1
|
Vasavada V, Agrawal D, Vasavada SA, Vasavada AR, Yagnik J. Intraoperative Performance and Early Postoperative Outcomes Following Phacoemulsification With Three Fluidic Systems: A Randomized Trial. J Refract Surg 2024; 40:e304-e312. [PMID: 38717085 DOI: 10.3928/1081597x-20240314-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
PURPOSE To compare intraoperative performance and early postoperative outcomes following phacoemulsification with two systems using active fluidics and one using gravity-based fluidics. METHODS In this prospective randomized trial, 200 eyes were randomized to the traditional and Active Sentry groups (n = 80 eyes each) where the Centurion Vision System was used with traditional or Active Sentry (Alcon Laboratories, Inc) hand-pieces, respectively, or the Infinit group (n = 40 eyes) where the Infiniti Vision System (Alcon Laboratories, Inc) was used. Within the traditional and Active Sentry groups, there were two subgroups with low (30 mm Hg) or high (55 mm Hg) intraocular pressure (IOP) used. Outcome measures compared were: cumulative dissipated energy (CDE), percentage change in central corneal thickness (CCT) at 1 day, 1 week, and 1 month, anterior chamber cells at 1 day and 1 week, rate of rise and fall of IOP following occlusion break, corneal endothelial cell density (ECD), and macular thickness 6 months postoperatively. RESULTS CDE was significantly lower in group II compared to the traditional group (2.96 ± 1.4 vs 4.14 ± 2.2, P = .001). With 30 mm Hg IOP, the Active Sentry group had significantly less percentage change in CCT at 1 week postoperatively compared to the traditional handpiece group (0.01% vs 0.02%, P = .008). Incidence of anterior chamber cells less than grade 2 on day 1 was significantly higher in the Active Sentry group (82.9% vs 52%, P = .03). Percentage change in ECD was significantly lower in the Active Sentry group (-0.957 vs -0.98%, P = .005). Significantly faster rise of IOP to baseline following occlusion break was seen in the Active Sentry group. CONCLUSIONS The use of Active Sentry handpiece was associated with lower CDE, less postoperative increase in CCT, fewer anterior chamber cells, and faster rise of IOP following occlusion break. [J Refract Surg. 2024;40(5):e304-e312.].
Collapse
|
2
|
Ichikawa K, Tanaka Y, Tokiwa S, Naito A, Hidaka Y, Ichikawa R, Ichikawa K, Yamamoto N. Comparison of INTREPID® balanced and hybrid tips on anterior capsule rupture in ex vivo porcine eyes. PLoS One 2023; 18:e0290657. [PMID: 37643177 PMCID: PMC10464992 DOI: 10.1371/journal.pone.0290657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023] Open
Abstract
Phacoemulsification has emerged as the global standard for cataract surgery, and various novel methods, tools, and agents have promoted surgical efficiency and reduced complications. Conventionally, the phaco tip, which cleaves and aspirates the cataractous lens, has been mainly constructed of metal. In this study, the risk of anterior capsule rupture was evaluated under conditions of different power modes, longitudinal (Mode-L), torsional (Mode-T), or both (Mode-LT), and different aspiration powers (0 or 200 mmHg), using a traditional metal phaco tip (Group-M) or a new phaco tip with a high-strength polymer overmold on the needle edge (Group-P), which was developed to reduce the risk of capsule rupture. One hundred twenty porcine eyes were used for experiments within a setting of typical human physiological intraocular pressure. We found that Group-M showed capsule rupture with a smaller ultrasound power than did Group-P, regardless of power mode or aspiration power. In Group-M, there was no significant difference in risk of capsule rupture among power modes, however in Group-P, capsule rupture was least likely to occur with Mode-T. These results provide useful information for inexperienced ophthalmologists to improve surgical safety.
Collapse
Affiliation(s)
- Kei Ichikawa
- Chukyo Eye Clinic, Nagoya, Aichi, Japan
- General Aoyama Hospital, Toyokawa, Aichi, Japan
| | | | | | | | | | | | | | - Naoki Yamamoto
- Support Office for Bioresource Research, Center for Translational Research, Translational Research Headquarters, Fujita Health University, Toyoake, Aichi, Japan
- International Center for Cell and Gene Therapy, Research Promotion Headquarters, Fujita Health University, Toyoake, Aichi, Japan
| |
Collapse
|
3
|
Wenzel DA, Schultheiss C, Druchkiv V, Hellwinkel OJC, Spitzer MS, Schultheiss M, Casagrande M, Steinhorst NA. Effect of elevated irrigation bottle height during cataract surgery on corneal endothelial cells in porcine eyes. BMC Ophthalmol 2023; 23:211. [PMID: 37170242 PMCID: PMC10173645 DOI: 10.1186/s12886-023-02954-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 04/29/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Cataract surgery induces corneal endothelial cell loss (ECL). This study investigates the relationship between bottle height (BH) and ECL induced due to irrigation and aspiration (I/A) in cataract surgery and quantifies protective effects of intraoperatively used ophthalmic viscoelastic substances. METHODS Intermittent I/A without phacoemulsification was performed in porcine eyes for 10 min with varying BHs of 100 cm (BH100), 125 cm (BH125), 150 cm (BH150) or no treatment (control, no I/A). Additionally, in one group a dispersive ophthalmic viscoelastic substance was injected into the anterior eye chamber before treatment with I/A at a BH of 150 cm (BH150 + V). After exposure of the corneal endothelium to I/A, the corneas were prepared to split corneal buttons on day 0 and cultivated for 15 days. Endothelial cell density (ECD) was analyzed blinded on days 1, 8 and 15. RESULTS Relative ECL significantly correlated with irrigation BH (control (n = 13): -9.69 ± 6.03% (average ± standard deviation); BH100 (n = 12): -9.69 ± 4.81%-p = 1.000; BH125 (n = 14): -19.44 ± 7.30% - p < 0.001; BH150 (n = 13): -21.99 ± 6.70%-p < 0.001). I/A-induced ECL was significantly decreased by the injection of ophthalmic viscoelastic, as BH150 + V (n = 14; -10.92 ± 4.09%-p = 1.000) showed a cell loss comparable to the control group. CONCLUSIONS ECL is altered by I/A BH and reduced when viscoelastic substances are used.
Collapse
Affiliation(s)
- Daniel A Wenzel
- University Eye Hospital, Centre for Ophthalmology, University Hospital Tübingen, Tübingen, Germany.
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Constanze Schultheiss
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Vasyl Druchkiv
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Olaf J C Hellwinkel
- Department of Forensic Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin S Spitzer
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Schultheiss
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maria Casagrande
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | |
Collapse
|
4
|
Suzuki H, Igarashi T, Takahashi H. Effect of a new phacoemulsification and aspiration handpiece on anterior chamber stability. J Cataract Refract Surg 2023; 49:91-96. [PMID: 36201661 DOI: 10.1097/j.jcrs.0000000000001071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/29/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE To evaluate the responsiveness of 3 phacoemulsification and aspiration (PEA) systems and a new handpiece to occlusion break by measuring anterior chamber depth (ACD) and intraocular pressure (IOP). SETTING Zengyo Suzuki Eye Clinic, Kanagawa, Japan. DESIGN Experimental study. METHODS ACD change during intentional occlusion breaks was observed and evaluated using the slit side view (SSV) method and IOP measurement with the Centurion Vision System (Group 1), Centurion Vision System with Active Sentry (Group 2), Infiniti Vision System (Group 3), and Constellation Vision System (Group 4). 5 eyes were included per group. Occlusion breaks were triggered at IOP of 30 mm Hg, vacuum limits of 550 mm Hg, and aspiration rate of 40 mL/min. ACD change ratio, surge duration, and surge volume were analyzed from videos of SSV and IOP measurement. RESULTS The smallest ACD change was observed in Group 2 with SSV. ACD change ratios in Groups 1 to 4 were 17.5% ± 3.9%, 7.3% ± 1.2%, 35.7% ± 9.5%, and 74.1 ± 7.7%, respectively. Surge duration and surge volume were calculated only for Groups 1 and 2 and were significantly lower in Group 2 than in Group 1 (0.32 ± 0.03 vs 1.17 ± 0.07 seconds; 18.91 ± 4.70 vs 45.70 ± 0.83 μL). In these 2 groups, ACD change ratio correlated with surge volume. CONCLUSIONS This study evaluated the responsiveness of 3 PEA systems and a new handpiece to occlusion breaks by measuring IOP and ACD. The Active Sentry system was useful for maintaining the ACD even during occlusion breaks.
Collapse
Affiliation(s)
- Hisaharu Suzuki
- From the Zengyo Suzuki Eye Clinic, Kanagawa, Japan (Suzuki); Department of Ophthalmology, Nippon Medical School, Chiba Hokusoh Hospital, Chiba, Japan (Igarashi); Department of Ophthalmology, Nippon Medical School, Tokyo, Japan (Takahashi)
| | | | | |
Collapse
|
5
|
Vasavada V, Vasavada AR, Vasavada VA, Vasavada SA, Bhojwani D. Real-time dynamic changes in intraocular pressure after occlusion break: comparing 2 phacoemulsification systems. J Cataract Refract Surg 2021; 47:1205-1209. [PMID: 33929803 DOI: 10.1097/j.jcrs.0000000000000666] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/21/2020] [Indexed: 10/21/2022]
Abstract
PURPOSE To compare real-time intraocular pressure (IOP) response to occlusion break event in 2 phacoemulsification systems. SETTING Iladevi Cataract and IOL Research Center, India. DESIGN Randomized, experimental study. METHODS Rabbits were randomized to:Group I (n = 10 eyes), Centurion Vision system with active fluidics, or, Group II (n = 10 eyes), Centurion with Active Sentry. Within each group, parameter set 1 (IOP 30 mm Hg, aspiration flow rate [AFR] 20 mL/min, and vacuum 600 mm Hg) and parameter set 2 (IOP 50 mm Hg, AFR 25 mL/min, and vacuum 600 mm Hg) were tested. Real-time rate of drop and rise of IOP after occlusion break event (mm Hg per second) and percentage reduction of IOP from maximum during nuclear fragment removal were compared. RESULTS 10 rabbits (20 eyes) were included. Rate of drop of IOP after occlusion break was not significantly different between groups. Rate of rise of IOP was statistically significantly higher in Group II with both parameter sets (199.09 ± 69.28 vs 94.33 ± 45.66 in parameter set 1, P = .006; and 256 ± 45.05 vs 165.25 ± 51.80 in parameter set 2, P = .005), suggesting faster recovery to baseline IOP after occlusion break. The mean percentage reduction of IOP from maximum was significantly higher in Group I (P = .003). CONCLUSIONS Rise of IOP to baseline after occlusion break event was faster and mean percentage reduction of IOP from maximum during nuclear fragment removal was lower when using the Centurion Vision system with the Active Sentry upgrade compared with the traditional handpiece. The ability to sense IOP at the level of the handpiece with the Active Sentry upgrade allows faster mitigation of surge response.
Collapse
|
6
|
Corneal endothelial damage in phacoemulsification using an anterior chamber maintainer compared with using an ophthalmic viscosurgical device. J Cataract Refract Surg 2021; 47:612-617. [PMID: 33252564 DOI: 10.1097/j.jcrs.0000000000000493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 10/01/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the effects of phacoemulsification surgery (PE) using an anterior chamber maintainer (ACM) and conventional PE using an ophthalmic viscosurgical device (OVD) on corneal endothelial cells. SETTING Department of Ophthalmology, Celal Bayar University, Manisa, Turkey. DESIGN Prospective randomized controlled trial. METHODS Eyes in the OVD group (n = 50) underwent conventional PE, whereas eyes in the ACM group (n = 50) underwent PE using an ACM. Endothelial cell density (ECD), coefficient of variation (CV), hexagonality (HEX), and noncontact central corneal thickness (CCT) measurements were performed by specular microscopy before and at 1 month, 3 months, and 6 months after PE. RESULTS This study included 100 eyes of 97 patients undergoing PE. The mean age was 64.7 ± 10.6 years in the OVD group, 64.0 ± 12.6 years in the ACM group (P > .05). The groups did not differ significantly in preoperative ECD, CV, HEX, and CCT or total PE time (P > .05 for all). ECD was significantly lower in the ACM group compared with the OVD group at postoperative 1 month, 3 months, and 6 months (P = .002, P = .002, and P = .001, respectively). Similarly, ECD loss compared with preoperative value was greater in the ACM group at all postoperative timepoints (P = .003, P = .001, and P = .001, respectively). CV increased and HEX decreased in both groups postoperatively (P > .05 for both). CCT showed a transient increase of less than 10 μm at postoperative 1 month in both groups (P = .296). CONCLUSIONS PE with ACM was associated with greater corneal ECD loss compared with conventional PE. ACM should not be used during PE in patients with limited corneal endothelial reserve.
Collapse
|
7
|
Effects of Combinations of Ophthalmic Viscosurgical Devices and Suction Flow Rates on the Corneal Endothelial Cell Damage Incurred during Phacoemulsification. J Ophthalmol 2020; 2020:2159363. [PMID: 32774899 PMCID: PMC7391086 DOI: 10.1155/2020/2159363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 07/03/2020] [Indexed: 12/03/2022] Open
Abstract
We examined the effects of different ophthalmic viscosurgical devices (OVDs) and suction flow rates during phacoemulsification on the amount of ultrasound power used and damage to the corneal endothelium. In total, 48 eyes of 24 patients who underwent phacoemulsification and intraocular lens insertion with different OVD settings in the left and right eye between February and August 2018 were examined retrospectively from medical records. Each of the following types of OVDs was used in either the right or left eye of each patient: a viscoadaptive OVD (V group) or a combination of dispersive and cohesive OVDs (soft-shell technique; S group). There was no significant difference in the lens nucleus hardness between the two groups. A 2.4 mm transconjunctival scleral incision was made, and phacoemulsification was performed by the same surgeon. The cumulative dissipated energy (CDE) and ultrasound time intraoperatively were compared between the two groups. The CDE was significantly larger in the V group (9.9 ± 4.6) than the S group (6.4 ± 3.0; p=0.006). The reduction rate of the endothelial cell density at the center of the cornea was significantly higher in the V group (4.1% ± 6.7%) than the S group (0.3% ± 4.5%; p=0.03) at 1 week postoperatively. Both groups had a good postoperative course. There was less corneal endothelial damage with the soft-shell technique combined with a normal flow setting than the viscoadaptive OVD combined with a low flow setting.
Collapse
|
8
|
Kunzmann BC, Wenzel DA, Bartz‐Schmidt KU, Spitzer MS, Schultheiss M. Effects of ultrasound energy on the porcine corneal endothelium - Establishment of a phacoemulsification damage model. Acta Ophthalmol 2020; 98:e155-e160. [PMID: 31469490 DOI: 10.1111/aos.14235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 08/07/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to establish a standardized in vitro phacoemulsification damage model for future investigations of the effects of phacoemulsification, surgical devices, protective ophthalmic viscoelastic devices (OVDs), irrigation solutions and other aspects related to cataract phacoemulsification surgery on the corneal endothelium using porcine eyes. METHODS Thirty-four porcine eyes were randomly assigned to three groups (phacoemulsification (n = 13), irrigation (n = 9), control (n = 12)). A total of 5 min of ultrasound energy with intermittent irrigation/aspiration was applied in the eyes of the phacoemulsification group. The eyes of the irrigation group received the identical treatment, but without the application of ultrasound energy. The control group was left untreated. All eyes were then prepared to split corneal buttons followed by 15 days of cultivation. Endothelial cell density (ECD) was assessed blinded on day 15. RESULTS Endothelial cell density declined significantly more until day 15 in the phacoemulsification group (2567 ± 317/267 cells/mm² (median ± 25%/75%-quartiles), -32.5 ± 7.0/6.4%) compared to the irrigation (3450 ± 350/383 cells/mm², -11.8 ± 5.3/2.6%; p < 0.001) and the control group (3650 ± 288/258 cells/mm², -10.2 ± 3.2/4.6%; p < 0.001). CONCLUSION The phacoemulsification damage model presented in this study is sensitive to phacoemulsification energy and may reliably be used to investigate various factors involved in phacoemulsification with regard to their influence on corneal endothelial cells. This method is able to replace animal experiments or in vitro cell culture experiments that often do not translate well to the in vivo situation in humans.
Collapse
Affiliation(s)
- Berenike C. Kunzmann
- University Eye Hospital Centre for Ophthalmology University Hospital Tübingen Tübingen Germany
| | - Daniel A. Wenzel
- Department of Ophthalmology University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - Karl U. Bartz‐Schmidt
- University Eye Hospital Centre for Ophthalmology University Hospital Tübingen Tübingen Germany
| | - Martin S. Spitzer
- Department of Ophthalmology University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - Maximilian Schultheiss
- Department of Ophthalmology University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| |
Collapse
|
9
|
Thorne A, Dyk DW, Fanney D, Miller KM. Phacoemulsifier occlusion break surge volume reduction. J Cataract Refract Surg 2018; 44:1491-1496. [DOI: 10.1016/j.jcrs.2018.01.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 12/04/2017] [Accepted: 01/02/2018] [Indexed: 11/28/2022]
|
10
|
Amir-Asgari S, Hirnschall N, Findl O. Using continuous intraoperative optical coherence tomography to classify swirling lens fragments during cataract surgery and to predict their impact on corneal endothelial cell damage. J Cataract Refract Surg 2018; 42:1029-36. [PMID: 27492102 DOI: 10.1016/j.jcrs.2016.04.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 04/20/2016] [Accepted: 04/22/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE To quantify and classify swirling lens fragments during cataract surgery and record their impact on the corneal endothelium using continuous intraoperative optical coherence tomography (OCT). SETTING Vienna Institute for Ocular Surgery, Hanusch Hospital, Vienna, Austria. DESIGN Prospective case series. METHODS Patients scheduled for cataract surgery without other ophthalmologic comorbidities were included. During surgery, continuous OCT recordings were performed to measure and score swirling lens fragments that came into contact with the corneal endothelium. Endothelial cell density (ECD) was measured preoperatively and 1 month postoperatively. In addition, the central corneal thickness and aqueous flare were measured preoperatively and 1 hour, 1 day, and 1 month postoperatively. RESULTS Continuous intraoperative OCT video recordings showed 104 swirling lens fragments in 40 eyes that came into contact with the corneal endothelium. A mean of 2.6 lens fragments (range 0 to 6) that came into contact were observed per eye. Small fragments and fragments touching the center of the endothelium had a significantly greater effect on postoperative ECD than other fragment parameters. The predictive power of the fragment score on ECD was found to be moderate (r(2) = 0.6). CONCLUSIONS Small swirling lens fragments touching the center of the corneal endothelium had a significant influence on ECD. With the newly developed fragment score, it was possible to predict the operative endothelial cell loss. FINANCIAL DISCLOSURE None of the authors has a financial or proprietary interest in any material or method mentioned.
Collapse
Affiliation(s)
- Sahand Amir-Asgari
- From the Vienna Institute for Research in Ocular Surgery (Amir-Asgari, Hirnschall, Findl), A Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria, and the Moorfields Eye Hospital NHS Foundation Trust (Findl), London, United Kingdom
| | - Nino Hirnschall
- From the Vienna Institute for Research in Ocular Surgery (Amir-Asgari, Hirnschall, Findl), A Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria, and the Moorfields Eye Hospital NHS Foundation Trust (Findl), London, United Kingdom
| | - Oliver Findl
- From the Vienna Institute for Research in Ocular Surgery (Amir-Asgari, Hirnschall, Findl), A Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria, and the Moorfields Eye Hospital NHS Foundation Trust (Findl), London, United Kingdom.
| |
Collapse
|
11
|
Suzuki H, Igarashi T, Shiwa T, Takahashi H. A Novel "Slit Side View" Method to Evaluate Fluid Dynamics during Phacoemulsification. J Ophthalmol 2018; 2018:5027238. [PMID: 30363725 PMCID: PMC6180966 DOI: 10.1155/2018/5027238] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 08/08/2018] [Indexed: 11/18/2022] Open
Abstract
Due to recent technical advances in cataract surgeries, there has been a significant improvement in the safety and surgical outcomes of phacoemulsification. However, the corneal endothelium can be damaged during phacoemulsification by multiple factors. Therefore, we used a slit lamp to analyze the fluid dynamics of ophthalmic viscosurgical devices (OVDs) in the anterior chamber during phacoemulsification. In this experimental study, extracted porcine eyes were injected with OVDs stained with fluorescein through a side port of the eye and then fixed on a slit lamp microscope. After inserting a phaco tip, phacoemulsification simulation was then performed on the iris plane. Subsequent movements of OVDs in the anterior chamber were observed during the procedure by using a slit lamp microscope. Aspiration and removal of cohesive OVDs from the inside of the anterior chamber occurred within a few seconds after the ultrasonic vibration. Aspiration of dispersive OVDs occurred gradually, with some of the OVDs remaining on the side of the anterior chamber side in an irregular shape. This shape enabled the OVD to trap the air, thereby preventing the air from directly touching the corneal endothelium. Viscoadaptive OVDs remained inside the anterior chamber as a lump, with the infusion solution flowing between the corneal endothelium and the OVD, thus leading to the eventual aspiration of the OVD. Viscous dispersive OVDs remained as a lump between the corneal endothelium and the phaco tip. However, once the infusion solution flowed between the cornea and the OVD, the OVD detached from the corneal endothelium, indicating that this type would likely be aspirated and removed. This method, termed the "slit side view," enables viewing of the movement of OVDs during surgery, as well as observation of the fluid dynamics in the anterior chamber.
Collapse
Affiliation(s)
- Hisaharu Suzuki
- Department of Ophthalmology, Nippon Medical School Musashikosugi Hospital, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki City, Kanagawa 211-8533, Japan
| | - Tsutomu Igarashi
- Department of Ophthalmology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Toshihiko Shiwa
- Department of Ophthalmology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Hiroshi Takahashi
- Department of Ophthalmology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
| |
Collapse
|
12
|
Kang S, Park S, Park E, Lim J, Seo K. Influence of an intentionally induced posterior lens capsule rupture on the real-time intraocular pressure during phacoemulsification in canine ex vivo eyes. Vet Ophthalmol 2017; 21:35-41. [PMID: 28503796 DOI: 10.1111/vop.12475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the changes in the intraocular pressure (IOP) following an intentionally induced posterior lens capsule rupture (PLCR) during phacoemulsification in enucleated canine eyes. Furthermore, to compare the IOPs between different stages of phacoemulsification for two different bottle heights (BH). PROCEDURES Coaxial phacoemulsification was performed using a venturi-based machine at a 60 or 90 cm BH. A pressure transducer, inserted into the anterior chamber through the peripheral cornea, monitored real-time IOP. For one half of the lens, the sculpt-segment removal (SS) was followed by irrigation/aspiration (IA). The PLCR was intentionally created, and the SS and IA were repeated on the residual lens fragments. RESULTS For the 60 cm BH, the mean IOP following the PLCR was significantly higher than before the PLCR during SS (28.30 ± 12.56 and 38.71 ± 9.43 mmHg before and after PLCR, respectively) and IA (42.76 ± 12.46 and 47.88 ± 7.10 mmHg before and after PLCR, respectively) stages (P < 0.001). For the 90 cm BH, the mean IOP following the PLCR was also significantly higher than before the PLCR during SS (33.39 ± 11.09 and 58.17 ± 6.89 mmHg before and after PLCR, respectively) and IA (62.39 ± 12.46 and 72.04 ± 8.59 mmHg before and after PLCR, respectively) stages (P < 0.001). CONCLUSIONS The occurrence of a PLCR led to an increase in IOP during both the SS and IA stages. The elevated IOP after the PLCR might be one of the most important factors for ocular tissue damage, as it reduces ocular perfusion. Additionally, the BH should be reduced following PLCR to prevent complications stemming from the raised IOP.
Collapse
Affiliation(s)
- Seonmi Kang
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Korea
| | - Sangwan Park
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Korea
| | - Eunjin Park
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Korea
| | - Jaegook Lim
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Korea
| | - Kangmoon Seo
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Korea
| |
Collapse
|
13
|
Kong SJ, Jang C, Lim TH, Choi KY, Cho BJ. Comparison between Active and Gravity-based Phacoemulsification Fluidics Systems in Immediate Sequential Bilateral Cataract Surgery. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2017. [DOI: 10.3341/jkos.2017.58.1.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
14
|
|
15
|
Nicoli CM, Dimalanta R, Miller KM. Experimental anterior chamber maintenance in active versus passive phacoemulsification fluidics systems. J Cataract Refract Surg 2016; 42:157-62. [PMID: 26948791 DOI: 10.1016/j.jcrs.2015.08.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Revised: 07/31/2015] [Accepted: 08/03/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the ability of phacoemulsifiers with active versus passive infusion fluidics control systems to maintain target intraocular pressures (IOPs) under varying flow conditions. SETTING Alcon Research, Ltd., Lake Forest, California, USA. DESIGN Experimental study. METHODS An acrylic test chamber was used to model the anterior chamber of the eye. Two passive (gravity-based) systems were tested using bottle heights yielding infusion pressures of 41, 75, and 109 cm of water under zero-flow conditions. One actively controlled system was tested using equivalent target IOPs of 30, 55, and 80 mm Hg. Test chamber IOPs were measured at aspiration flow rates of 15, 30, 45, and 60 cc/min. RESULTS The measured flow rates were similar between fluidics systems across the range of intended aspiration flow rates. All systems achieved the desired target IOPs under zero-flow conditions. After activation of aspiration flow, however, measured IOPs decreased from target IOPs for the 2 passive systems. Each 15 cc/min increase in the aspiration flow rate produced a pressure drop of 14.0 to 16.2 mm Hg or 9.3 to 14.2 mm Hg, depending on the system. Measured IOPs in the actively controlled system closely matched the targeted IOPs across all tested aspiration flow rates, deviating from targets by no more than 4.3 mm Hg. CONCLUSIONS All phacoemulsification aspiration infusion fluidics systems achieved target IOPs under zero-flow conditions. Only the actively controlled system maintained target IOPs across a range of aspiration flow rates. These experimental findings suggest that anterior chamber stability might be better in the clinical setting using an actively controlled system. FINANCIAL DISCLOSURE Dr. Dimalanta is an employee of Alcon Research, Ltd. Dr. Miller is an investigator and speaker for and a consultant to Alcon Laboratories, Inc. Dr. Nicoli has no financial or proprietary interest in any material or method mentioned.
Collapse
Affiliation(s)
- C Manuel Nicoli
- From the Jules Stein Eye Institute and Department of Ophthalmology (Nicoli, Miller), David Geffen School of Medicine, University of California, Los Angeles, and Alcon Research, Ltd. (Dimalanta), Lake Forest, California, USA
| | - Ramon Dimalanta
- From the Jules Stein Eye Institute and Department of Ophthalmology (Nicoli, Miller), David Geffen School of Medicine, University of California, Los Angeles, and Alcon Research, Ltd. (Dimalanta), Lake Forest, California, USA
| | - Kevin M Miller
- From the Jules Stein Eye Institute and Department of Ophthalmology (Nicoli, Miller), David Geffen School of Medicine, University of California, Los Angeles, and Alcon Research, Ltd. (Dimalanta), Lake Forest, California, USA.
| |
Collapse
|
16
|
Kang S, Park S, Noh H, Kwak J, Seo K. Real-time intraocular pressure measurement during phacoemulsification in dogs ex vivo. J Vet Med Sci 2015; 77:685-92. [PMID: 25716691 PMCID: PMC4488405 DOI: 10.1292/jvms.14-0412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study was performed to evaluate changes in intraocular pressure (IOP) during
standard coaxial phacoemulsification using 4 different bottle heights (BHs) and 2
different incision sizes. Coaxial phacoemulsification was performed with a venturi-based
machine in 8 enucleated canine eyes through 3.0 and 3.2 mm clear corneal incisions (CCIs).
A pressure transducer inserted in the peripheral cornea monitored the IOP in real-time.
The surgery was subdivided into 4 stages: sculpt-segment removal, irrigation/aspiration,
capsular polishing and viscoelastic removal. The mean IOP and the difference between the
maximum and minimum IOPs were calculated at each stage and compared. The ultrasound time
and volume of irrigation fluid used were recorded. The mean IOP increased with an
elevation in the BH. The mean IOP in the irrigation/aspiration stage was significantly
higher than that in the sculpt-segment removal stage at the same BH. The difference
between the maximum and minimum IOP at each stage was greater in the 3.2 mm than the 3.0
mm CCIs, although the mean IOP was lower with the 3.2 mm than the 3.0 mm CCIs. The
ultrasound time and irrigation fluid volume were greater with the 3.2 mm than the 3.0 mm
CCIs. Therefore, fluidic parameters during each stage could be reassessed and adjusted to
reduce complications arising from an elevated IOP. Phacoemulsification with 3.0 mm CCIs at
a lower BH might lead to less stress on the eye from IOP fluctuations, ultrasound energy
and irrigation fluid.
Collapse
Affiliation(s)
- Seonmi Kang
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 151-742, Republic of Korea
| | | | | | | | | |
Collapse
|
17
|
Vasavada V, Raj SM, Praveen MR, Vasavada AR, Henderson BA, Asnani PK. Real-time dynamic intraocular pressure fluctuations during microcoaxial phacoemulsification using different aspiration flow rates and their impact on early postoperative outcomes: a randomized clinical trial. J Refract Surg 2014; 30:534-40. [PMID: 25325894 DOI: 10.3928/1081597x-20140711-06] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 04/10/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the impact of varying fluidic parameters on intraoperative intraocular pressure (IOP) fluctuations and postoperative outcomes. METHODS Prospective randomized study of 80 eyes undergoing cataract surgery that were randomly assigned to low (aspiration flow rate: 20 cc/min; bottle height: 90 cm; vacuum: 400 mm Hg) and high (aspiration flow rate: 40 cc/min; bottle height: 110 cm; vacuum: 400 mm Hg) fluidic parameter groups. Real-time dynamic intraoperative IOP was measured during nuclear fragment removal. Mean maximum and minimum IOP and percentage reduction in IOP from maximum were compared between groups. Postoperatively, the rate of change in central corneal thickness and anterior chamber inflammation at days 1 and 7, endothelial cell density at 3 months, and corneal clarity on day 1 were compared. RESULTS Minimum IOP in the low and high parameters groups was 35 ± 4.0 and 34.5 ± 6.8 mm Hg, respectively. Maximum IOP in the low and high parameters groups was 69 ± 3.0 and 85 ± 1.2 mm Hg, respectively (P < .002). Mean percent reduction from maximum was 59% in the high parameters group compared to 41% in the low parameters group, with the difference being statistically significant (P < .002). Rate of change in central corneal thickness was greater in the high parameters group at postoperative days 1 and 7 (P < .001). Anterior chamber inflammation and corneal clarity on the first postoperative day were significantly better in the low parameters group. CONCLUSIONS Higher aspiration flow rate and bottle heights are associated with high intraoperative IOPs of up to 85 mm Hg. Prolonged elevated IOP during cataract surgery was found to have more anterior segment inflammation and more edematous corneas.
Collapse
|
18
|
Kang S, Park S, Noh H, Seo K. Fluid dynamics and intraocular pressure using venturi phacoemulsification machine in dogs ex vivo. Vet Ophthalmol 2014; 18:309-16. [PMID: 25348150 DOI: 10.1111/vop.12231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To optimize fluid dynamics through measuring intraocular pressure (IOP) in a venturi phacoemulsification machine in dogs. PROCEDURES In step I, flow and IOP of the test chamber were measured using a pressure transducer with the bottle height (BH) set at 50, 70, 100, and 120 cm and the vacuum from 30 to 450 mmHg. A 19-gauge phaco and a 0.3-mm irrigation/aspiration (I/A) handpiece were used. In step II, flow and IOP were measured in an enucleated canine eye with a 3.0- and a 3.2-mm clear corneal incision (CCI), respectively. IOP was measured using the pressure transducer at a 30-mmHg vacuum to allow corneal deformation, to define the fluidic parameters for preventing surge. RESULTS Flow was directly proportional to the BH and vacuum, whereas IOP was directly proportional to the BH and inversely to the vacuum. Flow with an I/A handpiece was significantly less than with a phaco handpiece, explaining why IOP with an I/A handpiece was significantly higher than with a phaco handpiece. With the I/A handpiece, vacuum parameters less than 450 mmHg did not result in corneal deformation. IOP with a 3.2-mm CCI was significantly lower than with a 3.0-mm CCI, with the 3.2-mm flow being greater than the 3.0-mm flow. CONCLUSIONS BH during the I/A stage could be reduced to avoid unnecessary stress on the canine eye when using a venturi system. Although phacoemulsification with a 3.2-mm CCI could induce lower IOP, a 3.0-mm CCI might lessen the irrigation flow stress on the eye.
Collapse
Affiliation(s)
- Seonmi Kang
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 151-742, Korea
| | - Sangwan Park
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 151-742, Korea
| | - Hyunwoo Noh
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 151-742, Korea
| | - Kangmoon Seo
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 151-742, Korea
| |
Collapse
|
19
|
Kang S, Jeong M, Ahn J, Lee E, Kim S, Park S, Yi K, Choi M, Seo K. Evaluation of fluid leakage into the canine vitreous humor during phacoemulsification using contrast-enhanced magnetic resonance imaging. Vet Ophthalmol 2014; 18:13-9. [DOI: 10.1111/vop.12156] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Seonmi Kang
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; Seoul National University; 1 Gwanak-ro, Gwanak-gu Seoul 151-742 Korea
| | - Manbok Jeong
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; Seoul National University; 1 Gwanak-ro, Gwanak-gu Seoul 151-742 Korea
| | - Jaesang Ahn
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; Seoul National University; 1 Gwanak-ro, Gwanak-gu Seoul 151-742 Korea
| | - Euiri Lee
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; Seoul National University; 1 Gwanak-ro, Gwanak-gu Seoul 151-742 Korea
| | - Soohyun Kim
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; Seoul National University; 1 Gwanak-ro, Gwanak-gu Seoul 151-742 Korea
| | - Sangwan Park
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; Seoul National University; 1 Gwanak-ro, Gwanak-gu Seoul 151-742 Korea
| | - Kangjae Yi
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; Seoul National University; 1 Gwanak-ro, Gwanak-gu Seoul 151-742 Korea
| | - Mincheol Choi
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; Seoul National University; 1 Gwanak-ro, Gwanak-gu Seoul 151-742 Korea
| | - Kangmoon Seo
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; Seoul National University; 1 Gwanak-ro, Gwanak-gu Seoul 151-742 Korea
| |
Collapse
|
20
|
Chaudhry P, Prakash G, Jacob S, Narasimhan S, Agarwal S, Agarwal A. Safety and efficacy of gas-forced infusion (air pump) in coaxial phacoemulsification. J Cataract Refract Surg 2010; 36:2139-45. [PMID: 21111318 DOI: 10.1016/j.jcrs.2010.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Revised: 06/15/2010] [Accepted: 07/09/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of gas-forced infusion (air pump) in uncomplicated coaxial phacoemulsification. SETTING Dr. Agarwal's Eye Hospital, Chennai, India. DESIGN Comparative case series. METHODS Specular microscopy and optical coherence tomography were used to analyze the endothelium, central macular thickness (CMT), and peripapillary retinal nerve fiber layer (RNFL) thickness before and approximately 1, 7, 30, and 90 days after coaxial phacoemulsification with (infusion group) or without (control group) gas-forced infusion. Surgical time, surge, phaco energy, irrigation fluid volume, surgical ease, complications, and visual gain in the 2 groups were compared. RESULTS The mean endothelial cell loss was lower in the infusion group than in the control group (6.98% ± 8.46% [SD] versus 10.54% ± 11.24%; P = .045) and the irrigation/aspiration time significantly shorter (54 ± 39 seconds versus 105 ± 84 seconds; P = .0001). The surgery was rated as easier with gas-forced infusion (scale 1 to 10: mean 8.3 ± 2.1 versus 6.6 ± 1.6; P = .00002). However, the amount of irrigating fluid volume was higher in the infusion group (117 ± 37 mL versus 94 ± 41 mL; P = .003). No surge occurred in the infusion group; it occurred a mean of 3.00 ± 4.16 times in the control group (P<.0001). The rate of visual gain, CMT, peripapillary RNFL thickness, phaco time, and amount of phaco energy were comparable in the 2 groups. CONCLUSION Gas-forced infusion was safe and effective in controlling surge and increased the safety, ease, and speed of coaxial phacoemulsification.
Collapse
|