NeoSoniX ultrasound versus ultrasound alone for phacoemulsification: randomized clinical trial

Intraoperative Pain Sensation During Cataract Surgery: Why Does Timing Matter?

Purpose: To investigate whether timing influences pain perception during cataract surgery and to investigate the possible mechanisms.Methods: Patients scheduled for cataract surgery both in the morning and afternoon were consecutively enrolled. Questionnaires to evaluate anxiety, including the Simplified State-Trait Anxiety Inventory, Amsterdam Preoperative Anxiety and Information Scale, and a visual analogue scale (VAS) for anxiety, were completed preoperatively, whereas a VAS for pain and the Wong-Baker FACES® Pain Rating Scale questionnaire were completed after surgery. Preoperative blood pressure and heart rate were recorded. Blood samples were acquired before surgery, and plasma cortisol, adrenocorticotropic hormone, adrenalin, and noradrenalin were tested.Results: Fifty-five patients underwent uneverntful cataract surgery (28 in the morning and 27 in the afternoon) were included in the final analysis. Greater intraoperative pain perception during cataract surgery was reported in the afternoon than in the morning. Overall anxiety levels were significantly higher in the afternoon. Plasma adrenalin levels were significantly higher in the afternoon. Cortisol levels were higher in the afternoon. Preoperative anxiety levels were closely related to intraoperative pain perception. Both adrenalin and cortisol correlated positively with preoperative anxiety, but only adrenalin correlated significantly with the pain scores.Conclusions: Patients undergoing cataract surgery in the afternoon showed more preoperative anxiety, which may have increased their relevant stress hormones. Both the patient's emotional state and hormone levels may together aggravate his/her perceived pain in the afternoon. Monitoring preoperative anxiety levels, blood pressure, and heart rate should help to identify patients at higher risk of perceived intraoperative pain.Clinical trial registration:Trial registration number: NCT02182921Registration site: clinicaltrials.gov.

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

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.

Torsional mode phacoemulsification: effective, safe cataract surgery technique of the future

Purpose:

To compare various outcome measures using torsional mode and longitudinal mode in the phacoemulsification of cataract with different nuclear densities.

Setting:

Magrabi Eye Hospitals, Kingdom of Saudi Arabia.

Design:

A randomized comparative clinical study.

Materials and Methods:

This study includes 200 eyes of 156 patients (100 in the ultrasound longitudinal “US” group and 100 in the torsional group). All eyes received AcrySof^® single piece intraocular lens (Alcon Surgical, Fort Worth, TX). The primary outcome measures were ultrasound time (UST), cumulative dissipated energy (CDE), and surgical complications. Postoperative outcome measures were the degree of corneal edema on the first postoperative day and final best corrected visual acuity (BCVA) and CCT (central corneal thickness).

Results:

The differences in UST and CDE between subgroups of nucleus hardness were statistically significant (P < 0.01). The UST and CDE consistently increased in eyes with higher grades of nucleus density. On day one, the mean BCVA was 0.61 ± 0.13 decimals in the ultrasound (US) group and 0.67 ± 0.11 decimals in the torsional group (significant P < 0.05). Corneal edema was significantly less in the torsional group (P < 0.05). At 30 days, the mean BCVA was 0.94 ± 0.22 decimals in the US group and 1.0 ± 0.12 decimals in the torsional group but this difference was not statistically different (P > 0.05).

Conclusions:

The torsional mode provides an effective and safe method for cataract removal with lower energy usage as compared to longitudinal traditional phacoemulsification. However, the final visual outcome was similar for both study groups.

Torsional ultrasound modality for hard nucleus phacoemulsification cataract extraction

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 (p0.01), 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 (p

CONCLUSIONS

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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MESH Headings

• Aged
• Aged, 80 and over
• Cornea/pathology
• Endothelium, Corneal/pathology
• Female
• Humans
• Lens Nucleus, Crystalline/surgery
• Male
• Middle Aged
• Phacoemulsification/methods
• Prospective Studies
• Tomography, Optical Coherence
• Treatment Outcome
• Ultrasonic Therapy/methods
• Visual Acuity

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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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AquaLase versus NeoSoniX--a comparison study

AIMS

To compare the metrics and surgical outcome when using Infiniti AquaLase and NeoSoniX cataract removal modalities.

METHODS

This prospective clinical study involved 50 patients with bilateral cataracts and lens removal using AquaLase in the right eye and NeoSoniX in the left eye. Best corrected visual acuity (BCVA), endothelial cell density and pachymetry were evaluted pre- and postoperatively. Statistical analysis was performed using the Wilcoxon Signed- Rank Test.

RESULTS

Preoperative mean pachymetry was 569 +/- 31 mu in the right eye (RE) and 560 +/- 37 mu in the left eye (LE), mean endothelial cell density 2744 +/- 418 cells/mm(2) (RE) and 2730 +/- 472 cells/mm(2) (LE). One week after operation pachymetry was 576 +/- 52 mu (RE) and 583 +/- 72 mu (LE) and endothelial cell density 2388 +/- 586 cells/mm(2) (RE) and 2463 +/- 615 cells/mm(2) (LE). One month after surgery pachymetry was 556 +/- 43 mu (RE) and 559 +/- 44 mu (LE) and endothelial cell density 2368 +/- 52 cells/mm(2) (RE) and 2495 +/- 548 cells/mm(2) (LE). BCVA improved in all eyes and was 0.8 or better on the first postoperative day.

CONCLUSIONS

Both the NeosoniX and AquaLase minimize intraoperative damage to ocular structures.