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Gilbert M, Zaugg B, Stagg B, Olson RJ. Safety Profile of Venturi Versus Peristaltic Phacoemulsification Pumps in Cataract Surgery Using a Capsular Surrogate for the Human Lens. Am J Ophthalmol 2015; 160:179-4.e1. [PMID: 25892125 DOI: 10.1016/j.ajo.2015.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 04/09/2015] [Accepted: 04/10/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the risk of capsular rupture of the human lens during cataract surgery from contact by phacoemulsification needles using different vacuum pumps, ultrasound modalities, and contact angles. DESIGN Experimental laboratory investigation. METHODS The John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, was the setting for this study. A Signature (Abbott Medical Optics, Inc) phacoemulsification machine was used in peristaltic and Venturi vacuum modes with transversal and micropulsed ultrasound. Contact was made with a capsular surrogate to achieve tip occlusion or tip contact only. Breakage rates were calculated by analyzing the capsular surrogate under a surgical microscope. RESULTS Venturi and peristaltic pump modes had similar risk of capsular rupture, regardless of whether the data were analyzed with tip occlusion data included (44.2% peristaltic vs 40.2% Venturi, P = .047) or excluded from the analysis (66.3% peristaltic vs 60.3% Venturi, P = .013). Transversal ultrasound was significantly more likely to cause capsular rupture than micropulsed ultrasound (69.8% vs 56.8%, P < .0001). Tip contact was significantly more likely than tip occlusion to cause capsular rupture (63.3% vs 0%, P < .0001). CONCLUSIONS There is no significant difference in risk of capsular rupture using Venturi rather than peristaltic vacuum pumps, while transversal seemed to increase the risk when compared to micropulsed ultrasound. Tip occlusion is not a risk factor for capsular rupture, as all breaks in the capsular surrogate occurred with tip contact.
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Affiliation(s)
- Michael Gilbert
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Brian Zaugg
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Brian Stagg
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Randall J Olson
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah.
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Abdelrahman AM. Noninvasive glaucoma procedures: current options and future innovations. Middle East Afr J Ophthalmol 2015; 22:2-9. [PMID: 25624667 PMCID: PMC4302472 DOI: 10.4103/0974-9233.148342] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Noninvasive glaucoma procedures (NIGPs) represent a new dawn in the management of glaucoma. They try to fill the gap between the shortcoming of invasive glaucoma surgeries and antiglaucoma medications. NIGPs were introduced as an adjunct or alternative treatments for glaucoma. Some of these procedures have shown good efficacy with few serious complications. Hence, they are now used as both primary and adjunctive therapy for glaucoma. The most common NIGPS involve laser and ultrasound technologies. Currently, the portfolio of NIGPs includes argon laser trabeculoplasty, selective laser trabeculoplasty, and micropulse diode laser trabeculoplasty. More recent innovations include therapeutic ultrasound for glaucoma, ultrasonic circular cyclocoagulation, and deep wave trabeculoplasty.
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Kim JH, Ko DA, Kim JY, Kim MJ, Tchah H. Phaco-efficiency test and re-aspiration analysis of repulsed particle in phacoemulsification. Graefes Arch Clin Exp Ophthalmol 2013; 251:1157-61. [DOI: 10.1007/s00417-012-2240-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Revised: 11/19/2012] [Accepted: 12/03/2012] [Indexed: 11/30/2022] Open
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Meyer JJ, Kuo AF, Olson RJ. The risk of capsular breakage from phacoemulsification needle contact with the lens capsule: a laboratory study. Am J Ophthalmol 2010; 149:882-886.e1. [PMID: 20231013 DOI: 10.1016/j.ajo.2009.12.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 12/19/2009] [Accepted: 12/21/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE To determine capsular breakage risk from contact by phacoemulsification needles by machine and tip type. DESIGN Experimental laboratory investigation. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Schmutz JS, Olson RJ. Thermal comparison of Infiniti OZil and Signature Ellips phacoemulsification systems. Am J Ophthalmol 2010; 149:762-7.e1. [PMID: 20202619 DOI: 10.1016/j.ajo.2009.12.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Revised: 11/25/2009] [Accepted: 12/01/2009] [Indexed: 11/19/2022]
Abstract
PURPOSE 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. DESIGN Laboratory investigation. METHODS 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. RESULTS 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). CONCLUSIONS 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.
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Affiliation(s)
- Joseph S Schmutz
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT 84132, USA
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Zeng M, Liu X, Liu Y, Xia Y, Luo L, Yuan Z, Zeng Y, Liu Y. Torsional ultrasound modality for hard nucleus phacoemulsification cataract extraction. Br J Ophthalmol 2008; 92:1092-6. [PMID: 18567650 PMCID: PMC2569137 DOI: 10.1136/bjo.2007.128504] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2008] [Indexed: 12/02/2022]
Abstract
AIM To evaluate the efficacy and safety of phacoemulsification using torsional modality with different parameter settings for hard nucleus cataract extraction. DESIGN A prospective, randomised clinical study. METHODS A clinical practice study conducted at the Cataract Service, Zhongshan Ophthalmic Center, Sun-Yat-Sen University, and Guangzhou. One eye each from 198 consecutive patients with cataract density grade IV according to the Emery-Little system classification system, requiring phacoemulsification and intraocular lens implantation, was included. Eyes were randomly assigned to the Linear Torsional combined with Ultrasound power group (Linear Tor+US group, n = 66), 100% Fixed Torsional group (Fixed Tor group, n = 65) and conventional Ultrasound burst group (US group, n = 67). All surgeries were performed by a single experienced surgeon and outcomes evaluated by another surgeon masked to treatment. Intraoperative parameters were Ultrasound Time (UST), Cumulative Dissipated Energy (CDE) and surgical complications. Patients were examined on post-op days 1, 7 and 30. Postoperative outcomes were final best corrected visual acuity (BCVA), average central and incisional corneal thickness and central endothelial cell counts. RESULTS The mean UST was lower in the Fixed Tor group than in the US group and in the Lin US+Tor group (p 0.01), greater average central corneal and incisional thickness on days 1, 7 (p0.01), and higher average corneal endothelial cell losses on day 7 and 30 days (pCONCLUSIONS Torsional combined with ultrasound power or high fixed torsional amplitude can yield more effective hard nucleus phacoemulsification than conventional ultrasound modality.
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Affiliation(s)
- M Zeng
- Zhongshan Ophthalmic Center, Sun-Yat-Sen University Guangzhou, People’s Republic of China
- The Second Affiliated Hospital of Guangzhou Medical College, Guangzhou, People’s Republic of China
| | - X Liu
- Zhongshan Ophthalmic Center, Sun-Yat-Sen University Guangzhou, People’s Republic of China
| | - Y Liu
- Zhongshan Ophthalmic Center, Sun-Yat-Sen University Guangzhou, People’s Republic of China
| | - Y Xia
- Zhongshan Ophthalmic Center, Sun-Yat-Sen University Guangzhou, People’s Republic of China
| | - L Luo
- Zhongshan Ophthalmic Center, Sun-Yat-Sen University Guangzhou, People’s Republic of China
| | - Z Yuan
- Zhongshan Ophthalmic Center, Sun-Yat-Sen University Guangzhou, People’s Republic of China
| | - Y Zeng
- Zhongshan Ophthalmic Center, Sun-Yat-Sen University Guangzhou, People’s Republic of China
| | - Y Liu
- Zhongshan Ophthalmic Center, Sun-Yat-Sen University Guangzhou, People’s Republic of China
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Ward MS, Georgescu D, Olson RJ. Effect of bottle height and aspiration rate on postocclusion surge in Infiniti and Millennium peristaltic phacoemulsification machines. J Cataract Refract Surg 2008; 34:1400-2. [DOI: 10.1016/j.jcrs.2008.04.042] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2008] [Accepted: 04/14/2008] [Indexed: 11/26/2022]
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Georgescu D, Kuo AF, Kinard KI, Olson RJ. A fluidics comparison of Alcon Infiniti, Bausch & Lomb Stellaris, and Advanced Medical Optics Signature phacoemulsification machines. Am J Ophthalmol 2008; 145:1014-1017. [PMID: 18343350 DOI: 10.1016/j.ajo.2008.01.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Revised: 01/11/2008] [Accepted: 01/12/2008] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare three phacoemulsification machines for measurement accuracy and postocclusion surge (POS) in human cadaver eyes. DESIGN In vitro comparisons of machine accuracy and POS. METHODS 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. RESULTS 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). CONCLUSIONS 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.
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Affiliation(s)
- Dan Georgescu
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, 65 Medical Drive, Salt Lake City, UT 84132, USA
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Tanaka T, Koshika S, Usui M. Cataract surgery using the bimanual phacoemulsification technique with an Accurus system and Mackool microphaco tip. J Cataract Refract Surg 2007; 33:1770-4. [PMID: 17889775 DOI: 10.1016/j.jcrs.2007.06.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2007] [Accepted: 06/05/2007] [Indexed: 12/01/2022]
Abstract
PURPOSE To investigate the safety and effectiveness of the Accurus vitreoretinal and phacoemulsification system (Alcon, Inc.) for bimanual phacoemulsification surgery. SETTING Kosei Chuo Hospital, Tokyo, Japan. METHODS Phacoemulsification for age-related cataract was performed using a bimanual technique in 55 eyes and a coaxial technique in 31 eyes. The Accurus system with a venturi pump and a sleeveless ultrasonic tip or a Mackool microphaco tip was used in all cases. The 2 techniques were compared. In bimanual phacoemulsification, the 2 tips were evaluated to determine whether either reduced ocular tissue impairment. RESULTS The mean best corrected visual acuity 1 day after the surgery was 20/20 in both groups. There was no significant difference between the bimanual group and coaxial group except in ultrasound output (bimanual 22%, coaxial 28%; P = .01). Iris impairment was observed only in the bimanual group but was reduced by the use of the Mackool sleeved microphaco tip. CONCLUSION Bimanual phacoemulsification for cataract surgery using the Accurus system with a venturi pump and a Mackool microphaco tip was safe and effective and may provide a means of performing combined or successive cataract and vitreoretinal surgery.
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Wade M, Isom R, Georgescu D, Olson RJ. Efficacy of Cruise Control in controlling postocclusion surge with Legacy and Millennium venturi phacoemulsification machines. J Cataract Refract Surg 2007; 33:1071-5. [PMID: 17531704 DOI: 10.1016/j.jcrs.2007.02.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2006] [Accepted: 02/23/2007] [Indexed: 11/23/2022]
Abstract
PURPOSE To determine the efficacy of the Cruise Control surge-limiting device (Staar Surgical) with phacoemulsification machines known to have high levels of surge. SETTING John A. Moran Eye Center Clinical Laboratories. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Matthew Wade
- Department of Ophthalmology and Visual Sciences, University of Utah Health Sciences Center, Salt Lake City, UT 84132, USA
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Georgescu D, Payne M, Olson RJ. Objective measurement of postocclusion surge during phacoemulsification in human eye-bank eyes. Am J Ophthalmol 2007; 143:437-40. [PMID: 17222793 DOI: 10.1016/j.ajo.2006.11.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2006] [Revised: 11/08/2006] [Accepted: 11/09/2006] [Indexed: 11/26/2022]
Abstract
PURPOSE To objectively compare the postocclusion vacuum surge among different phacoemulsification machines and devices. DESIGN Experimental study. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Dan Georgescu
- Department of Ophthalmology, John A. Moran Eye Center, Salt Lake City, Utah 84132, USA
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Abstract
PURPOSE OF REVIEW A working knowledge of the principles guiding recent technologic upgrades in phacoemulsification units will help the surgeon to maximize clinical benefits from the latest machines. RECENT FINDINGS Reduced thermal energy combined with more efficient emulsification resulting from microfractionation of ultrasound energy, and improved chamber stability from automatic fluidic adjustments are achievable with the recent technological advances. SUMMARY Improved safety and efficiency can be achieved with the most current advances in phacoemulsification technology.
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Affiliation(s)
- Pulin A Shah
- Bascom Palmer Eye Institute, Miami, Florida 33136, USA
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