Effects of phacoemulsification with versus without viscoelastic devices on surgical outcomes

Safety of intracameral application of moxifloxacin and dexamethasone (Vigadexa®) after phacoemulsification surgery

BACKGROUND

Intracameral antibiotics, such as moxifloxacin and cefuroxime, are safe to corneal endothelial cells and effective prophylaxis of endophthalmitis after cataract surgery. Corneal endothelial cells decrease in density after cataract surgery. Any substance used in the anterior chamber may affect corneal endothelial cells and lead to a greater decrease in density. This study wants to determine the percentage of endothelial cell loss after cataract extraction by phacoemulsification with off-label intracameral injection of moxifloxacin and dexamethasone (Vigadexa®).

METHODS

An observational retrospective study was performed. The clinical records of patients undergoing cataract surgery by phacoemulsification plus intracameral injection of Vigadexa® were analyzed. Endothelial cell loss (ECL) was calculated using preoperative and postoperative endothelial cell density. The relation of endothelial cell loss with cataract grade using LOCS III classification, total surgery time, total ultrasound time, total longitudinal power time, total torsional amplitude time, total aspiration time, estimated fluid usage, and cumulative dissipated energy (CDE) was studied using univariate linear regression analysis and logistic regression analysis.

RESULTS

The median loss of corneal endothelial cells was 4.6%, interquartile range 0 to 10.4%. Nuclear color and CDE were associated with increased ECL. ECL>10% was associated with age and total ultrasound time in seconds.

CONCLUSIONS

The endothelial cell loss after the intracameral use of Vigadexa® at the end of cataract surgery was similar to the reported in other studies of cataract surgery without the use of intracameral prophylaxis for postoperative endophthalmitis (POE). This study confirmed the association of CDE and nuclear opalescence grade with postoperative corneal endothelial cell loss.

Diluting 2.5% Viscoadaptive Sodium Hyaluronate to Prevent Postoperative Intraocular Pressure Rise After Phacoemulsification: A Pilot Study

The most common complication with intraoperative viscoelastic use is an immediate elevation of intraocular pressure, particularly if the viscoelastic agent remains in the eye, which can cause serious effects. Complications may include severe ocular pain, corneal epithelial edema, and increased risk of anterior ischemic optic neuropathy and retinal artery occlusion. This study aims to find an efficient and safe adjunctive method to decrease the incidence of postoperative intraocular pressure rise. When cohesive viscoelastic agents were unavailable due to the pandemic, we diluted Microvisc 2.5% sodium hyaluronate ophthalmic viscosurgical device by 50% prior to intraocular lens implantation. Twelve eyes are included in this study, which are divided into two groups. The study followed a double-blinded methodology in which the physician and the patient were unaware of what group they were in. The first group (seven patients, seven eyes) was treated using the diluted Microvisc 2.5%, and the second group (five patients, five eyes) was controlled with the undiluted Microvisc 2.5%. The primary variable was intraocular pressure, measured at four different timeline points (baseline, day 1, week 1, and month 1). We found that the technique used had easier irrigation and aspiration with minimal viscoelastic agent left in the bag, leading to a lower postoperative intraocular pressure spike. Analysis was conducted using the Wilcoxon signed rank test, and significance was noted between the two groups on postoperative day 1 (p=0.042). The analysis also included the populations' comorbidities (hypertension and diabetes) and postoperative outcomes (pain, corneal edema, and visual acuity).

Scleral Buckling with Viscoelastics or Gas Injection for Bulging Retinal Detachments: A Retrospective Cohort Study

Objective

To examine the use of a viscoelastic agent instead of air in the vitreous cavity during surgery for scleral buckling.

Methods

This was a retrospective cohort study of patients who underwent scleral buckling surgery for bulging rhegmatogenous retinal detachment (RRD) at Ningbo Eye Hospital from 07/2016 to 12/2019. The patients were grouped into drainage, air injection, cryotherapy and explant (DACE) and drainage, viscoelastic injection, cryotherapy, and explant (DVCE) groups, which were comparatively assessed.

Results

There were 25 and 22 patients in the DVCE and DACE groups, respectively. The surgery was significantly shorter with DVCE than DACE (P < 0.05), with less intraoperative external pressure adjustment (P < 0.05). BCVA was lower in the DVCE group at 1 week compared with the DACE group (P < 0.05). Successful retinal reattachment was observed in 92.0% and 81.8% of the DVCE and DACE groups, respectively (P < 0.05). Cases requiring laser replenishing after the operation were less in the DVCE group compared with the DACE group (P < 0.05). There were no differences in complications and intraocular pressure between the two groups (all P < 0.05).

Conclusion

DVCE has better operative characteristics and faster vision recovery than DACE, with similar outcomes.

Clinical outcomes of management of posterior capsule rupture with air bubble techniques

AIM

To introduce a new surgical technique, air-bubble technique for the management of posterior capsule rupture (PCR) and to evaluate the safety and efficacy of the technique.

METHODS

A retrospective case series analysis of 24 eyes of 24 patients, in which the air bubble technique was used for the management of PCR, was performed. Once PCR occurred, a dispersive ophthalmic viscosurgical device (OVD) was injected into the tear. And small volumes (0.2-0.3 mL) of air bubbles were injected beneath the OVD. The air bubble served as a physical barrier and supported the posterior capsule.

RESULTS

After surgery, none of the patients had serious complications during the follow-up period of 1y. Extension of the PCR size occurred in only 2 cases, and additional OVD injection was required only in 3 cases. Air bubbles imparted great stability to the nuclear pieces and the posterior capsule.

CONCLUSION

The air-bubble technique may be considered a safe and effective procedure for managing a PCR. It may be of value to the inexperienced cataract surgeon.

Intraoperative Evaluation of Phacoemulsification Cataract Surgery with and without the Use of Ophthalmic Viscosurgical Devices

PURPOSE:

The purpose of this study was to compare the efficacy and safety of cataract surgery by the phacoemulsification technique with and without the use of ophthalmic viscosurgical devices (OVDs).

SETTING:

This study was conducted at a tertiary eye care center in a rural area of Central India.

DESIGN:

This was a prospective, randomized, observational study.

METHODS:

In this study, 220 patients underwent phacoemulsification for cataract surgery with OVDs (OVD group) or without OVDs (BSS group) (n = 110 in each group). Patients with operable, nuclear Grade 2–4 cataracts were included in the study. The study was conducted from June 2017 to September 2018. The frequency of intraoperative complications, surgical time, and ease of the surgical procedure (easy, difficult, or very difficult) were recorded.

RESULTS:

There was no statistically significant difference in the nuclear opalescence, axial length, and intraocular lens (IOL) power between the two groups. Capsulorhexis extension was seen in two eyes in the OVD group and none of the eyes in the BSS group. The problems that occurred during IOL implantation included flip (OVD group, 2; BSS group, 1), haptic breakage (OVD group, 1; BSS group, 1), sulcus implantation (OVD group, 0; BSS group, 2), and stuck haptic (OVD group, 1; BSS group, 3). The total surgical time was almost equal in the two groups (OVD group, 9.2 min ± 3; BSS group, 9.5 min ± 3.5; P = 0.521). None of the patients had iris trauma or posterior capsular rupture.

CONCLUSIONS:

OVD-less phacoemulsification surgery is a safe and effective technique for treating age-related cataracts that requires no additional instrumentation and saves the cost of the OVD.