterior Corneal Curvature Radii Ratio to Improve the Accuracy of Intraocular Lens Power Calculation: Eom's Adjustment Method.

PubMed

Kim, Mingue; Eom, Youngsub; Lee, Hwa; Suh, Young-Woo; Song, Jong Suk; Kim, Hyo Myung

2018-02-01

To evaluate the accuracy of IOL power calculation using adjusted corneal power according to the posterior/anterior corneal curvature radii ratio. Nine hundred twenty-eight eyes from 928 reference subjects and 158 eyes from 158 cataract patients who underwent phacoemulsification surgery were enrolled. Adjusted corneal power of cataract patients was calculated using the fictitious refractive index that was obtained from the geometric mean posterior/anterior corneal curvature radii ratio of reference subjects and adjusted anterior and predicted posterior corneal curvature radii from conventional keratometry (K) using the posterior/anterior corneal curvature radii ratio. The median absolute error (MedAE) based on the adjusted corneal power was compared with that based on conventional K in the Haigis and SRK/T formulae. The geometric mean posterior/anterior corneal curvature radii ratio was 0.808, and the fictitious refractive index of the cornea for a single Scheimpflug camera was 1.3275. The mean difference between adjusted corneal power and conventional K was 0.05 diopter (D). The MedAE based on adjusted corneal power (0.31 D in the Haigis formula and 0.32 D in the SRK/T formula) was significantly smaller than that based on conventional K (0.41 D and 0.40 D, respectively; P < 0.001 and P < 0.001, respectively). The percentage of eyes with refractive prediction error within ± 0.50 D calculated using adjusted corneal power (74.7%) was significantly greater than that obtained using conventional K (62.7%) in the Haigis formula (P = 0.029). IOL power calculation using adjusted corneal power according to the posterior/anterior corneal curvature radii ratio provided more accurate refractive outcomes than calculation using conventional K.

Two-speed phacoemulsification for soft cataracts using optimized parameters and procedure step toolbar with the CENTURION Vision System and Balanced Tip.

PubMed

Davison, James A

2015-01-01

To present a cause of posterior capsule aspiration and a technique using optimized parameters to prevent it from happening when operating soft cataracts. A prospective list of posterior capsule aspiration cases was kept over 4,062 consecutive cases operated with the Alcon CENTURION machine and Balanced Tip. Video analysis of one case of posterior capsule aspiration was accomplished. A surgical technique was developed using empirically derived machine parameters and customized setting-selection procedure step toolbar to reduce the pace of aspiration of soft nuclear quadrants in order to prevent capsule aspiration. Two cases out of 3,238 experienced posterior capsule aspiration before use of the soft quadrant technique. Video analysis showed an attractive vortex effect with capsule aspiration occurring in 1/5 of a second. A soft quadrant removal setting was empirically derived which had a slower pace and seemed more controlled with no capsule aspiration occurring in the subsequent 824 cases. The setting featured simultaneous linear control from zero to preset maximums for: aspiration flow, 20 mL/min; and vacuum, 400 mmHg, with the addition of torsional tip amplitude up to 20% after the fluidic maximums were achieved. A new setting selection procedure step toolbar was created to increase intraoperative flexibility by providing instantaneous shifting between the soft and normal settings. A technique incorporating a reduced pace for soft quadrant acquisition and aspiration can be accomplished through the use of a dedicated setting of integrated machine parameters. Toolbar placement of the procedure button next to the normal setting procedure button provides the opportunity to instantaneously alternate between the two settings. Simultaneous surgeon control over vacuum, aspiration flow, and torsional tip motion may make removal of soft nuclear quadrants more efficient and safer.

Porcine lens nuclei as a model for comparison of 3 ultrasound modalities regarding efficiency and chatter.

PubMed

Oakey, Zack B; Jensen, Jason D; Zaugg, Brian E; Radmall, Bryce R; Pettey, Jeff H; Olson, Randall J

2013-08-01

To validate a porcine lens model by comparing density and ultrasound (US) with known human standards using the Infiniti Ozil with Intelligent Phacoemulsification (torsional), Whitestar Signature Micropulse (longitudinal), and Ellips FX (transversal) modalities. Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. Experimental study. Lens nuclei were formalin soaked in hour-based intervals and divided into 2.0 mm cubes. Density was characterized by crushing experiments and compared with known human measures. Efficiency and chatter were examined. The mean weight to cut thickness in half ranged from 16.9 g ± 5.5 (SD) in the 0-hour group to 121.3 ± 47.5 gm in the 4-hour group. Lenses in the 2-hour group (mean 70.2 ± 19.1 g) best matched human density (P=.215). The mean efficiency ranged from 0.432 ± 0.178 seconds to 9.111 ± 2.925 seconds; chatter ranged from zero to 1.85 ± 1.927 bounces. No significant difference was detected when comparing the 2-hour formalin group with human lenses in torsional and transversal US. There was no significant difference between transversal and torsional modalities, consistent with human studies. Although longitudinal (6 milliseconds on, 12 milliseconds off) was significantly more efficient at 50% power than at 25%, there was no significant difference compared with transversal or torsional US. Animal lenses soaked for 2 hours in formalin were most comparable to human lenses. Longitudinal US may be an acceptable alternative to torsional and transversal US. Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Fluidics and heat generation of Alcon Infiniti and Legacy, Bausch & Lomb Millennium, and advanced medical optics sovereign phacoemulsification systems.

PubMed

Floyd, Michael S; Valentine, Jeremy R; Olson, Randall J

2006-09-01

To study heat generation, vacuum, and flow characteristics of the Alcon Infiniti and Bausch & Lomb Millennium with results compared with the Alcon Legacy and advanced medical optics (AMO) Sovereign machines previously studied. Experimental study. Heat generation with continuous ultrasound was determined with and without a 200-g weight. Flow and vacuum were determined from 12 to 40-ml/min in 2-ml/min steps. The impact of a STAAR Cruise Control was also tested. Millennium created the most heat/20% of power (5.67 +/- 0.51 degrees C unweighted and 6.80 +/- 0.80 degrees C weighted), followed by Sovereign (4.59 +/- 0.70 degrees C unweighted and 5.65 +/- 0.72 degrees C weighted), Infiniti (2.79 +/- 0.62 degrees C unweighted and 3.96 +/- 0.31 degrees C weighted), and Legacy (1.99 +/- 0.49 degrees C unweighted and 4.27 +/- 0.76 degrees C weighted; P < .0001 for all comparisons between machines except Infiniti vs Legacy, both weighted). Flow studies revealed that Millennium Peristaltic was 17% less than indicated (P < .0001 to all other machines), and all other machines were within 3.5% of indicated. Cruise Control decreased flow by 4.1% (P < .0001 for same machine without it). Millennium Venturi had the greatest vacuum (81% more than the least Sovereign; P < .0001), and Cruise Control increased vacuum in a peristaltic machine 35% more than the Venturi system (P < .0001). Percent power is not consistent in regard to heat generation, however, flow was accurate for all machines except Millennium Peristaltic. Restriction with Cruise Control elevates unoccluded vacuum to levels greater than the Venturi system tested.

[Clinical results of the aspheric intraocular lens FY-60AD (Hoya) with particular respect to decentration and tilt].

PubMed

Mester, U; Heinen, S; Kaymak, H

2010-09-01

Aspheric intraocular lenses (IOLs) aim to improve visual function and particularly contrast vision by neutralizing spherical aberration. One drawback of such IOLs is the enhanced sensitivity to decentration and tilt, which can deteriorate image quality. A total of 30 patients who received bilateral phacoemulsification before implantation of the aspheric lens FY-60AD (Hoya) were included in a prospective study. In 25 of the patients (50 eyes) the following parameters could be assessed 3 months after surgery: visual acuity, refraction, contrast sensitivity, pupil size, wavefront errors and decentration and tilt using a newly developed device. The functional results were very satisfying and comparable to results gained with other aspheric IOLs. The mean refraction was sph + 0.1 D (±0.7 D) and cyl 0.6 D (±0.8 D). The spherical equivalent was −0.2 D (±0.6 D). Wavefront measurements revealed a good compensation of the corneal spherical aberration but vertical and horizontal coma also showed opposing values in the cornea and IOL. The assessment of the lens position using the Purkinje meter demonstrated uncritical amounts of decentration and tilt. The mean amount of decentration was 0.2 mm±0.2 mm in the horizontal and vertical directions. The mean amount of tilt was 4.0±2.1° in horizontal and 3.0±2.5° in vertical directions. In a normal dioptric power range the aspheric IOL FY-60AD compensates the corneal spherical aberration very well with only minimal decentration. The slight tilt is symmetrical in both eyes and corresponds to the position of the crystalline lens in young eyes. This may contribute to our findings of compensated corneal coma.

Comparison of visual outcomes after bilateral implantation of extended range of vision and trifocal intraocular lenses.

PubMed

Ruiz-Mesa, Ramón; Abengózar-Vela, Antonio; Aramburu, Ana; Ruiz-Santos, María

2017-06-26

To compare visual outcomes after cataract surgery with bilateral implantation of 2 intraocular lenses (IOLs): extended range of vision and trifocal. Each group of this prospective study comprised 40 eyes (20 patients). Phacoemulsification followed by bilateral implantation of a FineVision IOL (group 1) or a Symfony IOL (group 2) was performed. The following outcomes were assessed up to 1 year postoperatively: binocular uncorrected distance visual acuity (UDVA), binocular uncorrected intermediate visual acuity (UIVA) at 60 cm, binocular uncorrected near visual acuity (UNVA) at 40 cm, spherical equivalent (SE) refraction, defocus curves, mesopic and photopic contrast sensitivity, halometry, posterior capsule opacification (PCO), and responses to a patient questionnaire. The mean binocular values in group 1 and group 2, respectively, were SE -0.15 ± 0.25 D and -0.19 ± 0.18 D; UDVA 0.01 ± 0.03 logMAR and 0.01 ± 0.02 logMAR; UIVA 0.11 ± 0.08 logMAR and 0.09 ± 0.08 logMAR; UNVA 0.06 ± 0.07 logMAR and 0.17 ± 0.06 logMAR. Difference in UNVA between IOLs (p<0.05) was statistically significant. There were no significant differences in contrast sensitivity, halometry, or PCO between groups. Defocus curves were similar between groups from 0 D to -2 D, but showed significant differences from -2.50 D to -4.00 D (p<0.05). Both IOLs provided excellent distance and intermediate visual outcomes. The FineVision IOL showed better near visual acuity. Predictability of the refractive results and optical performance were excellent; all patients achieved spectacle independence. The 2 IOLs gave similar and good contrast sensitivity in photopic and mesopic conditions and low perception of halos by patients.

Standardised antibacterial Manuka honey in the management of persistent post-operative corneal oedema: a case series.

PubMed

Albietz, Julie M; Lenton, Lee M

2015-09-01

Corneal oedema is a common post-operative problem that delays or prevents visual recovery from ocular surgery. Honey is a supersaturated solution of sugars with an acidic pH, high osmolarity and low water content. These characteristics inhibit the growth of micro-organisms, reduce oedema and promote epithelialisation. This clinical case series describes the use of a regulatory approved Leptospermum species honey ophthalmic product, in the management of post-operative corneal oedema and bullous keratopathy. A retrospective review of 18 consecutive cases (30 eyes) with corneal oedema persisting beyond one month after single or multiple ocular surgical procedures (phacoemulsification cataract surgery and additional procedures) treated with Optimel Antibacterial Manuka Eye Drops twice to three times daily as an adjunctive therapy to conventional topical management with corticosteroid, aqueous suppressants, hypertonic sodium chloride five per cent, eyelid hygiene and artificial tears. Visual acuity and central corneal thickness were measured before and at the conclusion of Optimel treatment. A temporary reduction in corneal epithelial oedema lasting up to several hours was observed after the initial Optimel instillation and was associated with a reduction in central corneal thickness, resolution of epithelial microcysts, collapse of epithelial bullae, improved corneal clarity, improved visualisation of the intraocular structures and improved visual acuity. Additionally, with chronic use, reduction in punctate epitheliopathy, reduction in central corneal thickness and improvement in visual acuity were achieved. Temporary stinging after Optimel instillation was experienced. No adverse infectious or inflammatory events occurred during treatment with Optimel. Optimel was a safe and effective adjunctive therapeutic strategy in the management of persistent post-operative corneal oedema and warrants further investigation in clinical trials. © 2015 The Authors. Clinical and Experimental Optometry © 2015 Optometry Australia.

A study of patient satisfaction after cataract surgery with implantation of different types of intraocular lenses

PubMed Central

2012-01-01

Background The implementation of capitated payment has driven medical institutions through developing balance billing for medical services. By exploring the patients’ decision-making factors on different self-pay items, a reference for the pricing and sales strategy for the related products can be formed. The major purposes of this study were to analyze the determinants of preoperative selection and postoperative satisfaction with implantation of different types of intraocular lenses in cataract surgery. Methods This cross-sectional study consisted of 127 patients that were 50 years of age and older, and who had phacoemulsification with intraocular lens implantation in both eyes. Data were collected by using a structured questionnaire. The following parameters were measured: access to medical care, attitude towards receiving medical products at one’s own expense, overall patient satisfaction and postoperative visual clarity. Results The results showed that the patient’s gender, educational level and economic status influenced the type of intraocular lens chosen. Patients in the insurance group cared about access to medical care, and patients in the balance billing group cared about product differentiation. ANOVA results showed no statistically significant differences in the overall satisfaction of the patients among the groups with different types of intraocular lenses. Patients that received cataract surgery with implantation of multifocal intraocular lenses had better vision when trying to view smaller objects and when looking at objects under strong light. Conclusions Manufacturers should increase the number of differences between their products, and health care providers can then recommend the appropriate intraocular lens in accordance with the needs or demands of their patients, and also by keeping in mind the financial constraints of their patients. PMID:23107001

A study of patient satisfaction after cataract surgery with implantation of different types of intraocular lenses.

PubMed

Wei, Ching-Kuo; Wang, Shun-Mu; Lin, Jen-Chieh

2012-10-29

The implementation of capitated payment has driven medical institutions through developing balance billing for medical services. By exploring the patients' decision-making factors on different self-pay items, a reference for the pricing and sales strategy for the related products can be formed. The major purposes of this study were to analyze the determinants of preoperative selection and postoperative satisfaction with implantation of different types of intraocular lenses in cataract surgery. This cross-sectional study consisted of 127 patients that were 50 years of age and older, and who had phacoemulsification with intraocular lens implantation in both eyes. Data were collected by using a structured questionnaire. The following parameters were measured: access to medical care, attitude towards receiving medical products at one's own expense, overall patient satisfaction and postoperative visual clarity. The results showed that the patient's gender, educational level and economic status influenced the type of intraocular lens chosen. Patients in the insurance group cared about access to medical care, and patients in the balance billing group cared about product differentiation. ANOVA results showed no statistically significant differences in the overall satisfaction of the patients among the groups with different types of intraocular lenses. Patients that received cataract surgery with implantation of multifocal intraocular lenses had better vision when trying to view smaller objects and when looking at objects under strong light. Manufacturers should increase the number of differences between their products, and health care providers can then recommend the appropriate intraocular lens in accordance with the needs or demands of their patients, and also by keeping in mind the financial constraints of their patients.

Predictors of Intraocular Pressure After Phacoemulsification in Primary Open-Angle Glaucoma Eyes with Wide Versus Narrower Angles (An American Ophthalmological Society Thesis)

PubMed Central

Lin, Shan C.; Masis, Marisse; Porco, Travis C.; Pasquale, Louis R.

2017-01-01

Purpose To assess if narrower-angle status and anterior segment optical coherence tomography (AS-OCT) parameters can predict intraocular pressure (IOP) drop in primary open-angle glaucoma (POAG) patients after cataract surgery. Methods This was a prospective case series of consecutive cataract surgery patients with POAG and no peripheral anterior synechiae (PAS) using a standardized postoperative management protocol. Preoperatively, patients underwent gonioscopy and AS-OCT. The same glaucoma medication regimen was resumed by 1 month. Potential predictors of IOP reduction included narrower-angle status by gonioscopy and angle-opening distance (AOD500) as well as other AS-OCT parameters. Mixed-effects regression adjusted for use of both eyes and other potential confounders. Results We enrolled 66 eyes of 40 glaucoma patients. The IOP reduction at 1 year was 4.2±3 mm Hg (26%, P<.001) in the narrower-angle group vs 2.2±3 mm Hg (14%, P<.001) in the wide-angle group (P=.027 for difference), as classified by gonioscopy. By AOD500 classification, the narrower-angle group had 3.4±3 mm Hg (21%, P<.001) reduction vs 2.5±3 mm Hg (16%, P<.001) in the wide-angle group (P=.031 for difference). When the entire cohort was assessed, iris thickness, iris area, and lens vault were correlated with increasing IOP reduction at 1 year (P<.05 for all). Conclusions In POAG eyes, cataract surgery lowered IOP to a greater degree in the narrower-angle group than in the wide-angle group, and parameters relating to iris thickness and area, as well as lens vault, were correlated with IOP reduction. These findings can guide ophthalmologists in their selection of cataract surgery as a potential management option. PMID:29147104

Predictors of Intraocular Pressure After Phacoemulsification in Primary Open-Angle Glaucoma Eyes with Wide Versus Narrower Angles (An American Ophthalmological Society Thesis).

PubMed

Lin, Shan C; Masis, Marisse; Porco, Travis C; Pasquale, Louis R

2017-08-01

To assess if narrower-angle status and anterior segment optical coherence tomography (AS-OCT) parameters can predict intraocular pressure (IOP) drop in primary open-angle glaucoma (POAG) patients after cataract surgery. This was a prospective case series of consecutive cataract surgery patients with POAG and no peripheral anterior synechiae (PAS) using a standardized postoperative management protocol. Preoperatively, patients underwent gonioscopy and AS-OCT. The same glaucoma medication regimen was resumed by 1 month. Potential predictors of IOP reduction included narrower-angle status by gonioscopy and angle-opening distance (AOD500) as well as other AS-OCT parameters. Mixed-effects regression adjusted for use of both eyes and other potential confounders. We enrolled 66 eyes of 40 glaucoma patients. The IOP reduction at 1 year was 4.2±3 mm Hg (26%, P <.001) in the narrower-angle group vs 2.2±3 mm Hg (14%, P <.001) in the wide-angle group ( P =.027 for difference), as classified by gonioscopy. By AOD500 classification, the narrower-angle group had 3.4±3 mm Hg (21%, P <.001) reduction vs 2.5±3 mm Hg (16%, P <.001) in the wide-angle group ( P =.031 for difference). When the entire cohort was assessed, iris thickness, iris area, and lens vault were correlated with increasing IOP reduction at 1 year ( P <.05 for all). In POAG eyes, cataract surgery lowered IOP to a greater degree in the narrower-angle group than in the wide-angle group, and parameters relating to iris thickness and area, as well as lens vault, were correlated with IOP reduction. These findings can guide ophthalmologists in their selection of cataract surgery as a potential management option.

Surgical outcomes after epiretinal membrane peeling combined with cataract surgery.

PubMed

Yiu, Glenn; Marra, Kyle V; Wagley, Sushant; Krishnan, Sheela; Sandhu, Harpal; Kovacs, Kyle; Kuperwaser, Mark; Arroyo, Jorge G

2013-09-01

To compare functional and anatomical outcomes after idiopathic epiretinal membrane (ERM) peeling combined with phacoemulsification and intraocular lens implantation versus ERM peeling alone. A retrospective, non-randomised comparative case series study was conducted of 81 eyes from 79 patients who underwent ERM peeling at the Beth Israel Deaconess Medical Center between 2001 and 2010. Eyes that underwent combined surgery for ERM and cataracts (group 1) were compared with those that had ERM peeling alone (group 2) with respect to best-corrected visual acuity at 6 months and 1 year after surgery, postoperative central macular thickness (CMT) as measured on optical coherence tomography, and rates of complications, including elevated intraocular pressure (IOP), ERM recurrence and need for reoperation. Mean logMAR visual acuity improved significantly in both groups at 6 months (p<0.001) and 1 year (p<0.001) after surgery. There was no statistical difference between the two groups in visual acuity improvement at 6 months (p=0.108) or 1 year (p=0.094). Mean CMT of both groups also significantly decreased after surgery (p=0.002), with no statistical difference in CMT reduction between the two groups, but a trend toward less CMT reduction in group 1 (p=0.061). The rates of complications, including IOP elevation, ERM recurrence and frequency of reoperation, were similar in the two groups, with non-statistical trends toward greater ERM recurrence (p=0.084) and need for reoperation (p=0.096) in those that had combined surgery. Combined surgery for ERMs and cataracts may potentially be as effective as membrane peeling alone with respect to visual and anatomical outcomes. Further studies are necessary to determine if there may be greater ERM recurrence or need for reoperation after combined surgery.

Femtosecond laser-assisted cataract surgeries reported to the European Registry of Quality Outcomes for Cataract and Refractive Surgery: Baseline characteristics, surgical procedure, and outcomes.

PubMed

Lundström, Mats; Dickman, Mor; Henry, Ype; Manning, Sonia; Rosen, Paul; Tassignon, Marie-José; Young, David; Stenevi, Ulf

2017-12-01

To describe a large cohort of femtosecond laser-assisted cataract surgeries in terms of baseline characteristics and the related outcomes. Eighteen cataract surgery clinics in 9 European countries and Australia. Prospective multicenter case series. Data on consecutive eyes having femtosecond laser-assisted cataract surgery in the participating clinics were entered in the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO). A trained registry manager in each clinic was responsible for valid reporting to the EUREQUO. Demographics, preoperative corrected distance visual acuity (CDVA), risk factors, type of surgery, type of intraocular lens, visual outcomes, refractive outcomes, and complications were reported. Complete data were available for 3379 cases. The mean age was 64.4 years ± 10.9 (SD) and 57.8% (95% confidence interval [CI], 56.1-59.5) of the patients were women. A surgical complication was reported in 2.9% of all cases (95% CI, 2.4-3.5). The mean postoperative CDVA was 0.04 ± 0.15. logarithm of the minimum angle of resolution. A biometry prediction error (spherical equivalent) was within ±0.5 diopter in 71.8% (95% CI, 70.3-73.3) of all surgeries. Postoperative complications were reported in 3.3% (95% CI, 2.7-4.0). Patients with good preoperative CDVA had the best visual and refractive outcomes; patients with poor preoperative visual acuity had poorer outcomes. The visual and refractive outcomes of femtosecond laser-assisted cataract surgery were favorable compared with manual phacoemulsification. The outcomes were highly influenced by the preoperative visual acuity, but all preoperative CDVA groups had acceptable outcomes. Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Evaluation of the learning curve of non-penetrating glaucoma surgery.

PubMed

Aslan, Fatih; Yuce, Berna; Oztas, Zafer; Ates, Halil

2017-08-11

To evaluate the learning curve of non-penetrating glaucoma surgery (NPGS). The study included 32 eyes of 27 patients' (20 male and 7 female) with medically uncontrolled glaucoma. Non-penetrating glaucoma surgeries performed by trainees under control of an experienced surgeon between 2005 and 2007 at our tertiary referral hospital were evaluated. Residents were separated into two groups. Humanistic training model applied to the one in the first group, he studied with experimental models before performing NPGS. Two residents in the second group performed NPGS after a conventional training model. Surgeries of the residents were recorded on video and intraoperative parameters were scored by the experienced surgeon at the end of the study. Postoperative intraocular pressure, absolute and total success rates were analyzed. In the first group 19 eyes of 16 patients and in the second group 13 eyes of 11 patients had been operated by residents. Intraoperative parameters and complication rates were not statistically significant between groups (p > 0.05, Chi-square). The duration of surgery was 32.7 ± 5.6 min in the first group and 45 ± 3.8 min in the second group. The difference was statistically significant (p < 0.001, Student's t test). Absolute and total success was 68.8 and 93.8% in the first group and 62.5 and 87.5% in the second group, respectively. The difference was not statistically significant. Humanistic and conventional training models under control of an experienced surgeon are safe and effective for senior residents who manage phacoemulsification surgery in routine cataract cases. Senior residents can practice these surgical techniques with reasonable complication rates.

Incidental retinal phototoxicity associated with ingestion of photosensitizing drugs.

PubMed

Mauget-Faÿsse, M; Quaranta, M; Francoz, N; BenEzra, D; Mauget-Fa, M

2001-07-01

to report on the possible correlation between incident retinal phototoxicity and the use of photosensitizing drugs. four patients were examined because of scotomas and visual loss after an incidental exposure to a strong light source. One patient (two eyes) was exposed to standard camera flash; one patient (one eye) had a brief exposure to welding light; one patient (two eyes) underwent uncomplicated phacoemulsifications with intraocular lens implantation. The fourth patient had a severe retinal phototoxicity following a secondary intraocular lens implantation. All four patients underwent a thorough assessment including history of systemic drug use. These patients had ophthalmologic evaluation including: best corrected visual acuity (ETDRS charts), fundus examination, fluorescein and indocyanine green angiographies and were followed for 1 year. on presentation, the mean visual acuity was 7.5/20 (range: 20/400-20/20). Fundus examination disclosed yellow-gray sub-retinal lesions in all affected eyes. Early phase fluorescein angiography showed one or multiple hypofluorescent spots surrounded by a halo of hyperfluorescent window defect. In the late phase, some of these spots leaked the fluorescein dye. Indocyanine green angiography demonstrated hypofluorescent spots throughout with ill-defined borders of hyperfluorescence observed during the late stages. The common finding in these four patients was the fact that they were all taking one or more photosensitizing drugs (hydrochlorothiazide, furosemide, allopurinol, and benzodiazepines). Three of the patients had a full visual recovery a few months after the phototoxicity. The fourth patient remained with a visual acuity of 20/60 12 months after the light exposure. Despite the visual recovery, non-homogeneous retinal pigment epithelial disturbances persisted in all affected eyes. phototoxicity following incidental light exposure may occur in patients taking drugs of photosensitizing potential. Therefore, the thorough history of systemic drug ingestion should be obtained if patients have exposure to strong light sources.

Refractive Outcomes After Femtosecond Laser-Assisted Cataract Surgery in Eyes With Anterior Chamber Phakic Intraocular Lenses.

PubMed

Steinwender, Gernot; Shajari, Mehdi; Kohnen, Thomas

2018-05-01

To report the efficacy, predictability, and safety of femtosecond laser-assisted cataract surgery (FLACS) in eyes with anterior chamber phakic intraocular lenses (IOLs). This retrospective case series included eyes with previous implantation of an angle-supported and an iris-fixated phakic IOL for the correction of myopia that underwent a combined procedure of phakic IOL ex-plantation and FLACS with in-the-bag implantation of a posterior chamber IOL. Postoperative corrected distance visual acuity (CDVA), predictability of refractive outcome, and occurrence of intraoperative and postoperative complications were analyzed. Ten eyes of 7 patients with significant cataract were included: 5 eyes with an angle-supported foldable hydrophobic phakic IOL, 4 eyes with an angle-supported polymethylmethacrylate (PMMA) phakic IOL, and 1 eye with an iris-fixated PMMA phakic IOL. Mean follow-up after FLACS was 8.4 ± 5.8 months. Mean interval between phakic IOL implantation and FLACS was 11.9 ± 4.0 years. After the combined procedure of phakic IOL explantation and FLACS, mean manifest refractive spherical equivalent (MRSE) was -0.11 ± 0.49 diopters (D) and MRSE was within ± 0.75 D of target refraction in all eyes. Four eyes received a toric posterior chamber IOL after phacoemulsification. Mean preoperative CDVA of 0.40 ± 0.23 logMAR improved significantly to 0.22 ± 0.11 logMAR postoperatively (P = .027). No intraoperative or postoperative complications occurred. The results in this series showed that FLACS in eyes with previous implantation of both rigid and foldable anterior chamber phakic IOLs offers good refractive outcomes with a high level of predictability and safety. [J Refract Surg. 2018;34(5):338-342.]. Copyright 2018, SLACK Incorporated.

Long term outcomes of bilateral congenital and developmental cataracts operated in Maharashtra, India. Miraj pediatric cataract study III.

PubMed

Gogate, Parikshit M; Sahasrabudhe, Mohini; Shah, Mitali; Patil, Shailbala; Kulkarni, Anil N; Trivedi, Rupal; Bhasa, Divya; Tamboli, Rahin; Mane, Rekha

2014-02-01

To study long term outcome of bilateral congenital and developmental cataract surgery. 258 pediatric cataract operated eyes of 129 children. Children who underwent pediatric cataract surgery in 2004-8 were traced and examined prospectively in 2010-11. Demographic and clinical factors were noted from retrospective chart readings. All children underwent visual acuity estimation and comprehensive ocular examination in a standardized manner. L. V. Prasad Child Vision Function scores (LVP-CVF) were noted for before and after surgery. Statistical analysis was done with SPSS version 16 including multi-variate analysis. Children aged 9.1 years (std dev 4.6, range 7 weeks-15 years) at the time of surgery. 74/129 (57.4%) were boys. The average duration of follow-up was 4.4 years (stddev 1.6, range 3-8 years). 177 (68.6%) eyes had vision <3/60 before surgery, while 109 (42.2%) had best corrected visual acuity (BCVA) >6/18 and 157 (60.9%) had BCVA >6/60 3-8 years after surgery. 48 (37.2%) had binocular stereoacuity <480 sec of arc by TNO test. Visual outcome depended on type of cataract (P = 0.004), type of cataract surgery (P < 0.001), type of intra-ocular lens (P = 0.05), age at surgery (P = 0.004), absence of post-operative uveitis (P = 0.01) and pre-operative vision (P < 0.001), but did not depend on delay (0.612) between diagnosis and surgery. There was a statistically significant improvement for all the 20 questions of the LVP-CVF scale (P < 0.001). Pediatric cataract surgery improved the children's visual acuity, stereo acuity and vision function. Developmental cataract, use of phacoemulsification, older children and those with better pre-operative vision had betterlong-termoutcomes.

Effect of intracameral carbachol given during cataract surgery on macular thickness.

PubMed

Demir, Mehmet; Oba, Ersin; Dirim, Burcu; Can, Efe; Odabasi, Mahmut; Ozdal, Erhan

2012-10-01

To evaluate the effect of intracameral carbachol on foveal thickness in patients who underwent uneventful cataract surgery. This retrospective study included two groups: the study group patients (group 1, n = 47 eyes) had uneventful cataract surgery and received only carbachol 0.01 % for miosis; the control group patients (group 2, n = 49 eyes) had uneventful cataract surgery without carbachol or any intracameral medication(s). The groups were compared for foveal thickness after cataract surgery. All phacoemulsification plus intraocular lens implantation surgeries were performed under local anesthesia via temporal clear corneal tunnel incisions. Mean values and standard deviations were calculated for preoperative and postoperative visual acuity (VA) and foveal thickness (FT) at 1 and 4 weeks. Optical coherence tomography was used for the FT measurements, with the MM6 map program. The patients in the study and control groups had a mean age of 57.78 ± 9.07 and 59.72 ± 8.96, respectively (p = 0.355). All eyes had a significant improvement in VA. In the study group, the mean FT at the visits before and 1 and 4 weeks after surgery was 216.87 ± 21.06, 228.81 ± 30.52, and 222.94 ± 29.91 μm, respectively. For the control group, the mean FT, before and 1 and 4 weeks after surgery, was 222.53 ± 17.66, 231.67 ± 23.08, and 225.41 ± 22.59 μm, respectively. Intracameral carbachol 0.01 % had no effect on foveal thickness in patients who underwent uneventful cataract surgery.

Malignant glaucoma after cataract surgery.

PubMed

Varma, Devesh K; Belovay, Graham W; Tam, Diamond Y; Ahmed, Iqbal Ike K

2014-11-01

To report a series of eyes that developed malignant glaucoma after cataract surgery. Private academic practice, Toronto, Ontario, Canada. Retrospective case series. Eyes that developed malignant glaucoma after cataract surgery were treated with medical therapy. This was followed by laser iridozonulohyaloidotomy, anterior chamber reformation and intraocular lens (IOL) pushback, and finally with surgical iridozonulohyaloidovitrectomy if all other measures were unsuccessful. Refraction, intraocular pressure (IOP), gonioscopy, and anterior chamber depth (ACD) by anterior segment optical coherence tomography were analyzed before treatment and after treatment. The study evaluated 20 eyes of 18 female patients aged 44 to 86 years. Preoperatively, the mean refraction was +3.11 diopters (D) ± 2.89 (SD), the mean axial length was 21.30 ± 1.40 mm, and all eyes had narrow or closed angles. Malignant glaucoma was diagnosed a mean of 5.8 ± 7.1 weeks postoperatively. At diagnosis, the mean refraction was -2.15 ± 2.95 D; the mean ACD, 2.49 ± 0.72 mm; and the mean IOP, 28.3 ± 10.8 mm Hg on a mean of 1.3 ± 1.6 medications. Two eyes responded to cycloplegia, 7 to laser iridozonulohyaloidotomy, and 6 to anterior chamber reformation-IOL pushback; 5 eyes required vitrectomy. Posttreatment, the mean refraction was -0.56 ± 1.07 D; the mean ACD, 3.30 ± 0.50 mm; and the mean IOP, 14.4 ± 4.60 mm Hg on a mean of 1.2 ± 1.4 medications. Cycloplegia was discontinued in 17 eyes. Malignant glaucoma can occur after phacoemulsification and presents with myopic surprise, anterior chamber shallowing and, possibly, elevated IOP. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Determining the acoustic properties of the lens using a high-frequency ultrasonic needle transducer.

PubMed

Huang, Chih-Chung; Zhou, Qifa; Ameri, Hossein; Wu, Da Wei; Sun, Lei; Wang, Shyh-Hau; Humayun, Mark S; Shung, K Kirk

2007-12-01

Ultrasonic parameters including sound velocity and attenuation coefficient have recently been found to be useful in characterizing the cataract lens noninvasively. However, the regional changes of these acoustic parameters in the lens cannot be detected directly by those ultrasonic measurements. This prompted us to fabricate a 46-MHz needle transducer (lead magnesium niobate-lead titanate [PMN-PT] single crystal) with an aperture size of 0.4 mm and a diameter of 0.9 mm for directly measuring the sound velocity and frequency-dependent attenuation coefficient in lenses. These parameters have been shown to be related to the hardness of a cataract, and hence this technique may allow surgeons to detect the acoustic properties of the cataract via a small incision on the cornea before/during phacoemulsification surgery. To verify the performance of the needle transducer, experiments were performed on porcine lenses in which two types of cataracts (nucleus and cortical) were induced artificially. The needle transducer was mounted on a positioning system and its tip was inserted into the lens, allowing the anterior-to-posterior profiles of acoustic parameters along the lens axis to be obtained immediately. The experimental results show that the acoustic parameters are not constant within a single normal lens. The sound velocity and ultrasound attenuation coefficient (at 46 MHz) were 1701.2 +/- 8.4 m/s (mean +/- SD) and 9.42 +/- 0.57 dB/mm, respectively, at the nucleus, and 1597.2 +/- 9.6, 1589.3 +/- 6.1 m/s and 0.42 +/- 0.26 and 0.40 +/- 0.33 dB/mm close to the anterior and posterior capsules, respectively. Finally, the data obtained demonstrate that regional variations in the acoustic properties of lenses corresponding to the hardness of different types of cataract can be detected sensitively by a needle transducer.

Usefulness of surgical complexity classification index in cataract surgery process.

PubMed

Salazar Méndez, R; Cuesta García, M; Llaneza Velasco, M E; Rodríguez Villa, S; Cubillas Martín, M; Alonso Álvarez, C M

2016-06-01

To evaluate the usefulness of surgical complexity classification index (SCCI) to predict the degree of surgical difficulty in cataract surgery. This retrospective study includes data collected between January 2013 and December 2014 from patients who underwent cataract extraction by phacoemulsification at our hospital. A sample size of 159 patients was obtained by simple random sampling (P=.5, 10% accuracy, 95% confidence). The main variables were: recording and value of SCCI in electronic medical record (EMR), presence of exfoliation syndrome (XFS), criteria for inclusion in surgical waiting list (SWL), and functional results. SCCI was classified into 7 categories (range: 1-4) according to predictors of technical difficulty, which was indirectly estimated in terms of surgical time (ST). All statistical analyses were performed using SPSS v15.0 statistical software. Prevalence of XFS was 18.2% (95%CI: 11.9-24.5). In terms of quality indicators in the cataract surgery process, 96.8% of patients met at least one of the criteria to be included in SWL, and 98.1% gained ≥2 Snellen lines. The SCCI was recorded in EMR of 98.1% patients, and it was grouped for study into 2 categories: High and low surgical complexity. Statistically significant differences in the distribution of ST were found depending on the assigned SCCI (P<.005) and the presence of XFS (P<.005). The SCCI enables to estimate the degree of surgical complexity in terms of ST in cataract surgery, which is especially useful in those areas with high prevalence of XFS, because of the higher theoretical risk of surgical complications. Copyright © 2016 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

Financial modelling of femtosecond laser-assisted cataract surgery within the National Health Service using a 'hub and spoke' model for the delivery of high-volume cataract surgery.

PubMed

Roberts, H W; Ni, M Z; O'Brart, D P S

2017-03-16

To develop financial models which offset additional costs associated with femtosecond laser (FL)-assisted cataract surgery (FLACS) against improvements in productivity and to determine important factors relating to its implementation into the National Health Service (NHS). FL platforms are expensive, in initial purchase and running costs. The additional costs associated with FL technology might be offset by an increase in surgical efficiency. Using a 'hub and spoke' model to provide high-volume cataract surgery, we designed a financial model, comparing FLACS against conventional phacoemulsification surgery (CPS). The model was populated with averaged financial data from 4 NHS foundation trusts and 4 commercial organisations manufacturing FL platforms. We tested our model with sensitivity and threshold analyses to allow for variations or uncertainties. The averaged weekly workload for cataract surgery using our hub and spoke model required either 8 or 5.4 theatre sessions with CPS or FLACS, respectively. Despite reduced theatre utilisation, CPS (average £433/case) was still found to be 8.7% cheaper than FLACS (average £502/case). The greatest associated cost of FLACS was the patient interface (PI) (average £135/case). Sensitivity analyses demonstrated that FLACS could be less expensive than CPS, but only if increased efficiency, in terms of cataract procedures per theatre list, increased by over 100%, or if the cost of the PI was reduced by almost 70%. The financial viability of FLACS within the NHS is currently precluded by the cost of the PI and the lack of knowledge regarding any gains in operational efficiency. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Comparative Efficacy of the New Optical Biometer on Intraocular Lens Power Calculation (AL-Scan versus IOLMaster).

PubMed

Ha, Ahnul; Wee, Won Ryang; Kim, Mee Kum

2018-05-15

To evaluate the agreement in axial length (AL), keratometry, and anterior chamber depth measurements between AL-Scan and IOLMaster biometers and to compare the efficacy of the AL-Scan on intraocular lens (IOL) power calculations and refractive outcomes with those obtained by the IOLMaster. Medical records of 48 eyes from 48 patients who underwent uneventful phacoemulsification and IOL insertion were retrospectively reviewed. One of the two types of monofocal aspheric IOLs were implanted (Tecnis ZCB00 [Tecnis, n = 34] or CT Asphina 509M [Asphina, n = 14]). Two different partial coherence interferometers measured and compared AL, keratometry (2.4 mm), anterior chamber depth, and IOL power calculations with SRK/T, Hoffer Q, Holladay2, and Haigis formulas. The difference between expected and actual final refractive error was compared as refractive mean error (ME), refractive mean absolute error (MAE), and median absolute error (MedAE). AL measured by the AL-Scan was shorter than that measured by the IOLMaster (p = 0.029). The IOL power of Tecnis did not differ between the four formulas; however, the Asphina measurement calculated using Hoffer Q for the AL-Scan was lower (0.28 diopters, p = 0.015) than that calculated by the IOLMaster. There were no statistically significant differences between the calculations by MAE and MedAE for the four formulas in either IOL. In SRK/T, ME in Tecnis-inserted eyes measured by AL-Scan showed a tendency toward myopia (p = 0.032). Measurement by AL-Scan provides reliable biometry data and power calculations compared to the IOLMaster; however, refractive outcomes of Tecnis-inserted eyes by AL-Scan calculated using SRK/T can show a slight myopic tendency. © 2018 The Korean Ophthalmological Society.