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Ungricht EL, Harris JT, Jensen NR, Barlow WR, Murri MS, Olson RJ, Pettey JH. Effect of low and passive flow on OVD thermal properties during phacoemulsification. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023; 58:507-512. [PMID: 35868436 DOI: 10.1016/j.jcjo.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 06/03/2022] [Accepted: 06/23/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To study the thermal properties and response magnitude of a forced-infusion phacoemulsification machine on 4 ophthalmic viscosurgical devices (OVDs). DESIGN Experimental study. METHODS A phacoemulsification tip, thermocouple, and gauge were placed into an artificial anterior chamber with balanced saline solution (BSS) or approximately 0.1 mL of OVD. Once the thermocouple measured a consistent temperature, the pedal was engaged for 60 seconds; then the tip was removed. The machine was cooled for 5 minutes and flushed with BSS to return to baseline. This was repeated 10 times for each OVD. The research consisted of 2 scenarios: vacuum-blocked flow rate and low aspiration flow rate. RESULTS All OVDs showed greater temperature changes than BSS. In the vacuum-blocked scenario, these increases were statistically significant. The medium viscosity dispersive OVD (DiscoVisc) reached temperatures exceeding 60°C. In the low-flow scenario, HEALON5 and DisCoVisc were significantly different at 5 seconds and only HEALON5 at 10 seconds. No temperature increases over BSS were greater than 1.0°C. CONCLUSIONS The dispersive, cohesive, and viscoadaptive OVDs demonstrated higher temperature changes than BSS but did not reach the threshold for corneal incision contracture. The study team verified the need for at least a minimal flow rate before ultrasound, which is especially evident in the first 10 seconds, because a flow rate of only 20 mL/minute mitigated OVD-related thermal effects. Understanding thermal responses enables corneal incision contracture risk reduction.
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Affiliation(s)
- Emilie L Ungricht
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT; University of Utah School of Medicine, Salt Lake City, UT
| | - Jacob T Harris
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT; University of Utah School of Medicine, Salt Lake City, UT
| | - Nathan R Jensen
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT; University of Utah School of Medicine, Salt Lake City, UT
| | - William R Barlow
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT
| | - Michael S Murri
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT
| | - Randall J Olson
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT
| | - Jeff H Pettey
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT.
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Eom Y, Lee YJ, Song JS, Kim HM, Nam DH. Effect of surgical microscope and illuminated chopper on anterior chamber temperature. BMC Ophthalmol 2023; 23:29. [PMID: 36690966 PMCID: PMC9869552 DOI: 10.1186/s12886-023-02784-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/16/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND To evaluate the effect of the light intensity of the surgical microscope and illuminated chopper on the anterior chamber temperature. STUDY DESIGN Experimental study. METHODS A model eye (Kitaro WetLab System; FCI Ophthalmics, Pembroke, MA, USA) was used in this experimental study. The illuminance of a surgical microscope (Leica M300; Leica Microsystems, Wetzlar, Germany) and illuminated chopper (iChopper NAM-25 GB; Oculight, Korea) with a light source (iVision; Oculight) was measured using an illuminometer. In addition, the temperature in the anterior chamber of the model eye filled with balanced salt solution when using the surgical microscope with a light intensity from level 1 to level 6 and the illuminated chopper at 99% light intensity was measured for 10 min. RESULTS The anterior chamber temperature was increased by 0.2, 0.5, 1.0, and 1.4 ℃ when using the surgical microscope at level 3 (10050 lux), 4 (16490 lux), 5 (24900 lux), and 6 (32500 lux), respectively, for 10 min. The illuminated chopper at 99% light intensity (14893 lux) positioned in the anterior chamber increased the anterior chamber temperature by 0.2° C after 10 min, which was equal to the increase in the temperature caused by the surgical microscope at level 3. CONCLUSION The photothermal effect of the illuminated chopper directly positioned in the anterior chamber appeared to be similar to that of a microscope with similar illuminance. Therefore, the illuminated chopper is safe in terms of anterior chamber temperature changes in cataract surgery.
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Affiliation(s)
- Youngsub Eom
- grid.222754.40000 0001 0840 2678Department of Ophthalmology, Ansan Hospital, Korea University College of Medicine, 123, Jeokgeum-Ro, Danwon-Gu, Ansan-Si, Gyeonggi-Do 15355 Republic of Korea ,grid.222754.40000 0001 0840 2678Department of Ophthalmology, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841 Republic of Korea ,grid.189967.80000 0001 0941 6502Department of Ophthalmology, Emory University School of Medicine, Emory Clinic Building B, 1365B Clifton Road, Atlanta, GA 30322 USA
| | - Young Joo Lee
- grid.222754.40000 0001 0840 2678Department of Ophthalmology, Ansan Hospital, Korea University College of Medicine, 123, Jeokgeum-Ro, Danwon-Gu, Ansan-Si, Gyeonggi-Do 15355 Republic of Korea ,grid.222754.40000 0001 0840 2678Department of Ophthalmology, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841 Republic of Korea
| | - Jong Suk Song
- grid.222754.40000 0001 0840 2678Department of Ophthalmology, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841 Republic of Korea
| | - Hyo Myung Kim
- grid.222754.40000 0001 0840 2678Department of Ophthalmology, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841 Republic of Korea
| | - Dong Heun Nam
- grid.411652.5Department of Ophthalmology, Gil Medical Center, College of Medicine, Gachon University Gil Hospital, 21, Namdong-daero 774beon-gil, Namdong-gu, Incheon, 21565 Republic of Korea
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Transient temperature distribution on the corneal endothelium during ophthalmic phacoemulsification: a numerical simulation using the nodeless variable element. ASIAN BIOMED 2018. [DOI: 10.2478/abm-2010-0116] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Background: During cataract operation (phacoemulsification), a phaco needle-tip is inserted into the anterior chamber of eye. Then, heat is generated by the oscillation of the phaco needle, which may injury the corneal endothelial cells. There are no data available for temperature responses at the corneal endothelium to heat from the phaco needle during phacoemulsification. Objective: Investigate temperature distribution on the corneal endothelium during ophthalmic phacoemulsification using numerical simulation, and compare the transient temperature response to heat between balanced salt solution (BSS) and ophthalmic viscoelastic device (OVD), Viscoat®. Methods: Heat flux from a phaco needle was measured with thermal properties of BSS and AVS in an experimental setting. Then, nodeless variable finite element method was applied to predict temperature changes in the eye by the phaco needle inserted into the anterior chamber. The transient temperature distribution on the corneal endothelium was calculated at 10, 20, and 30 seconds after heat generation by the needle. Results: The heat generation of phaco needle without sleeve cover was 1.6 kW/m2. The numerical simulation showed that the maximum temperature occurs on the wound location at all times after heat generation by the phaco needle. Especially, at time 30 seconds, it was 49.2 and 41.7°C in BSS and OVD, respectively. The temperature elevation by the phaco needle was lower in OVD than BSS. Conclusion: Phacoemulsification is a heat-generating procedure performed between the anterior chamber structures of eye. During this procedure, OVD may protect the corneal endothelium against heat better than BSS.
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Sethi HS, Saluja K, Naik MP. Comparative analysis of coaxial phacoemulsification with 2.2- and 2.8-mm clear corneal incisions. Int Ophthalmol 2017; 38:215-222. [PMID: 28144795 DOI: 10.1007/s10792-017-0450-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 01/06/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE To compare the intraoperative efficiency and postoperative visual outcome of coaxial phacoemulsification using 2.2- and 2.8-mm clear corneal incision coaxial phacoemulsification. SETTING The study was conducted at Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi which is a tertiary health care centre. STUDY DESIGN This is a prospective, randomized, comparative interventional study. MATERIALS AND METHODS A total of 140 eyes of patients undergoing cataract surgery were enrolled according to the inclusion-exclusion criteria and randomly divided in two groups of 70 such that Group I-Patients underwent phacoemulsification through 2.8-mm clear corneal incision. Group II-Patients underwent phacoemulsification through 2.2-mm clear corneal incision.Postoperative assessment was done at 1 day, 1 and 6 weeks to note best-corrected visual acuity (BCVA), ophthalmic examination, corneal topography, central corneal thickness and corneal endothelial cell count. STATISTICS 1. Quantitative variables were compared using Mann-Whitney test and Wilcoxon ranked-sum test. 2. Qualitative variables were compared using Fisher's exact test. p value of <0.05 was considered statistically significant. RESULTS There is steady trend in decrease in postoperative astigmatism with time, more so in 2.8 mm group; however, differences were not found to be statistically significant. 2.2 mm group had larger increase in CCT and ECC compared to 2.8 mm group which was not statistically significant (p = 0.296). CONCLUSION Reducing the incision size from 2.8 to 2.2 mm does not result in any significant reduction in the amount of surgically induced astigmatism. Also, both the incision sizes have similar intraoperative efficacy when compared in terms of postoperative decrease in corneal endothelial cell count and increase in central corneal thickness.
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Affiliation(s)
- Harinder Singh Sethi
- Department of Ophthalmology, V.M.M.C & Safdarjung Hospital, Room No. 430 of Eye OPD, 4th Floor of OPD Building, Ansari Nagar, Ring Road, Newdelhi, 110029, India
| | - Komal Saluja
- Department of Ophthalmology, V.M.M.C & Safdarjung Hospital, Room No. 430 of Eye OPD, 4th Floor of OPD Building, Ansari Nagar, Ring Road, Newdelhi, 110029, India
| | - Mayuresh P Naik
- Department of Ophthalmology, V.M.M.C & Safdarjung Hospital, Room No. 430 of Eye OPD, 4th Floor of OPD Building, Ansari Nagar, Ring Road, Newdelhi, 110029, India.
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Nair S, Nair RU. Wound and surface temperatures in vivo in torsional and longitudinal modalities of ultrasound in coaxial microincisional cataract surgery. Clin Ophthalmol 2017; 11:249-255. [PMID: 28184151 PMCID: PMC5291324 DOI: 10.2147/opth.s123222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Swapna Nair
- Department of Cataract and Refractive Surgery
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Zacharias J. Laboratory assessment of thermal characteristics of three phacoemulsification tip designs operated using torsional ultrasound. Clin Ophthalmol 2016; 10:1095-101. [PMID: 27358554 PMCID: PMC4912312 DOI: 10.2147/opth.s105065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Ultrasound activation of phacoemulsification (phaco) tips can create considerable thermal energy that may increase the risk of tissue damage during cataract surgery. The purpose of this study was to define the thermal profiles of three phaco tip designs in simulated surgical conditions. Methods In this laboratory investigation, sleeved phaco tips (mini-flared Kelman® tip with aspiration bypass port and Intrepid® Balanced Tip with aspiration bypass port, and MST A1 bent-mini phaco tip (without aspiration bypass) were tested using an ultrasonic phaco device operated in torsional mode at power levels of 50%, 75%, and 100% amplitude. An automated fixture applied a 30 g load to simulate compression against the incision site, leading to friction between the silicone sleeve and the titanium tip. Temperature was recorded by high rate infrared imaging under conditions of free flow and occlusion, which was simulated by clamping the aspiration line. Data were summarized using descriptive statistics. Results Baseline temperatures of ~26°C were observed for all tips. During ultrasonic operation at 50%, 75%, and 100% amplitude, temperatures were lower for the mini-flared and balanced tips versus the bent-mini tip, both when load was applied and during occlusion. The bent-mini tip reached temperatures as high as 70°C during occlusion with load when operated at 100% amplitude, whereas the mini-flared tip remained <50°C, and the balanced tip remained <36°C in all test conditions. For the mini-flared and balanced tips, temperature increases during operation were not markedly different from free flow and no-load conditions when occlusion or frictional events were simulated. Conclusion In all experiments for each tip design, increasing ultrasound power was associated with greater increases in tip temperature. Tip temperatures increased with applied load, but marked temperature increases during occlusion were observed only with the bent-mini tip. The balanced tip produced minimal thermal peaks in all tests.
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Affiliation(s)
- Jaime Zacharias
- Phacodynamics Laboratory, Pasteur Ophthalmic Clinic, Santiago, Chile
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Suzuki H, Igarashi T, Shiwa T, Takahashi H. Efficacy of Ophthalmic Viscosurgical Devices in Preventing Temperature Rise at the Corneal Endothelium during Phacoemulsification. Curr Eye Res 2016; 41:1548-1552. [DOI: 10.3109/02713683.2015.1136420] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Hisaharu Suzuki
- Department of Ophthalmology, Nippon Medical School Musashikosugi Hospital, Nakahara-ku, Kawasaki City, Kanagawa, Japan
| | - Tsutomu Igarashi
- Department of Ophthalmology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Toshihiko Shiwa
- Department of Ophthalmology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Hiroshi Takahashi
- Department of Ophthalmology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
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Hwang HS, Ahn YJ, Lee HJ, Kim MS, Kim EC. Comparison of macular thickness and inflammatory cytokine levels after microincision versus small incision coaxial cataract surgery. Acta Ophthalmol 2016; 94:e189-94. [PMID: 25828946 DOI: 10.1111/aos.12716] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 02/11/2015] [Indexed: 12/01/2022]
Abstract
PURPOSE To compare the macular thickness and volume change, and inflammatory cytokine levels after cataract surgery performed using two different sizes of incision (microincision versus small incision). METHODS In this randomized, comparative clinical trial, 84 eyes with nuclear density from Grade 3-4 were randomly divided into two groups (microincision, 2.2 mm; and small incision, 2.75 mm). Forty-two patients underwent phacoemulsification with microincision coaxial cataract surgery and 42 patients underwent phacoemulsification with small incision coaxial cataract surgery. Clinical measurements included preoperative, 1-week, 1-month and 2-month postoperative best corrected visual acuity, central corneal thickness (CCT) and endothelial cell count. ELISA and RT-PCR were performed for IL-1β, IL-6, VEGF and PGE2 preoperatively and at 1 week postoperatively. RESULTS The percentage increase in CCT in the microincision group was significantly higher than that in the small incision group at 1 week after cataract surgery (p = 0.01). The increase in macular thickness in the microincision group was significantly higher than that in small incision group at 1 month after cataract operation (p = 0.04). Also, IL-1β, IL-6, VEGF and PGE2 concentrations and their expression ratio in the microincision group were significantly higher than those in the small incision group at 1 week after cataract surgery compared to the preoperative period (p < 0.05). CONCLUSIONS Phacoemulsification with microincision coaxial cataract surgery may increase the macular thickness compared to phacoemulsification with small incision coaxial cataract surgery. Blood-aqueous barrier breakdown may occur more frequently after microincision cataract surgery than after small incision cataract surgery.
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Affiliation(s)
- Ho Sik Hwang
- Department of Ophthalmology; Chuncheon Sacred Heart Hospital; College of Medicine; Hallym University; Chuncheon Korea
| | - Ye Jin Ahn
- Department of Ophthalmology & Visual Science; College of Medicine; Catholic University of Korea; Seoul Korea
| | - Hee Jin Lee
- Institute of Clinical Medicine Research; College of Medicine; Catholic University of Korea; Seoul Korea
| | - Man Soo Kim
- Department of Ophthalmology & Visual Science; College of Medicine; Catholic University of Korea; Seoul Korea
| | - Eun Chul Kim
- Department of Ophthalmology & Visual Science; College of Medicine; Catholic University of Korea; Seoul Korea
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Rossi M, Di Censo F, Di Censo M, Oum MA. Changes in Aqueous Humor pH After Femtosecond Laser-Assisted Cataract Surgery. J Refract Surg 2015; 31:462-5. [PMID: 26158926 DOI: 10.3928/1081597x-20150623-04] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 05/12/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare aqueous humor pH values in patients during femtosecond laser-assisted cataract surgery with patients during conventional phacoemulsification. METHODS A prospective clinical study was conducted in 29 eyes of 29 patients who underwent cataract surgery by a single surgeon. The femtosecond laser group included 15 eyes operated on with a femtosecond laser platform (Catalys; Abbott Medical Optics, Santa Ana, CA) and the phacoemulsification group included 14 eyes that were operated on with conventional phacoemulsification. The femtosecond laser group was subdivided into low, medium, and high level of cavitation gas bubbles after docking and the femtosecond laser procedure, according to the judgment of the surgeon. Aqueous humor samples (0.10 to 0.15 mL) were collected through a paracentesis from each patient after docking, corneal incisions, and nucleus fragmentation in the femtosecond laser group and after corneal incisions but before injection of viscoelastic in the phacoemulsification group, then analyzed with a pH meter. RESULTS The mean pH was 6.53 ± 0.09 (range: 6.42 to 6.70) and 7.42 ± 0.07 (range: 7.28 to 7.48) in the femtosecond laser and phacoemulsification groups, respectively (P < .001). In the femtosecond laser group, no significant differences in pH were observed between the three subgroups after docking and the femtosecond laser surgical procedure: low (6.55 ± 0.09 [range: 6.53 to 6.57]), medium (6.54 ± 0.07 [range: 6.52 to 6.55]), and high (6.42 ± 0.00 [range: 6.40 to 6.44]) level of gas bubbles. CONCLUSIONS Cavitation bubbles derived from the photodisruption process in femtosecond laser-assisted cataract surgery lead to an acidic shift of the aqueous humor pH as a result of the transformation of carbon dioxide to carbonic acid. The level of gas bubbles visible after the laser photodisruption does not seem to correlate with this pH shift. Further analysis of femtosecond laser-assisted cataract surgery is necessary.
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Buschschlüter S, von Eicken J, Koch C, Höh H. Experimental and Numerical Determination of the Local Temperature Distribution during Phacoemulsification and Comparison of Different Surgery Situations within Enucleated Porcine Eyes. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:2161-2172. [PMID: 25944286 DOI: 10.1016/j.ultrasmedbio.2015.03.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 03/07/2015] [Accepted: 03/27/2015] [Indexed: 06/04/2023]
Abstract
Phacoemulsification, a common treatment for cataract, is accompanied by cell damage at the corneal endothelium. Thermal exposure during treatment has been considered a reason for this damage, but a thorough experimental and theoretical assessment of the local temperature distribution inside the eye had not yet been conducted. Measurements in porcine eyes and a finite-element simulation enabled such an assessment and localized the highest temperature rise very close to the probe. The results described in this study indicate that a distance of 1 mm between the probe and the endothelium should be maintained during treatment as a safety margin, especially when fluid flow is blocked. The highest measured temperature rise with surgically reasonable system settings and unblocked fluid flow was 1.11°C. The finite-element simulation described here is able to calculate the temperature rise at the endothelium and could serve as a tool for comparing arbitrary surgical situations with respect to thermal exposure of the endothelium.
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Affiliation(s)
| | - Jörn von Eicken
- Klinik für Augenheilkunde, Dietrich-Bonhoeffer-Klinikum, Neubrandenburg, Germany
| | - Christian Koch
- Physikalisch-Technische Bundesanstalt, Braunschweig, Germany
| | - Helmut Höh
- Klinik für Augenheilkunde, Dietrich-Bonhoeffer-Klinikum, Neubrandenburg, Germany
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Bang JW, Lee JH, Kim JH, Lee DH. Structural analysis of different incision sizes and stromal hydration in cataract surgery using anterior segment optical coherence tomography. KOREAN JOURNAL OF OPHTHALMOLOGY 2015; 29:23-30. [PMID: 25646057 PMCID: PMC4309865 DOI: 10.3341/kjo.2015.29.1.23] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 07/07/2014] [Indexed: 11/23/2022] Open
Abstract
Purpose To analyze healing changes of corneal wounds of different corneal incision sizes with or without stromal hydration in cataract surgery using anterior segment optical coherence tomography. Methods Cataract surgeries were performed by a single surgeon and 2.2- and 2.8-mm corneal incisions were made using a diamond blade (ME-759; Meyco, Biel-Bienne, Swiss). Patients were divided into four groups according to incision size (2.2 and 2.8 mm), and with/without stromal hydration. Fifteen eyes were assigned to each group and incision wounds were measured using anterior segment optical coherence tomography at 2 hours, 1 day, 1 week, 1 month, and 3 months postoperatively. Corneal thickness, incision length and incision angle were measured and existence of epithelial, endothelial gaping and Descemet's membrane detachment was evaluated. Results Incision thickness was greater in the group with stromal hydration than in the group without on operation day (p < 0.05). Stromal hydration exerted greater influence in the 2.2-mm incision group than in the 2.8-mm incision group. Corneal thickness decreased more rapidly in the stromal hydration group than in the group with no hydration (p = 0.022). Endothelial gaping was greater in the 2.2-mm incision group than in the 2.8-mm incision group 1 day, 1 month, and 3 months after surgery (p = 0.035, p = 0.009, and p = 0.008, respectively). No other statistical significance was observed between the two groups (2.2 and 2.8 mm) during follow-up regarding corneal thickness, epithelial gaping and Descemet's membrane detachment. Conclusions Corneal wounds with a smaller incision could be more vulnerable to external stimuli such as stromal hydration and are less stable than those with a larger incision.
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Affiliation(s)
- Jong-Wook Bang
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jong-Hyun Lee
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jin-Hyoung Kim
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Do-Hyung Lee
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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Zacharias J. Thermal characterization of phacoemulsification probes operated in axial and torsional modes. J Cataract Refract Surg 2015; 41:208-16. [DOI: 10.1016/j.jcrs.2014.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 06/24/2014] [Accepted: 06/25/2014] [Indexed: 11/26/2022]
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von Sonnleithner C, Bergholz R, Gonnermann J, Klamann MK, Torun N, Bertelmann E. Clinical Results and Higher-Order Aberrations after 1.4-mm Biaxial Cataract Surgery and Implantation of a New Aspheric Intraocular Lens. Ophthalmic Res 2014; 53:8-14. [DOI: 10.1159/000364808] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 05/16/2014] [Indexed: 11/19/2022]
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Buschschlüter S, Koch C, von Eicken J, Höh H. Computation of the temperature rise at the corneal endothelium during cataract surgery by modeling of heat generation inside the anterior chamber. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:2431-2444. [PMID: 25130447 DOI: 10.1016/j.ultrasmedbio.2014.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 05/05/2014] [Accepted: 05/20/2014] [Indexed: 06/03/2023]
Abstract
The corneal endothelium sustaining the transparency of the cornea is a vulnerable cell layer. Thermal exposure during phacoemulsification is considered to be a potential cause of post-operative cell loss. Knowledge of the temperature rise and particularly of its dependence on region and system settings could deliver useful information about a potential correlation with cell damage. However, there exists a lack of understanding of the process and location of heat generation. Analytical calculations and experiments enabled the quantification of different mechanisms acting as heat sources during phacoemulsification. Heat generation caused by viscous friction was estimated using both an analytical approach and a numerical simulation. In contrast to absorption of sound and self-heating of the probe, this effect was ascertained to be the main heat source. Calorimetric measurement of the power input verified this modeling. On the basis of these results, the local temperature distribution inside a porcine eye was computed time dependently using the finite-element method. Two different amplitude settings were compared with respect to the temperature increase at the corneal endothelium. Various conclusions on the mitigation of thermal exposure during treatment can be drawn from this finite-element simulation.
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Affiliation(s)
| | - Christian Koch
- Physikalisch-Technische Bundesanstalt, Braunschweig, Germany
| | - Jörn von Eicken
- Klinik für Augenheilkunde, Dietrich-Bonhoeffer-Klinikum, Neubrandenburg, Germany
| | - Helmut Höh
- Klinik für Augenheilkunde, Dietrich-Bonhoeffer-Klinikum, Neubrandenburg, Germany
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Suzuki H, Oki K, Igarashi T, Shiwa T, Takahashi H. Temperature in the anterior chamber during phacoemulsification. J Cataract Refract Surg 2014; 40:805-10. [DOI: 10.1016/j.jcrs.2013.08.063] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 08/24/2013] [Accepted: 08/27/2013] [Indexed: 10/25/2022]
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Lee HS, Lee TH, Yoon KC. A Case of Corneal Burn During Phacoemulsification. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2014. [DOI: 10.3341/jkos.2014.55.3.454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hyo Seok Lee
- Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea
| | - Tae Hee Lee
- Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea
| | - Kyung Chul Yoon
- Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea
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Ahn YJ, Kim EC. Change in Central Macular Thickness after 2.2-mm Microincision Coaxial versus 2.75-mm Small Incision Cataract Surgery. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2014. [DOI: 10.3341/jkos.2014.55.10.1460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ye Jin Ahn
- Department of Ophthalmology, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
| | - Eun Chul Kim
- Department of Ophthalmology, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
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Ryoo NK, Kwon JW, Wee WR, Miller KM, Han YK. Thermal imaging comparison of Signature, Infiniti, and Stellaris phacoemulsification systems. BMC Ophthalmol 2013; 13:53. [PMID: 24118895 PMCID: PMC4015929 DOI: 10.1186/1471-2415-13-53] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 10/07/2013] [Indexed: 11/24/2022] Open
Abstract
Background To compare the heat production of 3 different phacoemulsification machines under strict laboratory test conditions. More specifically, the thermal behavior was analyzed between the torsional modality of the Infiniti system and longitudinal modalities of the Abbot WhiteStar Signature Phacoemulsification system and Bausch and Lomb Stellaris system. Methods Experiments were performed under in-vitro conditions in this study. Three phacoemulsification handpieces (Infiniti, Signature, and Stellaris) were inserted into balanced salt solution-filled silicone test chambers and were imaged side-by-side by using a thermal camera. Incision compression was simulated by suspending 30.66-gram weights from the silicone chambers. The irrigation flow rate was set at 0, 1, 2, 3, 4, and 5 cc/min and the phacoemulsification power on the instrument consoles was set at 40, 60, 80, and 100%. The highest temperatures generated from each handpiece around the point of compression were measured at 0, 10, 30, and 60 seconds. Results Under the same displayed phacoemulsification power settings, the peak temperatures measured when using the Infiniti were lower than when using the other two machines, and the Signature was cooler than the Stellaris. At 10 seconds, torsional phacoemulsification with Infiniti at 100% power showed data comparable to that of the Signature at 80% and the Stellaris at 60%. At 30 seconds, the temperature from the Infiniti at 100% power was lower than the Signature at 60% and the Stellaris at 40%. Conclusions Torsional phacoemulsification with the Infiniti generates less heat than longitudinal phacoemulsification with the Signature and the Stellaris. Lower operating temperatures indicate lower heat generation within the same fluid volume, which may provide additional thermal protection during cataract surgery.
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Affiliation(s)
- Na Kyung Ryoo
- Department of Ophthalmology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, #41 Boramae-Gil, Dongjak-Gu, Seoul 156-707, South Korea.
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Abulafia A, Michaeli A, Belkin A, Assia EI. Temperature profiles of sleeveless and coaxial phacoemulsification. J Cataract Refract Surg 2013; 39:1742-8. [PMID: 23945028 DOI: 10.1016/j.jcrs.2013.02.056] [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: 09/29/2012] [Revised: 02/12/2013] [Accepted: 02/14/2013] [Indexed: 11/18/2022]
Abstract
PURPOSE To study the temperature profile at the corneal wound during 2 sleeveless techniques versus 2 coaxial phacoemulsification techniques. SETTING Department of Ophthalmology, Meir Medical Center, Kfar Saba and Ein-Tal Eye Center, Tel-Aviv, Israel. DESIGN Experimental study. METHODS Thirty-six porcine eyes were randomized into 4 groups: Group 1: conventional coaxial system (3.0 mm incision); Group 2: coaxial microincision cataract surgery (MICS) system (2.2 mm incision); Group 3: bimanual MICS (1.1 mm incision); Group 4: sleeveless tri-MICS (1.1 mm incision) using a 19-gauge anterior chamber maintainer as the sole fluid source. Temperature measurements were taken using a thermocouple and an infrared thermal imaging system. Measurements were taken in 2 settings; that is, with and without occlusion. RESULTS With no occlusion, corneal burns did not occur in any group. However, corneal temperatures were lower with the sleeveless systems (Groups 3 and 4) than with the coaxial systems (Groups 1 and 2) (P=.0003). When occlusion was induced, temperatures were kept constantly low in the sleeveless groups, whereas in the coaxial groups, temperatures increased rapidly, causing corneal burns within seconds. The mean temperature elevations at the incision sites were 39 °C, 48.5 °C, 13.6 °C, and 11.3 °C in Groups 1, 2, 3, and 4, respectively (P<.0001). CONCLUSIONS Sleeveless phacoemulsification maintained lower tissue temperatures than sleeved coaxial methods. During occlusion, fluid flow around the naked tip of the sleeveless systems prevented heat accumulation and corneal burns.
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Affiliation(s)
- Adi Abulafia
- From the Department of Ophthalmology (Abulafia, Belkin, Assia), Meir Medical Center, Kfar Saba, and the Ein-Tal Eye Center (Abulafia, Michaeli, Assia), the Department of Ophthalmology (Michaeli), Tel-Aviv Medical Center, and the Sackler School of Medicine (Abulafia, Michaeli, Belkin, Assia), Tel-Aviv University, Tel-Aviv, Israel.
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Vasavada AR, Johar K, Praveen MR, Vasavada VA, Arora AI. Histomorphological and immunofluorescence evaluation of clear corneal incisions after microcoaxial phacoemulsification with 2.2 mm and 1.8 mm systems. J Cataract Refract Surg 2013; 39:617-23. [DOI: 10.1016/j.jcrs.2012.12.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 12/12/2012] [Accepted: 12/12/2012] [Indexed: 11/16/2022]
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Smaller Incision Size Leads to Higher Predictability in Microcoaxial Cataract Surgery. Eur J Ophthalmol 2012; 23:202-7. [DOI: 10.5301/ejo.5000207] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2012] [Indexed: 11/20/2022]
Abstract
Purpose. 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. Results. 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. Conclusions. 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.
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Microincision versus small-incision coaxial cataract surgery using different power modes for hard nuclear cataract. J Cataract Refract Surg 2011; 37:1799-805. [DOI: 10.1016/j.jcrs.2011.04.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Revised: 03/23/2011] [Accepted: 04/01/2011] [Indexed: 11/22/2022]
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Thermal study of longitudinal and torsional ultrasound phacoemulsification: tracking the temperature of the corneal surface, incision, and handpiece. J Cataract Refract Surg 2010; 36:832-7. [PMID: 20457377 DOI: 10.1016/j.jcrs.2009.11.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Revised: 11/18/2009] [Accepted: 11/23/2009] [Indexed: 11/20/2022]
Abstract
PURPOSE 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. SETTING Department of Ophthalmology, Duke University, Durham, North Carolina, USA. METHODS 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. RESULTS 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. CONCLUSION 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.
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Espiritu CRG, Bernardo JP. Incision sizes at different stages of phacoemulsification with foldable intraocular lens implantation. J Cataract Refract Surg 2010; 35:2115-20. [PMID: 19969217 DOI: 10.1016/j.jcrs.2009.06.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 06/17/2009] [Accepted: 06/18/2009] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate incision sizes during different stages of phacoemulsification and after implantation of a foldable acrylic intraocular lens (IOL). SETTING Private eye center, Manila, Philippines. METHODS In this prospective observational case series, incision widths were measured before and after microcoaxial phacoemulsification (2.2 mm), after cortical removal, and after implantation of a 6.0 mm optic, foldable, single-piece aspheric hydrophobic acrylic IOL using a D cartridge and a Monarch III injector. RESULTS The incision width increased in 101 (93.5%) of the 108 eyes; the enlargement was 0.1 mm in 78 eyes (77.2%) and 0.2 mm in 23 eyes (22.8%). The final incision width was 2.3 mm in 78 eyes (72.2%), 2.2 mm in 27 eyes (25.0%), 2.1 mm in 2 eyes, and 2.4 mm in 1 eye. Enlargement occurred during phacoemulsification in 39 eyes, during cortical removal in 33 eyes, and during IOL implantation in 52 eyes; 23 eyes had more than 1 enlargement. Before IOL implantation, the incision was smaller than 2.2 mm in 76 eyes (70.4%); after IOL implantation, the incision increased to 2.3 mm in 47 eyes (61.8%). Thirty-two eyes (29.6%) had a 2.3 mm incision before IOL implantation; the incision increased further (by 0.1 mm) after IOL implantation in 1 eye. CONCLUSIONS Incision enlargement occurred at different stages of phacoemulsification, mostly during IOL implantation. More than 72% of eyes had a final incision of 2.3 mm. Beginning with a 2.3 mm incision may prevent wound tears and surface irregularities.
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Jun B, Berdahl JP, Kuo AN, Cummings TJ, Kim T. Corneal Wound Architecture and Integrity After Torsional and Mixed Phacoemulsification: Evaluation of Standard and Microincisional Coaxial Techniques. Ophthalmic Surg Lasers Imaging Retina 2010; 41:128-34. [PMID: 20128583 DOI: 10.3928/15428877-20091230-23] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2009] [Indexed: 11/20/2022]
Affiliation(s)
- Bokkwan Jun
- Erwin Road - Box 3802, Duke University Eye Center, Durham, NC 27710, USA
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Wang J, Zhang EK, Fan WY, Ma JX, Zhao PF. The effect of micro-incision and small-incision coaxial phaco-emulsification on corneal astigmatism. Clin Exp Ophthalmol 2009; 37:664-9. [PMID: 19788662 DOI: 10.1111/j.1442-9071.2009.02117.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the effect of micro-incision (2.2 mm) and small-incision (2.6 mm or 3.0 mm) coaxial phaco-emulsification on surgically induced astigmatism (SIA). METHODS Cataract patients (n = 83, 129 eyes) were randomized into three groups: 43 eyes in the 2.2-mm incision group, 42 eyes in the 2.6-mm group and 44 eyes in the 3.0-mm group. Torsional phaco-emulsification was followed by intraocular lens implantation via the Monarch II injector with the C cartridge (Alcon Laboratories Inc., Fort Worth, TX, USA). Corneal astigmatism, SIA and uncorrected distance visual acuity were assessed 30 and 90 days after cataract surgery. RESULTS At 30 and 90 days postoperative, SIA of the 3.0-mm group was greater than SIA of the 2.2-mm and 2.6-mm groups (P < or = 0.015), but SIA was similar between the 2.2-mm group and the 2.6-mm group. Timewise, mean SIA at 30 days was greater than SIA at 90 days in the 3.0-mm group (P = 0.04), while SIA did not change with time for the 2.2-mm and 2.6-mm groups. Postoperative uncorrected distance visual acuity tended to be better with the smaller incisions, but this trend did not reach statistical significance (P > or = 0.07). CONCLUSION Incision size contributed to postoperative corneal astigmatism. When incision size was reduced from 3.0 mm to 2.6 mm, SIA was reduced and refractive stabilization was faster. Reduction of incision size from 2.6 mm to 2.2 mm offered no greater reduction of SIA when using the C cartridge; however, the D cartridge (designed for 2.2-mm incisions) should be evaluated.
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Affiliation(s)
- Jun Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
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Elkady B, Piñero D, Alió JL. Corneal incision quality: Microincision cataract surgery versus microcoaxial phacoemulsification. J Cataract Refract Surg 2009; 35:466-74. [DOI: 10.1016/j.jcrs.2008.11.047] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Revised: 11/21/2008] [Accepted: 11/23/2008] [Indexed: 11/15/2022]
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Hayashi K, Yoshida M, Hayashi H. Postoperative corneal shape changes: Microincision versus small-incision coaxial cataract surgery. J Cataract Refract Surg 2009; 35:233-9. [DOI: 10.1016/j.jcrs.2008.10.031] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Revised: 10/22/2008] [Accepted: 10/23/2008] [Indexed: 10/21/2022]
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Praveen MR, Vasavada AR, Gajjar D, Pandita D, Vasavada VA, Vasavada VA, Raj SM. Comparative quantification of ingress of trypan blue into the anterior chamber after microcoaxial, standard coaxial, and bimanual phacoemulsification. J Cataract Refract Surg 2008; 34:1007-12. [DOI: 10.1016/j.jcrs.2008.03.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2008] [Accepted: 03/10/2008] [Indexed: 11/26/2022]
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Histomorphological and immunofluorescence evaluation of bimanual and coaxial phacoemulsification incisions in rabbits. J Cataract Refract Surg 2008; 34:670-6. [DOI: 10.1016/j.jcrs.2007.11.047] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2007] [Accepted: 11/24/2007] [Indexed: 11/17/2022]
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Gajjar D, Praveen MR, Vasavada AR, Pandita D, Vasavada VA, Patel DB, Johar K, Raj S. Ingress of bacterial inoculum into the anterior chamber after bimanual and microcoaxial phacoemulsification in rabbits. J Cataract Refract Surg 2007; 33:2129-34. [DOI: 10.1016/j.jcrs.2007.07.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2007] [Accepted: 07/16/2007] [Indexed: 10/22/2022]
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Vasavada V, Vasavada V, Raj SM, Vasavada AR. Intraoperative performance and postoperative outcomes of microcoaxial phacoemulsification. J Cataract Refract Surg 2007; 33:1019-24. [PMID: 17531697 DOI: 10.1016/j.jcrs.2007.02.029] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2007] [Accepted: 02/28/2007] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate the intraoperative performance and postoperative outcomes after microcoaxial phacoemulsification. SETTING Iladevi Cataract & IOL Research Centre, Ahmedabad, India. METHODS 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). RESULTS 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%. CONCLUSION Microcoaxial phacoemulsification was safely and effectively performed, achieving consistent and satisfactory postoperative outcomes.
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Affiliation(s)
- Viraj Vasavada
- Iladevi Cataract & IOL Research Centre, Raghudeep Eye Clinic, Gurukul Road, Memnagar, Ahmedabad-380052, India
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Abstract
BACKGROUND Evaluation of rotational stability of a microincision intraocular lens with plate haptic design (*Acri. Smart 46S, *Acri.Tec AG) and its centering in the capsular bag after implantation. MATERIAL AND METHOD In a total of 43 eyes in 37 patients a foldable, spherical microincision cataract surgery (MICS) intraocular lens (IOL) with plate haptic design was implanted through a 1.4-mm microincision by means of an injector system. The IOL was marked prior to implantation to allow exact determination of its endocapsular position. After 1 1/2 years the best corrected visual acuity, refraction, centering and rotational stability of the IOL were determined. RESULTS No rotation or decentration was observed in any of the 42 eyes 12-19 months postoperatively. On the first postoperative day 1 IOL rotated in the counterclockwise direction by approx. 6 degrees as a result of flattening of the anterior chamber. Its position then remained stable. No unwanted complications occurred. CONCLUSIONS Conclusions: *Acri. Smart 46S is a safe, effective and stable IOL that can also be used as the basis of complex refractive optical systems, e.g. for correction of astigmatism.
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Affiliation(s)
- W Wehner
- Maximilians-Augenklinik, 90491, Nürnberg.
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Osher RH, Injev VP. Microcoaxial phacoemulsification. J Cataract Refract Surg 2007; 33:401-7. [PMID: 17321389 DOI: 10.1016/j.jcrs.2006.10.058] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2006] [Accepted: 10/31/2006] [Indexed: 11/26/2022]
Abstract
PURPOSE To examine and compare the fluidic, thermal, and incision behaviors of 2.2 mm microcoaxial and sleeveless bimanual phacoemulsification. SETTING Private practice, Cincinnati, Ohio, USA. METHOD Fluidic performance of microcoaxial phacoemulsification and sleeveless bimanual microphacoemulsification was examined using a reduced-size irrigating sleeve and numerous irrigating choppers, respectively. Incision temperature during phacoemulsification, incision sealability after phacoemulsification, and incision leak were compared in cadaver eyes. Porcine eyes were used to determine whether a full-sized single-piece SN60AT intraocular lens (IOL) (AcrySof) could be inserted through a 2.2 mm incision. RESULTS Fluidic comparison indicated greater irrigation flow and a more stable occlusion break response with the microcoaxial setup than with the sleeveless bimanual setup under the same test conditions. Incision temperature during phacoemulsification, incision sealability after phacoemulsification, and incision leakage tests indicated that the microcoaxial setup produced less temperature rise, better incision sealability, and less incision leakage. A full-sized SN60AT IOL could be inserted through a 2.2 mm incision. CONCLUSIONS Laboratory results indicate that microcoaxial phacoemulsification through a 2.2 mm incision offers fluidic-, thermal-, and incision-related benefits over sleeveless bimanual microphacoemulsification. Moreover, a full-sized single-piece acrylic IOL could be safely implanted without enlarging the 2.2 mm incision.
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Affiliation(s)
- Robert H Osher
- University of Cincinnati College of Medicine, Cincinnati, Ohio 45343-5201, 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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