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Ganesh S, Brar S, Sriganesh S, Bhavsar HD. Comparative Clinical Study of Surgical Performance of Quatera 700 versus Centurion and Signature Pro Phacoemulsification Systems. Clin Ophthalmol 2024; 18:2685-2695. [PMID: 39346969 PMCID: PMC11430833 DOI: 10.2147/opth.s456660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 08/15/2024] [Indexed: 10/01/2024] Open
Abstract
Purpose To compare the intra-operative surgical performance of Quatera 700 with Centurion and Signature Pro phacoemulsification systems. Setting Nethradhama Superspeciality Eye Hospital, Bangalore, India. Study Design Prospective, interventional, 3-arm, randomized comparison study. Methods A total of 180 non-consecutive eyes satisfying the eligibility criteria were recruited. N = 60 eyes were operated using each of the above systems, of which n = 30 eyes had LOCS III grade 1-2, and n = 30 eyes had grade 3-4 nuclear density. Phacoemulsification with foldable IOL implantation was performed by a single experienced surgeon. Chamber stability scores (1-4, 4 being the worst), fluid turnover per case, surge incidence and intra-operative complications were assessed. Results Intra-operatively, the mean chamber stability score was significantly better for the Quatera 700 in both the soft and dense cataract groups compared to the other two machines (p < 0.001). Total Phaco Time (TPT) with Quatera 700 was significantly lower compared to Signature Pro, while it was comparable with Centurion for both the soft and dense cataract groups. The mean fluid turnover was significantly lower for the Quatera 700 in the dense cataract group (p = 0.04) and so was the combined phaco and I/A time (p = 0.01) when compared with Signature Pro. One eye operated with Signature Pro and 2 eyes operated with Centurion had PCR due to surge. The mean corneal clarity scores on POD-1 and specular counts at 2 weeks and 6 months were comparable. Conclusion The new Quatera 700 system resulted in lesser TPT, fluid turnover and phaco + I/A time than Signature Pro, while its performance was comparable to Centurion for these parameters. Moreover, the surgeon graded intra-operative chamber stability scoring was highest, when compared to the other two systems. Ctri Registration Number CTRI/2022/01/039296.
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Affiliation(s)
- Sri Ganesh
- Department of Phaco-Refractive Surgery, Nethradhama Super Speciality Eye Hospital, Bengaluru, Karnataka, India
| | - Sheetal Brar
- Department of Phaco-Refractive Surgery, Nethradhama Super Speciality Eye Hospital, Bengaluru, Karnataka, India
| | - Supriya Sriganesh
- Department of Phaco-Refractive Surgery, Nethradhama Super Speciality Eye Hospital, Bengaluru, Karnataka, India
| | - Hemali D Bhavsar
- Department of Phaco-Refractive Surgery, Nethradhama Super Speciality Eye Hospital, Bengaluru, Karnataka, India
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Noor NA. The use of lens anterior capsule disc for corneal endothelium protection during femtosecond laser-assisted cataract surgery in eyes with low endothelial cell density. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2024; 4:65-68. [PMID: 38590554 PMCID: PMC10999371 DOI: 10.1016/j.aopr.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/04/2024] [Accepted: 02/23/2024] [Indexed: 04/10/2024]
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Perone JM, Luc MS, Zevering Y, Vermion JC, Gan G, Goetz C. Narrative review after post-hoc trial analysis of factors that predict corneal endothelial cell loss after phacoemulsification: Tips for improving cataract surgery research. PLoS One 2024; 19:e0298795. [PMID: 38512953 PMCID: PMC10956851 DOI: 10.1371/journal.pone.0298795] [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: 08/09/2023] [Accepted: 01/21/2024] [Indexed: 03/23/2024] Open
Abstract
PURPOSE Identifying pre/perioperative factors that predict corneal endothelial-cell loss (ECL) after phacoemulsification may reveal ways to reduce ECL. Our literature analysis showed that 37 studies have investigated one or several such factors but all have significant limitations. Therefore, the data of a large randomized controlled trial (PERCEPOLIS) were subjected to post-hoc multivariate analysis determining the ability of nine pre/perioperative variables to predict ECL. METHODS PERCEPOLIS was conducted in 2015-2016 to compare two phacoemulsification techniques (subluxation and divide-and-conquer) in terms of 3-month ECL. Non-inferiority between the techniques was found. In the present study, post-hoc univariate and multivariate analyses were conducted to determine associations between ECL and age, sex, cataract density, preoperative endothelial-cell density, phacoemulsification technique, effective phaco time (EPT), and 2-hour central-corneal thickness. The data are presented in the context of a narrative review of the literature. RESULTS Three-month data were available for 275 patients (94% of the randomized cohort; mean age, 74 years; 58% women). Mean LOCSIII cataract grade was 3.2. Mean EPT was 6 seconds. Mean ECL was 13%. Only an older age (beta = 0.2%, p = 0.049) and higher EPT (beta = 1.2%, p = 0.0002) predicted 3-month ECL. Cataract density was significant on univariate (p = 0.04) but not multivariate analysis. The other variables did not associate with ECL. CONCLUSIONS Older age may amplify ECL due to increased endothelial cell fragility. EPT may promote ECL via cataract density-dependent and -independent mechanisms that should be considered in future phacoemulsification research aiming to reduce ECL. Our literature analysis showed that the average ECL for relatively unselected consecutively-sampled cohorts is 12%.
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Affiliation(s)
- Jean-Marc Perone
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, Metz, Grand Est, France
| | - Marie-Soline Luc
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, Metz, Grand Est, France
| | - Yinka Zevering
- Clinical Research Support Unit, Regional Hospital Center of Metz-Thionville, Mercy Hospital, Metz, Grand Est, France
| | - Jean-Charles Vermion
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, Metz, Grand Est, France
| | - Grace Gan
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, Metz, Grand Est, France
| | - Christophe Goetz
- Clinical Research Support Unit, Regional Hospital Center of Metz-Thionville, Mercy Hospital, Metz, Grand Est, France
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Vital MC, Jong KY, Trinh CE, Starck T, Sretavan D. Endothelial Cell Loss Following Cataract Surgery Using Continuous Curvilinear Capsulorhexis or Precision Pulse Capsulotomy. Clin Ophthalmol 2023; 17:1701-1708. [PMID: 37346471 PMCID: PMC10281278 DOI: 10.2147/opth.s411454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/25/2023] [Indexed: 06/23/2023] Open
Abstract
Purpose To compare endothelial cell density (ECD), percentage of hexagonal cells (%Hex) and coefficient of variation (CV) in cell size following lens cataract surgery with phacoemulsification performed using Continuous Curvilinear Capsulorhexis (CCC) or Precision Pulse Capsulotomy (PPC). Patients and Methods Sixty-seven subjects were randomly assigned to undergo lens cataract removal with the capsulotomy step performed using either CCC or PPC. Specular microscopy images were obtained pre-operatively, 1 month and 3 months after surgery. ECD, %Hex and CV were analyzed in a masked fashion by an independent reading center. Results The mean percentage ECD loss at 1 month was 11.5% in the CCC group and 12.3% in the PPC group (P = 0.818; t-test). At 3 months, the mean percentage ECD loss was 11.7% in the CCC group and 12.4% in the PPC group (P = 0.815; t-test). The mean %Hex at 1 month was 54.3% in the CCC group and 54.7% in the PPC group (P = 0.695; t-test). At 3 months, the mean %Hex was 56.2% in the CCC group and 54.7% in the PPC group (P = 0.278; t-test). The CV at 1 month was 34.4% in the CCC group and 34.3% in the PPC group (P = 0.927; t-test). At 3 months, the CV was 32.7% in the CCC group and 33.4% in the PPC group (P = 0.864; t-test). Conclusion No differences in ECD loss, %Hex and CV were observed between patients who received CCC or PPC. PPC use during cataract surgery does not result in any increased endothelial cell loss beyond that normally associated with this surgery.
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Wilkinson SW, Park SSE, Ungricht EL, Trapnell M, Nydegger J, Cardenas IA, Brintz BJ, Mamalis N, Olson RJ, Werner L. Effect of simulated lenticular debris on corneal endothelial cells: experimental study in rabbit eyes. J Cataract Refract Surg 2022; 48:1325-1330. [PMID: 36026701 DOI: 10.1097/j.jcrs.0000000000001032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 07/25/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate mechanical damage of simulated lenticular debris on corneal endothelial cells during phacoemulsification. SETTING University setting, Salt Lake City, Utah. DESIGN Experimental study. METHODS 12 New Zealand rabbits underwent bilateral surgery. After incision, 10 1.0 mm beads were injected into the anterior chamber of test eyes to simulate lenticular debris. A balanced salt solution was injected into the contralateral eyes with the same injector. The Intrepid Balanced Tip of the Centurion Ozil handpiece was inserted into the anterior chamber, and 60% torsional ultrasound was applied for 20 seconds with 50 mL/min flow, 70 mm Hg intraocular pressure, and 600 mm Hg vacuum. Cumulative dissipated energy (CDE) was noted. After euthanasia and enucleation, the corneas were removed, stained with trypan blue/alizarin red, and photographed in a standardized manner (×400 photographs from 5 specific areas and 1 overview photograph from each corneal button). The ImageJ program was used to evaluate cell damage and loss in the photographs. RESULTS CDE was 4.64 ± 0.19 for test eyes with beads and 4.66 ± 0.17 for control eyes without beads ( P = .58). The percentage of intact cells was statistically higher in the control group ( P = .0005), whereas the percentages of damaged and lost cells were statistically higher in the test group ( P = .0010 and .0005, respectively). This was observed in the analysis of the ×400 photographs and overview photographs. CONCLUSIONS This study suggests that lenticular debris swirling around the anterior chamber may cause significant damage to the corneal endothelium, providing further insight on mechanisms of damage during phacoemulsification.
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Affiliation(s)
- Samuel W Wilkinson
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah (Wilkinson, Park, Ungricht, Trapnell, Nydegger, Cardenas, Mamalis, Olson, Werner); University of Utah, School of Medicine, Salt Lake City, Utah (Ungricht, Cardenas); Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah (Brintz)
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Comparative evaluation of the results of phacoemulsification using domestic and foreign viscoelastics. OPHTHALMOLOGY JOURNAL 2022. [DOI: 10.17816/ov109016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND: Phacoemulsification, being the safest technique, is the golden standard of cataract surgery worldwide. However, as any surgery, it is accompanied by inevitable damage to intraocular structures. The most prevalent among them is the loss of corneal endothelial cells. In order to prevent these complications, various viscoelastics with particular features and characteristics are widely used.
AIM: To compare the anatomical and functional state of ocular structures after standard phacoemulsification with monofocal posterior chamber intraocular lens (IOL) implantation using domestic (Kogevisc and Adgevisc) and foreign (Viscoat and Amvisc Plus) viscoelastics.
MATERIALS AND METHODS: 60 cataract patients (60 eyes) were included in the clinical study, which were divided into two equal groups. In the first group (30 patients, 30 eyes), Adgevisc and Kogevisc (Solofarm, Russia) were used during the procedure. The mean age of the patients was 66 11 years. In the second group (30 patients, 30 eyes), Viscoat (Alcon) and Amvisc Plus (BauschLomb) were used. The mean age of the patients was 69.03 10.44 years. All patients underwent phacoemulsification with the implantation of the AcrySof IOL (model SA60AT, Alcon) according to the standard technique. Visual acuity, IOP level, CCT, corneal endothelial cell density were assessed. All studies were performed before surgery, the next day, 7 days and 1 month after surgery.
RESULTS: In patients of the second group, on the 1st (p 0.05) and 7th day (p 0.01) after surgery, a statistically significant increase in IOP was revealed compared to the first group. The central cornea thickness in the early postoperative period was higher in patients of the second group, however, it was not statistically significant. The loss of corneal endothelial cells 1 month after surgery was 8.5 7.0% (p 0.01) in the first group and 6.6 6.4% in the second group (p 0.01). The mean value of endothelial cell loss in patients of the first group was higher, however, it was not statistically significant. The best corrected visual acuity in both groups at all stages of follow-up after surgery (days 1, 7 and 30) was comparable, there was no significant difference between the groups.
CONCLUSIONS: The clinical efficacy of domestic adhesive and cohesive viscoelastics Adgevisc and Kogevisc (Solofarm, Russia) in phacoemulsification using the soft-shell technique is comparable to the foreign analogues Viscoat (Alcon) and Amvisc Plus (Bausch Lomb), which is confirmed by the absence of statistically significant differences in the studied parameters of the postoperative state of ocular structures and explained by their similar composition, molecular weight and viscosity.
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Ungricht EL, Culp C, Qu P, Jensen N, Harris JT, Brintz BJ, Mamalis N, Olson RJ, Werner L. Effect of longitudinal and torsional ultrasound on corneal endothelial cells: experimental study in rabbit eyes. J Cataract Refract Surg 2022; 48:349-354. [PMID: 34224479 PMCID: PMC8712615 DOI: 10.1097/j.jcrs.0000000000000737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/22/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE To compare corneal endothelial damage from longitudinal and torsional ultrasound during phacoemulsification. SETTING John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. DESIGN Experimental study. METHODS 9 New Zealand white rabbits underwent bilateral surgery. After incision, the Intrepid Balanced Tip of the Centurion Ozil handpiece was inserted into the anterior chamber, and the following settings were used: 50 mL/min flow, 70 mm Hg intraocular pressure, 600 mm Hg vacuum, and 60% longitudinal (1 eye) or torsional (contralateral eye) ultrasound for 30 seconds. Cumulative dissipated energy (CDE) was noted. After euthanasia and enucleation, the corneas were removed, stained with trypan blue/alizarin red, and photographed (400× photographs from 5 specific areas and 1 overview photograph from each corneal button). The ImageJ program was used to evaluate cell damage and loss in the photographs obtained from each cornea. RESULTS Cavitation bubbles around the phacoemulsification tip were generally observed in the longitudinal group. CDE was 17.4 ± 0.58 and 6.93 ± 0.15 in the longitudinal and torsional groups, respectively (P = .003). The percentage of intact cells was statistically higher in the torsional group (94.22% ± 5.99% vs 56.85% ± 22.29%), and the percentage of lost cells was statistically higher in the longitudinal group (42.10% ± 22.02% vs 4.97% ± 6.23%) (P = .003). This was observed in the analysis of the 400× photographs and the overview photographs. CONCLUSIONS This study suggests that torsional ultrasound was associated with significantly less corneal endothelial cell damage than classical longitudinal tip motion, providing further insight on mechanisms of corneal endothelial damage during phacoemulsification.
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Affiliation(s)
- Emilie L. Ungricht
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
- From the University of Utah, School of Medicine, Salt Lake City, UT, USA
| | - Catherine Culp
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Phillip Qu
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Nathan Jensen
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
- From the University of Utah, School of Medicine, Salt Lake City, UT, USA
| | - Jacob T. Harris
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
- From the University of Utah, School of Medicine, Salt Lake City, UT, USA
| | - Ben J. Brintz
- From the Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Nick Mamalis
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Randall J. Olson
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Liliana Werner
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
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Ahmed IIK, De Francesco T, Rhee D, McCabe C, Flowers B, Gazzard G, Samuelson TW, Singh K. Long term outcomes from the HORIZON randomized trial for a Schlemm's canal microstent in combination cataract and glaucoma surgery. Ophthalmology 2022; 129:742-751. [PMID: 35218867 DOI: 10.1016/j.ophtha.2022.02.021] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 02/07/2022] [Accepted: 02/15/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE 5-year results of the HORIZON trial comparing cataract surgery combined with an intracanalicular microstent to cataract surgery alone. DESIGN Prospective, multicenter, controlled randomized clinical trial. PARTICIPANTS Patients with cataract and POAG treated with ≥ 1 glaucoma medication, washed out diurnal intraocular pressure (DIOP) 22-34 mmHg and no prior incisional glaucoma surgery. METHODS Eyes were randomized 2:1 to receive a Hydrus® Microstent (Ivantis, Inc.) or no stent after successful cataract surgery. Follow-up was conducted through 5 years postoperatively. MAIN OUTCOME MEASURES IOP, glaucoma medication usage, repeat glaucoma surgery, visual acuity, visual field, procedure related adverse events, and corneal endothelial cell counts. RESULTS 369 eyes were randomized to microstent treatment (HMS) and 187 to cataract surgery only (CS). Study groups were well matched for preoperative IOP, medication usage, washed out DIOP, and glaucoma severity. Five year follow up was completed in 80% of patients. At 5 years, the HMS group had a higher proportion of eyes with IOP ≤18 mmHg without medications compared to CS (49.5% vs. 34.8%, p=0.003) as well as a greater likelihood of IOP reduction of ≥ 20% without medications compared to CS alone (54.2% vs. 32.8%, p<0.001). The number of glaucoma medications was 0.5 ± 0.9 in the HMS group and 0.9 ± 0.9 in the CS group (p<0.001), and 66% of eyes in the HMS group were medication free compared to 46% in the CS group (p<0.001). The cumulative risk of incisional glaucoma surgery was lower in the HMS group (2.4% vs. 6.2%, log-rank p=0.027). There was no clinical or statistically significant difference in the rate of endothelial cell loss from 3 months to 60 months between the HMS and CS groups (p=0.261). Visual acuity did not differ between groups, and there was no difference in long term postoperative adverse events. CONCLUSIONS The addition of a Schlemm's canal microstent in conjunction with cataract surgery was safe, resulted in lowered IOP and medication use, and reduced the need for postoperative incisional glaucoma filtration surgery compared to cataract surgery alone after 5 years. Long term presence of the implant did not adversely affect the corneal endothelium.
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Affiliation(s)
- Iqbal Ike K Ahmed
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Ticiana De Francesco
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; Clinica de Olhos De Francesco, Fortaleza, Brazil & Hospital de Olhos Leiria de Andrade (HOLA), Fortaleza, Brazil.
| | - Douglas Rhee
- Case Western Reserve University Hospitals, Cleveland, Ohio
| | | | | | - Gus Gazzard
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, and Institute of Ophthalmology, University College London, London, United Kingdom
| | - Thomas W Samuelson
- Minnesota Eye Consultants, University of Minnesota, Minneapolis, Minnesota
| | - Kuldev Singh
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California
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The effect of phacoemulsification fluid flow on the corneal endothelium: An experimental study in rabbit eyes. J Cataract Refract Surg 2021; 48:481-486. [PMID: 34371510 DOI: 10.1097/j.jcrs.0000000000000768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/25/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To quantify the damage to the corneal endothelium from the flow of balanced salt solution during phacoemulsification. SETTING John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. DESIGN Experimental Study. METHODS Twelve New Zealand white rabbits received bilateral surgery. Six eyes served as controls with no irrigation (incision only). In 18 eyes, the Intrepid Balanced tip of the Centurion (Alcon) Ozil handpiece was inserted into the anterior chamber for continuous irrigation at 50mL/minute with either 250 mL or 500 mL of balanced salt solution (BSS). After euthanasia and enucleation, the corneas were removed, stained with trypan blue/alizarin red, and photographed in a standardized manner (X400 photographs from 5 specific areas, and 1 overview photograph from each corneal button). The ImageJ program was used to evaluate cell damage and loss in the photographs obtained from each cornea. RESULTS Analysis of the X400 photographs showed no statistical differences between control, 250 mL, and 500 mL groups in the percentage of intact, damaged, or lost cells (P= 0.896, 0.851, and 0.972 respectively). For the overview photos, the differences in areas of intact and damaged cells among the groups were statistically significant, likely due to the peripheral areas of damage related to touches between the phaco tip and the endothelium during irrigation. CONCLUSION The volume of BSS flow alone does not appear to be a major contributing source of endothelial cell damage and loss, providing further insight on mechanisms of corneal endothelium damage during phacoemulsification.
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Subudhi P, Khan Z, Subudhi BNR, Sitaram S, Patro S. Phacoemulsification vs manual small incision cataract surgery in eyes affected by pseudo exfoliation syndrome with grade II and III cataracts. Saudi J Ophthalmol 2020; 34:18-24. [PMID: 33542982 PMCID: PMC7849866 DOI: 10.4103/1319-4534.301292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 09/11/2019] [Accepted: 09/15/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE: To compare the postoperative alteration of central corneal thickness (CCT) and visual outcomes between phacoemulsification (group A) and manual small incision cataract surgery (MSICS) (group B) in grade II and III nuclear cataracts (NS II and III) with pseudoexfoliation syndrome (PXF). METHODS: It is a double masked prospective randomised interventional study. A total of 60 eyes of 60 patients were assigned randomly to either the phacoemulsification (group A) or MSICS (group B) groups. All eyes had nuclear sclerosis grade II and III (LOCS II grading system) with pseudoexfoliation material either over the pupillary margin, anterior lens capsule, or both. All surgeries were done by a single surgeon. Postoperative evaluation was scheduled on the 1st, 30th, 90th, and 180th-day. Statistical analyses were done using appropriate methods. Outcome of the study were measured with changes in central corneal thickness (CCT), Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA) and the spherical equivalent in the operated eye up to 6 months post surgery. RESULTS: The mean preoperative CCT showed no difference between the groups (0.9659). The mean rise in CCT on the 1st postoperative day (POD) showed a significant difference between the groups {24.65 (SD 9.32) [group A (Phacoemulsification)] and 33.34 (SD11.68) [group B (MSICS)] (P < 0.0023)}. At the 1st, 3rd, and 6th month postoperative visits, there was no significant difference. The mean uncorrected distance visual acuity (UDVA) on the 1st POD was 0.189 (SD 0.118) in Group A and 0.302 (SD 0.121) in group B (P < 0.0005) which was significantly better with the phacoemulsification procedure. At the 1st month it was 0.039 (SD 0.084) in group A and 0.148 (SD 0.089) in group B (P < 0.004), which remained almost stable after that. The mean corrected distance visual acuity (CDVA) at the 1st, 3rd, and 6th-month postoperative visits showed no significant difference (P 0.8). The mean spherical equivalent was 0.29 in group A and 0.8 in group B. CONCLUSION: In moderately hard nuclear cataracts with PXF, phacoemulsification provides better unaided visual outcomes with less endothelial dysfunction than MSICS in the immediate and subsequent postoperative period.
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Affiliation(s)
- Praveen Subudhi
- Ruby Eye Hospital, Govinda Vihar, Berhampur, Bhubaneswar, Odisha, India.,Department of Ophthalmology, Hitech Medical College, Bhubaneswar, Odisha, India
| | - Zahiruddin Khan
- Department of Ophthalmology, Hitech Medical College, Bhubaneswar, Odisha, India
| | | | - Silla Sitaram
- Department of Ophthalmology Department, SDH Chatrapur, Odisha, India
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Comparison of Femtosecond Laser-Assisted Cataract Surgery and Conventional Phacoemulsification in Shallow Anterior Chambers and Glaucoma. J Ophthalmol 2020; 2020:3690528. [PMID: 34104481 PMCID: PMC8162248 DOI: 10.1155/2020/3690528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 10/27/2020] [Accepted: 11/07/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose To compare femtosecond laser-assisted cataract surgery (FLACS) versus conventional phacoemulsification in shallow anterior chamber cataract patients with glaucoma or zonulysis. Methods This was a single-center retrospective review of cataract surgeries in shallow anterior chamber and glaucoma patients between January 2016 and December 2018 in which a LenSx femtosecond laser was used. The outcome measures included pre- and postoperative uncorrected and corrected distance visual acuity (UDVA and CDVA), intraocular pressure (IOP), endothelial cell density (ECD), endothelial cell loss (ECL), and object scatter index (OSI). Results One hundred and six eyes of 106 patients with a mean anterior chamber depth of 1.54 ± 0.51 mm were included in this study. Among them, 26 (23.2%) had zonulysis and 18 eyes had capsular tension ring implantation in general. The percentage of capsular tension ring implantation was statistically significantly lower in the FLACS group (P = 0.027). The UDVA, CDVA, ECD, and IOP were not statistically significant between the two groups at all time points. The postoperative ECL and OSI of the FLACS group was better than those of the conventional group (P < 0.01). Conclusions FLACS can reduce ECL and improve visual quality compared to the conventional phacoemulsification in shallow anterior chamber patients. Also, it has the trend of reducing the use of capsular tension rings in subluxated cataracts. It is an ideal choice for patients with complicated cataract such as with shallow anterior chambers, glaucoma, and zonulysis.
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Ahmed IIK, Rhee DJ, Jones J, Singh IP, Radcliffe N, Gazzard G, Samuelson TW, Ong J, Singh K. Three-Year Findings of the HORIZON Trial: A Schlemm Canal Microstent for Pressure Reduction in Primary Open-Angle Glaucoma and Cataract. Ophthalmology 2020; 128:857-865. [PMID: 33166551 DOI: 10.1016/j.ophtha.2020.11.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 10/24/2020] [Accepted: 11/02/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To report 3-year outcomes of the HORIZON study comparing cataract surgery (CS) with Hydrus Microstent (Ivantis, Inc) implantation versus CS alone. DESIGN Multicenter randomized clinical trial. PARTICIPANTS Five hundred fifty-six eyes from 556 patients with cataract and primary open-angle glaucoma (POAG) treated with 1 or more glaucoma medication, washed out diurnal intraocular pressure (IOP) of 22 to 34 mmHg, and no prior incisional glaucoma surgery. METHODS After phacoemulsification, eyes were randomized 2:1 to receive a Hydrus Microstent or no stent. Follow-up included comprehensive eye examinations through 3 years. MAIN OUTCOME MEASURES Outcome measures included IOP, medical therapy, reoperation rates, visual acuity, adverse events, and changes in corneal endothelial cell counts. RESULTS Three hundred sixty-nine eyes were randomized to microstent treatment and 187 to CS only. Preoperative IOP, medication use, washed-out diurnal IOP, and glaucoma severity did not differ between the two treatment groups. At 3 years, IOP was 16.7 ± 3.1 mmHg in the microstent group and 17.0 ± 3.4 mmHg in the CS group (P = 0.85). The number of glaucoma medications was 0.4 ± 0.8 in the microstent group and 0.8 ± 1.0 in the CS group (P < 0.001), and 73% of microstent group eyes were medication free compared with 48% in the CS group (P < 0.001). The microstent group included a higher proportion of eyes with IOP of 18 mmHg or less without medications compared with the CS group (56.2% vs. 34.6%; P < 0.001), as well as IOP reduction of at least 20%, 30%, or 40% compared with CS alone. The cumulative probability of incisional glaucoma surgery was lower in the microstent group (0.6% vs. 3.9%; hazard ratio, 0.156; 95% confidence interval, 0.031-0.773; P = 0.020). No difference was found in postoperative corneal endothelial cell loss between groups. No procedure- or device-related serious adverse events resulting in vision loss occurred in either group. CONCLUSIONS Combined CS and microstent placement for mild to moderate POAG is safe, more effective in lowering IOP with fewer medications, and less likely to result in further incisional glaucoma filtration surgery than CS alone at 3 years.
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Affiliation(s)
- Iqbal Ike K Ahmed
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada.
| | - Douglas J Rhee
- University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | | | | | | | - Gus Gazzard
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, and Institute of Ophthalmology, University College London, London, United Kingdom
| | | | - Jeb Ong
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Kuldev Singh
- Stanford University School of Medicine, Byers Eye Institute, Palo Alto, California
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Comparative evaluation of femtosecond laser-assisted cataract surgery and conventional phacoemulsification in eyes with a shallow anterior chamber. J Cataract Refract Surg 2020; 45:547-552. [PMID: 31030773 DOI: 10.1016/j.jcrs.2018.11.037] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 11/26/2018] [Accepted: 11/26/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare intraoperative performance and postoperative outcomes between femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification in eyes with a shallow anterior chamber (AC). SETTING Iladevi Cataract & IOL Research Centre, India. DESIGN Prospective randomized masked clinical study. METHODS Patients undergoing cataract surgery with a shallow AC (<2.5 mm) were randomized to have FLACS (Group 1, n = 91) or conventional phacoemulsification (Group 2, n = 91). Patients were followed up at 1 day, 1 week, and at 1, 3, and 6 months. The primary outcome measure was central corneal thickness (CCT). The secondary outcome measures were corneal clarity, AC cells and flare, endothelial cell density (ECD), coefficient of variance, hexagonality, and uncorrected distance visual acuity (UDVA) at 1 week. RESULTS The study comprised 182 eyes (91 in each group) The cumulative dissipative energy was lower in the FLACS group (P < .05). The mean CCT was significantly lower with FLACS (540.40 μm + 49.40 [SD] vs 556 + 12.5 μm, P = .03) at 1 day and 1 week (535.5 + 44.3 μm vs 551 + 40.8 μm, P = .04), with fewer eyes having higher than grade 2 AC cells and flare with FLACS (85% vs 72%, P = .056) at 1 day and 1 week (15% vs 28%, P = .03). At 1 week, the UDVA was better with FLACS (0.089 ± 0.31 logarithm of the minimum angle of resolution [logMAR] vs 0.178 ± 0.65 logMAR, P = .042). At 6 months, the reduction in ECD was lower in the FLACS group; however, the difference was not statistically significant. CONCLUSION In eyes with shallow ACs, compared with conventional phacoemulsification, FLACS maintained clearer corneas, showed less increase in CCT, lower AC inflammation, and better UDVA in the early postoperative period.
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Elmekawey H, Abdelaziz M, El Baradey M, Kotb M. Epithelial Remodeling Following Phacoemulsification in Diabetic Patients Using Anterior-Segment Optical Coherence Tomography: A Comparative Study. Clin Ophthalmol 2020; 14:2515-2523. [PMID: 32921979 PMCID: PMC7457868 DOI: 10.2147/opth.s266464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 07/27/2020] [Indexed: 11/26/2022] Open
Abstract
Purpose To compare the effect of phacoemulsification on corneal epithelial thickness in diabetic and nondiabetic cataract patients. Methods Fifty eyes with cataracts were enrolled in a prospective comparative interventional study. They were divided into two groups: group A (diabetics) and group B (nondiabetics) and underwent uneventful phacoemulsification. Epithelial thickness was assessed in the central, paracentral, and peripheral cornea on the first day and at 1 week, 1 month, and 3 months postoperatively using spectral-domain ocular coherence tomography. Results A significant increase in the first-day postoperative central epithelial thickness was noticed in both groups (57.16±3.5 µm and 55.96±2.81 µm in groups A and B, respectively), with increased baseline epithelial thickness of 3.8±2.1 µm and 3.4±2.14 µm in groups A and B, respectively (P<0.001). A significant decrease in epithelial thickness was noticed in both groups after 1 week (−2.40±3.1 µm and −2.76±2.71 µm in group A and B, respectively). No further significant change was noticed in the nondiabetic group at 1 month; however, significant reductions in for central epithelial thickness were found in the diabetic group up to the first month (−0.80±1.9 µm, P=0.05). Central corneal thickness followed the same pattern of change as the epithelium. A nonsignificant delay in visual acuity improvement was noticed in diabetic patients. Conclusion Phacoemulsification induces a temporary increase in corneal and epithelial thickness that should resolve by the first week postoperatively. However, diabetic patients had slower epithelial recovery that took up to 1 month, which could be reflected in delayed visual recovery with no effect on the final visual outcome.
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Affiliation(s)
- Hany Elmekawey
- Ophthalmology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Magda Abdelaziz
- Ophthalmology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed El Baradey
- Ophthalmology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Kotb
- Ophthalmology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
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Vargas V, Marinho A, El Sayyad F, Alio Del Barrio JL, Alio JL. Safety and visual outcomes following Iris-claw phakic intraocular lens bilensectomy. Eur J Ophthalmol 2020; 31:1795-1801. [PMID: 32715788 DOI: 10.1177/1120672120944033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the visual outcomes, safety, efficacy, and causes of bilensectomy for iris fixated phakic intraocular lenses (pIOLs). METHODS This was a two center consecutive retrospective study that included 43 eyes that underwent iris-claw pIOL bilensectomy. Patients with follow up less than 4 months were excluded from the study. Uncorrected, corrected visual acuity (UCVA, CDVA), refractive outcomes, efficacy, safety (number of eyes in which the postoperative CDVA was worse than the preoperative CDVA), endothelial cell density (ECD), causes of bilensectomy, the time between the implantation of the pIOL and bilensectomy, intra and postoperative complications were analyzed. RESULTS There was a statistically significant improvement in UCVA and CDVA after surgery (p = 0.001). The efficacy index was 0.7, four eyes had a postoperative CDVA worse than the preoperative CDVA. The mean spherical equivalent 1 year after bilensectomy was -0.78 ± 1.70 D. There was a statistically significant endothelial cell loss after iris claw lens bilensectomy (p = .003). Cataract development and endothelial cell loss were the only reasons for bilensectomy. The mean time between pIOL implantation and bilensectomy was 12.2 ± 5.5 years. One patient had corneal edema 8 months after surgery and one had a retinal detachment 11 months after surgery. CONCLUSION Bilensectomy was successful in improving UCVA and CDVA with an acceptable refractive outcome. Significant loss of ECD was found after surgery. The results recommend a larger ACD as selection criteria when choosing to implant an Artisan lens, and a close postoperative monitoring of the endothelial cell count.
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Affiliation(s)
- Veronica Vargas
- Cornea, Cataract and Refractive Surgery Department, VISSUM, Alicante, Spain.,Research & Development Department, VISSUM, Alicante, Spain
| | | | - Fouad El Sayyad
- Cornea, Cataract and Refractive Surgery Department, VISSUM, Alicante, Spain.,Research & Development Department, VISSUM, Alicante, Spain
| | - Jorge L Alio Del Barrio
- Cornea, Cataract and Refractive Surgery Department, VISSUM, Alicante, Spain.,Research & Development Department, VISSUM, Alicante, Spain.,Universidad Miguel Hernández, School of Medicine, Alicante, Spain
| | - Jorge L Alio
- Cornea, Cataract and Refractive Surgery Department, VISSUM, Alicante, Spain.,Research & Development Department, VISSUM, Alicante, Spain.,Universidad Miguel Hernández, School of Medicine, Alicante, Spain.,IBERIA eye bank, Oftalred, Universidad Miguel Hernández, Alicante, Spain
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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.
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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
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Subudhi P. This study compares the changes in central corneal thickness and post op visual outcome between phacoemulsification and manual small incision cataract surgery in Indian eyes with pseudoexfoliation syndrome with grade II and III nuclear cataracts: A single surgeon series. Saudi J Ophthalmol 2019. [DOI: 10.1016/j.sjopt.2019.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Ganesan N, Srinivasan R, Babu KR, Vallinayagam M. Risk factors for endothelial cell damage in diabetics after phacoemulsification. Oman J Ophthalmol 2019; 12:94-98. [PMID: 31198294 PMCID: PMC6561038 DOI: 10.4103/ojo.ojo_200_2017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND To assess the corneal endothelium, central corneal thickness and the factors associated with endothelial cell damage after phacoemulsification in diabetics in comparison with non-diabetics. METHODS It was a case control study with 80 eyes each in the diabetic group and the control group. Intraoperative mydriasis, effective phaco time (EPT) and postoperative inflammation were measured. Preoperative, 1st week, 6th week and 3rd month postoperative endothelial cell density (ECD), coefficient of variation (CV), hexagonality and central corneal thickness (CCT) were also measured using Konan noncon robo specular microscope (Model - NSP 9900). RESULTS In the control group, patients in the age group of 60-69 years were 3.8 times more at risk of ECL compared to patients in the age group of 50-59 years. Patients in whom EPT was ≥0.50 min, were 8.8 times more at risk of ECL when compared to patients in whom EPT <0.25 min. In the diabetic group, patients who had an inflammatory score of 1+ in the first postoperative week; also had 5.7 times more risk of ECL when compared to patients in whom the inflammatory score was 0.5+ in the first postoperative week. There was a significant increase in CV (p-0.03) and CCT (p-0.03), significant decrease in the hexagonality (p-0.01) and no statistically significant difference in the endothelial cell loss (ECL) (p-0.34) in diabetics after phacoemulsification when compared to controls. CONCLUSION The present study reveals postoperative inflammation as a risk factor for ECL in diabetics and not intraoperative mydriasis and EPT.
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Affiliation(s)
- Niruban Ganesan
- Cornea and Refractive Services, Aravind Eye Hospital, Puducherry, India
| | | | - K Ramesh Babu
- Department of Ophthalmology, JIPMER, Puducherry, India
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Yang WJ, Wang XH, Zhao F, Mei ZM, Li S, Xiang Y. Torsional and burst mode phacoemulsification for patients with hard nuclear cataract: A randomized control study. Medicine (Baltimore) 2019; 98:e15870. [PMID: 31145344 PMCID: PMC6708861 DOI: 10.1097/md.0000000000015870] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
This article aims to evaluate the outcomes of torsional and burst mode phacoemulsification in hard nuclear cataracts.Eighty eyes with grade IV or V nuclear opalescence were treated with phacoemulsification and intraocular lens implantation using conventional mode (Group A, n = 40) or torsional and burst mode phacoemulsification (Group B, n = 40). For good visualization of anterior capsule, trypan blue was injected to the anterior chamber before continuous circular capsulorhexis. The mean cumulative dissipated energy and ultrasound time were recorded. The best-corrected visual acuity, endothelial cell density, and central corneal thickness were measured before and at 1 month after surgery.The cumulative dissipated energy and ultrasound time of Group B were significantly less than that of Group A. The postoperative best-corrected visual acuities of the 2 groups were comparable. At 1 month after surgery, the changes in the endothelial cell density were significantly greater in Group A than in Group B, and the changes in the central corneal thickness were not significantly different between the 2 groups.Torsional and burst mode is a safe and effective surgical method for treating hard cataracts.
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Affiliation(s)
- Wan-Ju Yang
- Department of Ophthalmology, Central Hospital of Wuhan, Tongji Medical College of Huazhong University of Science and Technology
| | - Xing-Hua Wang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Fang Zhao
- Department of Ophthalmology, Central Hospital of Wuhan, Tongji Medical College of Huazhong University of Science and Technology
| | - Zhong-Ming Mei
- Department of Ophthalmology, Central Hospital of Wuhan, Tongji Medical College of Huazhong University of Science and Technology
| | - Shuang Li
- Department of Ophthalmology, Central Hospital of Wuhan, Tongji Medical College of Huazhong University of Science and Technology
| | - Yi Xiang
- Department of Ophthalmology, Central Hospital of Wuhan, Tongji Medical College of Huazhong University of Science and Technology
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Dasgupta S, Mehra R. Comparative studies between longitudinal and torsional modes in phacoemulsification, using active fluidics technology along with the intrepid balanced tip. Indian J Ophthalmol 2018; 66:1417-1422. [PMID: 30249825 PMCID: PMC6173017 DOI: 10.4103/ijo.ijo_7_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose: To compare and report the intra- and postoperative outcomes of phacoemulsification between longitudinal (LPKE) and torsional (TPKE) mode, using active fluidics along with the intrepid balanced tip. Methods: This single center prospective randomized comparative study comprised a total 108 consecutive eyes of 108 patients having senile cataract subdivided into nuclear opalescence (NO) grades II–IV according to the lens opacities classification system III (LOCS III). Cataracts of each grade were randomly assigned to two groups LPKE (n = 54) and TPKE (n = 54) mode, who were operated on by the same surgeon using same machine (Centurion® Alcon Laboratories, Inc., USA) having features of both active fluidics and intrepid balanced tip. Pre-, intra-, and postoperative evaluations were done independently by a different author, who was masked to the surgical procedures. Patients were evaluated on the postoperative days (PODs) 1, 7, 15, and 28. Intraoperative outcome measures were cumulative dissipated energy (CDE) and ultrasound time (UST). Postoperative outcome measures were endothelial cell loss (ECL), central corneal thickness (CCT), and best-corrected visual acuity (BCVA). Results: Age, gender, and NO-grade distribution among two modes were comparable (P > 0.05). Difference of CDE and UST between modes were found to be significant (P < 0.001) in favor of TPKE with all NO-grades. TPKE mode performs better than LPKE mode with regard to ECL, CCT-change, and BCVA-change, although the differences were found to be insignificant (P > 0.05). Conclusion: When using active fluidics along with the intrepid balanced tip, TPKE mode appeared to be a more efficient mode of PKE with reduced mean UST and CDE across all NO-grades, as compared to LPKE mode. However, ECL, CCT-change, and BCVA-change were seemed to be comparable between the two modes.
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Affiliation(s)
- Sushobhan Dasgupta
- Department of Ophthalmology, SGRR-Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India
| | - Rohan Mehra
- Department of Ophthalmology, SGRR-Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India
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Prophylactic exposure of human corneal endothelial cells to Rho-associated kinase inhibitor reduced apoptosis rate after phacoemulsification: Ex vivo study. J Cataract Refract Surg 2018; 44:1261-1266. [PMID: 30172567 DOI: 10.1016/j.jcrs.2018.04.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 04/05/2018] [Accepted: 04/08/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate whether prophylactic exposure of corneal endothelial cells (CECs) to a selective Rho-associated kinase (ROCK) inhibitor will inhibit CEC apoptosis after phacoemulsification. SETTING Laboratory evaluations at the Edith Wolfson Medical Center, Holon, Israel and the Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel and the Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel. DESIGN Experimental study. METHOD Human donor corneolimbal rings were divided into fragments that were stored in commercial storage media with or without the addition of 10 mM ROCK inhibitor for 1 week and were then exposed to phacoemulsification energy. Samples were dissociated into single cells by trypsin digestion and CECs were targeted using the antihuman CD166 antibody, a new biomarker. The CEC survival was evaluated for early and late apoptosis rate with flow cytometric analysis of annexin-V and propidium iodide (PI) double staining. RESULTS Six corneoscleral rings from 4 donors were studied. After phacoemulsification, CEC exposed to ROCK inhibitor demonstrated a 37.06% reduction in early apoptosis rate (29.36% ± 4.33% [SD] versus 46.65% ± 1.51%, P = .006) and 45.27% reduction in late apoptosis rate (17.6% ± 16.81% versus 32.16% ± 26.30%, P = .007), compared with controls. Subsequently, ROCK levels in apoptotic CECs were significantly lower in cells incubated with ROCK inhibitor than the control medium. CONCLUSIONS In this ex vivo study, ROCK inhibitor reduced endothelial loss and thus, could be used to limit or slow down CEC loss. Rho-associated kinase inhibitor might be used before cataract surgery, especially in high risk patients. This might be a promising new method for preventing pseudophakic bullous keratopathy.
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Awidi A, Dzhaber D, Daoud YJ. Application of femtosecond laser-assisted cataract surgery in patients with corneal pathologies. Am J Ophthalmol Case Rep 2018; 11:170-171. [PMID: 30128369 PMCID: PMC6097640 DOI: 10.1016/j.ajoc.2018.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/01/2018] [Accepted: 06/18/2018] [Indexed: 11/19/2022] Open
Affiliation(s)
- Abdelhalim Awidi
- Faculty of Medicine, University of Jordan, Queen Rania Al Abdullah Street, Amman, 11942, Jordan
| | - Daliya Dzhaber
- Cornea, Cataract, and Anterior Segment Division, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, 600 N Wolfe Street, Baltimore, MD 21287, USA
| | - Yassine J Daoud
- Cornea, Cataract, and Anterior Segment Division, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, 600 N Wolfe Street, Baltimore, MD 21287, USA
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Li S, Chen X, Zhao J, Xu M, Yu Z. Isolated Capsulorhexis Flap Technique in Femtosecond Laser-Assisted Cataract Surgery to Protect the Corneal Endothelial Cells. J INVEST SURG 2017; 32:35-38. [PMID: 29252045 DOI: 10.1080/08941939.2017.1372537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Shaowei Li
- Aier School of Ophthalmology, Central South University, Changsha, China
- Beijing Aier-Intech Eye Hospital, Beijing, China
| | - Xu Chen
- Department of Cataract and Glaucoma, Shanghai Aier Eye Hospital, Shanghai, China
| | - Jun Zhao
- Aier School of Ophthalmology, Central South University, Changsha, China
| | - Man Xu
- Aier School of Ophthalmology, Central South University, Changsha, China
| | - Zhouxing Yu
- Aier School of Ophthalmology, Central South University, Changsha, China
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Malik PK, Dewan T, Patidar AK, Sain E. Effect of IOP based infusion system with and without balanced phaco tip on cumulative dissipated energy and estimated fluid usage in comparison to gravity fed infusion in torsional phacoemulsification. EYE AND VISION 2017; 4:22. [PMID: 28932753 PMCID: PMC5602781 DOI: 10.1186/s40662-017-0087-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 09/02/2017] [Indexed: 05/29/2023]
Abstract
Background To evaluate the effect of three different combinations of tip designs and infusion systems in torsional phacoemulsification (INFINITI and CENTURION) in patients with cataract. According to the manufacturer, two unique improvements in the Centurion are: active fluid dynamic management system and use of an intrepid balanced tip. The study specifically aimed to evaluate the beneficial effects, if any, of change in tip design and infusion system individually and in combination on both per-operative parameters as well as endothelial health over 6 months. Methods One hundred and twenty six consenting patients of grade 4.0–6.9 senile cataract were randomized into three groups for phacoemulsification: Group A (n = 42): Gravity fed infusion system and 450 Kelman miniflared ABS phaco tip; Group B (n = 42): intraocular pressure (IOP) based infusion system and 450 Kelman miniflared ABS phaco tip; Group C (n = 42): IOP based infusion system and 450 Intrepid balanced phaco tip. The cumulative dissipated energy (CDE), estimated fluid usage (EFU) and total aspiration time (TAT) were compared peroperatively. The endothelial parameters were followed up postoperatively for six months. Results The three arms were matched for age (p = 0.525), gender (p = 0.96) and grade of cataract (p = 0.177). Group C was associated with significant reductions in CDE (p = 0.001), EFU (p < 0.0005) as well as TAT (p = 0.001) in comparison to the other groups. All three groups had comparable baseline endothelial cell density (p = 0.876) and central corneal thickness (p = 0.561). On post-operative evaluation, although all groups were comparable till 3 months, by 6 months, the percentage losses in endothelial cell density were significantly lower in group C as compared to the other groups. Conclusions Use of an IOP based phacoemulsification system in association with use of the Intrepid balanced tip reduces the CDE, EFU and TAT in comparison to a gravity fed system with a mini flared tip or IOP based system with a mini flared tip while also providing better endothelial preservation thus favouring the use of an IOP fed system with a balanced tip. Trial registration Trial registration No.: CTRI/2016/06/007022.
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Affiliation(s)
| | - Taru Dewan
- Dr Ram Manohar Lohia Hospital, New Delhi, India
| | | | - Ekta Sain
- Dr Ram Manohar Lohia Hospital, New Delhi, India
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Comparative clinical study of Whitestar Signature phacoemulsification system with standard and Ellips FX handpieces. Int Ophthalmol 2017; 38:1697-1702. [DOI: 10.1007/s10792-017-0649-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 07/05/2017] [Indexed: 10/19/2022]
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Joshi RS, Muley SJ. Combined 30-degree bevel up and down technique against 0-degree phaco tip for phacoemulsification surgery of hard cataracts. Clin Ophthalmol 2017; 11:1073-1079. [PMID: 28652692 PMCID: PMC5472415 DOI: 10.2147/opth.s131921] [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 To evaluate the effective phaco time (EPT), cumulative dissipated energy (CDE) and nucleus emulsification time (NET) as phaco parameters with 0- and 30-degree phaco tip. Patients and methods This prospective, interventional and observational case series included 294 patients scheduled for cataract removal by phacoemulsification technique. Patients with nuclear cataracts of grade 4 and 5 nuclear opalescence of Lens Opacities Classification System III were included in the study. Patients were consecutively allocated to phaco chop technique with 0-degree (0-degree group, n=147) and combined bevel up and down position using 30-degree phaco tip (combined bevel up/down group, n=147). The 0-degree group had phacoemulsification with 0-degree phaco tip, while the 30-degree group had chopping of the nucleus with bevel down phaco tip and emulsification of nuclear fragments was accomplished with bevel up tip. EPT, CDE, NET and intraoperative complications were noted and compared between the groups using analysis of variance. Results Average EPT, CDE and NET were lower in the 30-degree group than in the 0-degree group. However, no statistically significant difference was found in EPT (P=0.0733), CDE (P=0.0663) and NET (P=0.0633) between the two groups. No serious intraoperative complications were noted. The anterior chamber was maintained throughout the procedure in both groups. No patients had wound burn and miosis during the procedure. None of the patients developed bullous keratopathy, uveitis and cystoid macular edema during the follow-up period. Conclusion Combined bevel up and down 30-degree tip can yield effective hard nucleus phacoemulsification. Bevel down tip of 30-degree helps in effective chopping and bevel up tip assists in emulsification of the nuclear fragments. Although combined bevel up and down 30-degree tip can yield effective hard nucleus phacoemulsification, no statistically significant difference was found in EPT, CDE and NET between the two groups.
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Affiliation(s)
- Rajesh Subhash Joshi
- Department of Ophthalmology, Vasantrao Naik Government Medical College, Yavatmal, Maharashtra, India
| | - Sonal Jayant Muley
- Department of Ophthalmology, Vasantrao Naik Government Medical College, Yavatmal, Maharashtra, India
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Leon P, Umari I, Mangogna A, Zanei A, Tognetto D. An evaluation of intraoperative and postoperative outcomes of torsional mode versus longitudinal ultrasound mode phacoemulsification: a Meta-analysis. Int J Ophthalmol 2016; 9:890-7. [PMID: 27366694 DOI: 10.18240/ijo.2016.06.18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 08/18/2015] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate and compare the intraoperative parameters and postoperative outcomes of torsional mode and longitudinal mode of phacoemulsification. METHODS Pertinent studies were identified by a computerized MEDLINE search from January 2002 to September 2013. The Meta-analysis is composed of two parts. In the first part the intraoperative parameters were considered: ultrasound time (UST) and cumulative dissipated energy (CDE). The intraoperative values were also distinctly considered for two categories (moderate and hard cataract group) depending on the nuclear opacity grade. In the second part of the study the postoperative outcomes as the best corrected visual acuity (BCVA) and the endothelial cell loss (ECL) were taken in consideration. RESULTS The UST and CDE values proved statistically significant in support of torsional mode for both moderate and hard cataract group. The analysis of BCVA did not present statistically significant difference between the two surgical modalities. The ECL count was statistically significant in support of torsional mode (P<0.001). CONCLUSION The Meta-analysis shows the superiority of the torsional mode for intraoperative parameters (UST, CDE) and postoperative ECL outcomes.
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Affiliation(s)
- Pia Leon
- University Eye Clinic of Trieste, Ospedale Maggiore, Trieste 34125, Italy
| | - Ingrid Umari
- University Eye Clinic of Trieste, Ospedale Maggiore, Trieste 34125, Italy
| | - Alessandro Mangogna
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste 34149, Italy
| | - Andrea Zanei
- University Eye Clinic of Trieste, Ospedale Maggiore, Trieste 34125, Italy
| | - Daniele Tognetto
- University Eye Clinic of Trieste, Ospedale Maggiore, Trieste 34125, Italy
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A Comparison of Endothelial Cell Loss in Combined Cataract and MIGS (Hydrus) Procedure to Phacoemulsification Alone: 6-Month Results. J Ophthalmol 2015; 2015:769289. [PMID: 26664740 PMCID: PMC4664806 DOI: 10.1155/2015/769289] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/20/2015] [Indexed: 11/17/2022] Open
Abstract
Purpose. To compare the corneal endothelial cell loss after phacoemulsification, alone or combined with microinvasive glaucoma surgery (MIGS), in nonglaucomatous versus primary open angle glaucoma (POAG) eyes affected by age-related cataract. Methods. 62 eyes of 62 patients were divided into group 1 (n = 25, affected by age-related cataract) and group 2 (n = 37, affected by age-related cataract and POAG). All patients underwent cataract surgery. Group 2 was divided into subgroups A (n = 19, cataract surgery alone) and B (n = 18, cataract surgery and MIGS). Prior to and 6 months after surgery the patients' endothelium was studied. Main outcomes were CD (cell density), SD (standard deviation), CV (coefficient of variation), and 6A (hexagonality coefficient) variations after surgeries. Results. There were no significant differences among the groups concerning preoperative endothelial parameters. The differences in CD before and after surgery were significant in all groups: 9.1% in group 1, 17.24% in group 2A, and 11.71% in group 2B. All endothelial parameters did not significantly change after surgery. Conclusions. Phacoemulsification determined a loss of endothelial cells in all groups. After surgery the change in endothelial parameters after MIGS was comparable to the ones of patients who underwent cataract surgery alone.
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Endothelial Cell Loss after Phacoemulsification according to Different Anterior Chamber Depths. J Ophthalmol 2015; 2015:210716. [PMID: 26417452 PMCID: PMC4568363 DOI: 10.1155/2015/210716] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 08/19/2015] [Indexed: 11/23/2022] Open
Abstract
Purpose. To compare the loss of corneal endothelial cells after phacoemulsification according to different anterior chamber depths (ACDs). Methods. We conducted a prospective study on 135 eyes with senile cataracts. Eyes with nuclear density grades of 2 to 4 were divided into three groups according to ACD: ACD I, 1.5 < ACD ≤ 2.5 mm; ACD II, 2.5 < ACD ≤ 3.5 mm; or ACD III, 3.5 < ACD ≤ 4.5 mm. Intraoperative mean cumulative dissipated energy (CDE) was measured. Clinical examinations included central corneal thickness (CCT) and endothelial cell count (ECC) preoperatively and 2 months postoperatively. Results. There were no significant differences in CDE among the ACD groups (P > 0.05). Endothelial cell loss was significantly higher in ACD I than in ACD III in grades 3 and 4 cataract density groups 2 months after phacoemulsification (P < 0.05). There were also more changes in CCT in all of the cataract density groups in the ACD I group compared to the ACD II and III groups 2 months postoperatively, but the difference was not statistically significant. Conclusions. Eyes with shallow ACDs, especially those with relatively hard cataract densities, can be vulnerable to more corneal endothelial cell loss in phacoemulsification surgery.
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Abstract
Purpose/aim of the study To present a phacoemulsification technique for hard cataracts and compare postoperative results using two different ultrasonic tip motions during quadrant removal. Materials and methods A phacoemulsification technique which employs in situ fracture and endocapsular debulking for hard cataracts is presented. The prospective study included 56 consecutive cases of hard cataract (LOCS III NC [Lens Opacification Classification System III, nuclear color], average 4.26), which were operated using the Infiniti machine and the Partial Kelman tip. Longitudinal tip movement was used for sculpting for all cases which were randomized to receive longitudinal or torsional/interjected longitudinal (Intelligent Phaco [IP]) strategies for quadrant removal. Measurements included cumulative dissipated energy (CDE), 3 months postoperative surgically induced astigmatism (SIA), and corneal endothelial cell density (ECD) losses. Results No complications were recorded in any of the cases. Respective overall and longitudinal vs IP means were as follows: CDE, 51.6±15.6 and 55.7±15.5 vs 48.6±15.1; SIA, 0.36±0.2 D and 0.4±0.2 D vs 0.3±0.2 D; and mean ECD loss, 4.1%±10.8% and 5.9%±13.4% vs 2.7%±7.8%. The differences between longitudinal and IP were not significant for any of the three categories. Conclusion The endocapsular phacofracture debulking technique is safe and effective for phacoemulsification of hard cataracts using longitudinal or torsional IP strategies for quadrant removal with the Infiniti machine and Partial Kelman tip.
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Influence of anterior chamber depth, anterior chamber volume, axial length, and lens density on postoperative endothelial cell loss. Graefes Arch Clin Exp Ophthalmol 2015; 253:745-52. [DOI: 10.1007/s00417-015-2934-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 01/07/2015] [Accepted: 01/12/2015] [Indexed: 01/26/2023] Open
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Noh JH, Jung MS. Comparison of Clinical Outcomes between Torsional and Longitudinal Phacoemulsification. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.7.1028] [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]
Affiliation(s)
- Ju Hee Noh
- Department of Ophthalmology, Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Moon Sun Jung
- Department of Ophthalmology, Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
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Abouzeid H, Ferrini W. Femtosecond-laser assisted cataract surgery: a review. Acta Ophthalmol 2014; 92:597-603. [PMID: 24835818 DOI: 10.1111/aos.12416] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 03/12/2014] [Indexed: 02/06/2023]
Abstract
Introduced in 2008, the femtosecond laser is a promising new technological advance which plays an ever increasing role in cataract surgery where it automates the three main surgical steps: corneal incision, capsulotomy and lens fragmentation. The proven advantages over manual surgery are: a better quality of incision with reduced induced astigmatism; increased reliability and reproducibility of the capsulotomy with increased stability of the implanted lens; a reduction in the use of ultrasound. Regarding refractive results or safety, however, no prospective randomized study to date has shown significant superiority compared with standard manual technique. The significant extra cost generated by this laser, undertaken by the patient, is a limiting factor for both its use and study. This review outlines the potential benefits of femtosecond-laser-assisted cataract surgery due to the automation of key steps and the safety of this new technology.
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Affiliation(s)
- Hana Abouzeid
- Cataract Unit; Department of ophthalmology; University of Lausanne; Lausanne Switzerland
- Jules-Gonin Eye Hospital; Lausanne Switzerland
- Fondation Asile des Aveugles; Lausanne Switzerland
- IRO-Institute for Research in Ophthalmology; Sion Switzerland
| | - Walter Ferrini
- Cataract Unit; Department of ophthalmology; University of Lausanne; Lausanne Switzerland
- Jules-Gonin Eye Hospital; Lausanne Switzerland
- Fondation Asile des Aveugles; Lausanne Switzerland
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Ataş M, Demircan S, Karatepe Haşhaş AS, Gülhan A, Zararsız G. Comparison of corneal endothelial changes following phacoemulsification with transversal and torsional phacoemulsification machines. Int J Ophthalmol 2014; 7:822-7. [PMID: 25349800 DOI: 10.3980/j.issn.2222-3959.2014.05.15] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Accepted: 03/04/2014] [Indexed: 11/02/2022] Open
Abstract
AIM To compare and evaluate the phacoemulsification parameters and postoperative endothelial cell changes of two different phacoemulsification machines, each with different modes, but also to assess the relationship between postoperative endothelial cell loss and the phacoemulsification parameters, as well as the other factors in both groups. METHODS This prospective observational study was comprised of consecutive eligible cataract patients operated with phacoemulsification technique performed by the same surgeon using either a WHITESTAR Signature Ellips FX (transversal, group 1) or Infiniti OZil IP (torsional, group 2) machine. RESULTS The study included 86 patients. Baseline characteristics in the groups were similar. The median nuclear sclerosis grade was 3 (2-4) in the first group and 2 (2-4) in the second group (P=0.265). Both groups had similar phacoemulsification needle times (group 1: 60.63±36 s; group 2: 55.98±30 s; P=0.789). The percentage of endothelial cell loss 30d after surgery ranged from 3% to 15% with a median of 7% in group 1, and from 2% to 13% with a median of 6% in group 2; however, there was no statistically significant difference between the groups (P=0.407). Hexagonality (P=0.794) and the coefficient of variation (CV; P=0.142) did not differ significantly between the groups before and 30d after surgery. A significant positive correlation was found between the endothelial cell loss and nuclear sclerosis grade (group 1: P<0.001; group 2: P<0.001) and between the endothelial cell loss and average phacoemulsification power (group 1: P=0.007; group 2: P=0.008). CONCLUSION Both of these machines were efficient, with similar endothelial cell loss. This endothelial cell loss was related to the increased nuclear sclerosis grade and increased phacoemulsification power.
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Affiliation(s)
- Mustafa Ataş
- Department of Ophthalmology and Vision Sciences, Kayseri Traning and Research Hospital, Kocasinan-Kayseri 38010, Turkey
| | - Süleyman Demircan
- Department of Ophthalmology and Vision Sciences, Kayseri Traning and Research Hospital, Kocasinan-Kayseri 38010, Turkey
| | - Arzu Seyhan Karatepe Haşhaş
- Department of Ophthalmology and Vision Sciences, Kayseri Traning and Research Hospital, Kocasinan-Kayseri 38010, Turkey
| | - Ahmet Gülhan
- Department of Ophthalmology and Vision Sciences, Kayseri Traning and Research Hospital, Kocasinan-Kayseri 38010, Turkey
| | - Gökmen Zararsız
- Department of Biostatistics, Faculty of Medicine, Erciyes University, Kocasinan-Kayseri 38010, Turkey
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Kotb AMEM, Elawamry AI. Feasibility of the New Torsional Phacoemulsification Software Phacoemulsification (Ozil IP) in Hard Cataracts. Asia Pac J Ophthalmol (Phila) 2013; 2:372-4. [PMID: 26107149 DOI: 10.1097/apo.0b013e31828a56f7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To assess the feasibility of using the new torsional intelligent phacoemulsification software (Ozil IP) phacoemulsification in hard cataracts of N3+. DESIGN A cohort study. METHODS Eighty patients were recruited and randomized into 2 groups, the study group and the control group. Each group consisted of 40 eyes. Routine cataract surgeries were performed using standard torsional software (Ozil) and Ozil IP in hard cataracts of N3+. Main outcome measures included cumulative dissipated energy (CDE), amount of balanced salt solution (BSS) used, and changes in central corneal thickness (CCT). RESULTS The mean CDE was significantly less in the study group compared with the control group (P = 0.05). The mean time in foot pedal position 3 (FP3) for varying grades of cataract density ranged from 16.3 to 30.2 seconds in the study group and from 19.1 to 39.7 seconds in the control group, which was statistically significant (P = 0.03). The amount of BSS used was 34.19 mL in the study group and 44.05 mL in the control group. On the first postoperative day, CCT was significantly different between the study and the control group (P = 0.005). CONCLUSIONS The 3 parameters (CDE, FP3 and BSS amount) were found to be effective with no significant complications. The new Ozil IP required less CDE and less FP3 time with less postoperative corneal edema, and thus patients had a more rapid visual recovery.
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Affiliation(s)
- Ahmed Mohamed El-Moatassem Kotb
- From the *Ophthalmology Department, Medicine, Ain Shams University, Cairo, Egypt; and †International Medical Center, Dubai, United Arab Emirates
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Kugu S, Erdogan G, Sahin Sevim M, Ozerturk Y. A clinical comparison of safety and efficacy in phacoemulsification with versus without ophthalmic viscoelastic device. Semin Ophthalmol 2013; 30:96-100. [PMID: 24171791 DOI: 10.3109/08820538.2013.833261] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate in a comparative manner the safety and efficacy of 1.0% sodium-Hyaluronate used during capsulorhexis and intraocular lens (IOL) implantation in phacoemulsification surgery. MATERIALS AND METHODS 1.0% sodium-Hyaluronate, which is commonly used as one of the ophthalmic viscoelastic devices, was compared to intraocular irrigating solution, which can bring up these effects. In addition, the effect of both methods on occurring corneal endothelial cell (CEC) loss was investigated. RESULTS Each group comprised 19 eyes. The mean preoperative CEC density was 2525.68 ± 181.85 in Group H and 2514.16 ± 174.59 in Group V; no statistically significant difference was found between the groups (p > 0.05). Preoperative and postoperative first and twelfth week CEC densities were 2438.21 ± 198.12 (p < 0.001) and 2390.74 ± 202.31, respectively, in group H (p < 0.001). Preoperative and postoperative first and twelfth week CEC densities were 2415.32 ± 197.24 (p < 0.001) and 2353.47 ± 212.69 in group V (p < 0.001). Compared with preoperative values, decrease in CEC density on the postoperative first and twelfth weeks was not statistically significant in either group (p > 0.05). CONCLUSION Although it was found that there was no statistically difference in terms of preventing CEC loss between 1.0% sodium-Hyaluronate and the irrigation method during phacoemulsification, it was observed clinically that 1.0% sodium-hyaluronate can make the procedure easy, safer, very helpful, especially for understanding phacoemulsification.
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Affiliation(s)
- Suleyman Kugu
- Dr. Lutfi Kırdar Kartal Training and Research Hospital, Eye Clinic , Istanbul , Turkey
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Kanellopoulos AJ. All-laser bladeless cataract surgery, combining femtosecond and nanosecond lasers: a novel surgical technique. Clin Ophthalmol 2013; 7:1791-5. [PMID: 24049439 PMCID: PMC3775700 DOI: 10.2147/opth.s47188] [Citation(s) in RCA: 3] [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
Purpose To report the safety and efficacy of a novel surgical technique using two lasers in cataract surgery. Methods In this contralateral eye report, a 57-year-old female underwent cataract extraction. Two laser devices and a standard phacoemulsification, platform were used to conduct the procedures. First, a femtosecond laser was used to perform the corneal incision, capsulorhexis, and initial lens fragmentation in each eye. Following this, a nanosecond laser was used to enter the 2.8 mm incision, uni-axially, and complete the viscoelastic-divided nucleus fragment emulsification and removal in one eye. Standard phacoemulsification was used in the completion of the other eye. Posterior chamber foldable acrylic intraocular lenses were implanted in both cases. We evaluated perioperative acuity, refraction, keratometry, Scheimpflug tomography, intraocular pressure, endothelial cell counts, and total energy used with each laser in each case. Results Corrected distance visual acuity improved from preoperative 20/60 and 20/70 to postoperative 20/20 in both eyes, with 6-month follow-up. In the right eye, the total intraocular energy used was 2 J by the femtosecond laser and 6 J by the phacoemulsification device. In the left eye, the nanosecond laser utilized the same energy of 2 J and the nanosecond laser 2.4 J (80 pulses of 30 mJ each). There were no other differences noted in intraocular pressure or endothelial cell counts. Conclusion In this report, we introduce a bladeless all-laser cataract surgery extraction alternative technique, with several potential novel advantages: enhanced incision and capsulorhexis reproducibility, reduction in intraocular energy used, and elimination of the potential of thermal corneal injury.
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Chen X, Ji Y, Lu Y. Comparison of clear corneal incision injuries between torsional and conventional phacoemulsification. Graefes Arch Clin Exp Ophthalmol 2013; 251:2147-54. [PMID: 23873255 DOI: 10.1007/s00417-013-2423-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 05/15/2013] [Accepted: 07/08/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To compare thermal and mechanical clear corneal incision (CCI) injuries after conventional and torsional phacoemulsification. DESIGN A prospective, randomized clinical study. METHODS A total of 80 eyes were evaluated for the profile of the incision at 1 day and 3 months postoperatively. The wound architecture was recorded with anterior segment optical coherence tomography (AS-OCT). The incisional thickness increased by thermal injury, Descemet's membrane detachment (DMD) caused by mechanical injury, the presence of endothelial gaping, loss of coaptation, and wound retraction of the conventional phaco group and the torsional phaco group were compared. RESULTS The corneal thickness at the incision site of the torsional ultrasound group was significantly lower than the conventional group compared to at the first postoperative visit (1187.55 ± 75.66, 1233.62 ± 85.87, P = .013). However, this thickness was similar between the two groups at 3 months postoperatively. The central endothelial cell loss was significantly lower in the torsional ultrasound group after 3 months (417 ± 143, 322 ± 130, P = .003). There was a positive correlation between cumulated dissipated energy (CDE) and the incisional corneal thickness change that was observed by AS-OCT. Other OCT outcome parameters (such as endothelial gap, DMD, epithelial gap, and uncoaptation) that may be caused by mechanical injury did not differ significantly between the groups on postoperative day one or after 3 months. CONCLUSIONS The torsional ultrasound mode may provide a lower level of phacoemulsification time and energy and induce less incisional corneal thickness caused by thermal injury in the early postoperative period. The long-term wound healing appeared the same in both ultrasound mode groups.
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Affiliation(s)
- Xu Chen
- Department of Ophthalmology, Zhongshan Hospital of Fudan University, Shanghai, China
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Assaf A, Roshdy MM. Comparative analysis of corneal morphological changes after transversal and torsional phacoemulsification through 2.2 mm corneal incision. Clin Ophthalmol 2013; 7:55-61. [PMID: 23326184 PMCID: PMC3544352 DOI: 10.2147/opth.s39019] [Citation(s) in RCA: 3] [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
Purpose This paper compares and evaluates the corneal morphological changes occurring after cataract surgery through a 2.2 mm corneal incision. We use two platforms for comparison and evaluation, transversal and torsional phacoemulsification. Patients and methods This study includes 139 consecutive cataractous eyes (nuclear color 2–4, according to the Lens Opacities Classification System III [LOCSIII]) of 82 patients undergoing cataract surgery through a 2.2 mm corneal incision. Two different phacoemulsification platforms were used and assigned randomly: we used the WhiteStar Signature® system with the Ellips™ FX transversal continuous ultrasound (US) mode for group I (mean age: 65.33 ± 6.97 years), and we used the Infiniti® system with the OZil® Intelligent Phaco (IP) torsional US mode for group II (mean age: 64.02 ± 7.55 years). The corneal endothelium and pachymetry were evaluated preoperatively and at 1 month postoperatively. Incision size changes were also evaluated. Results All surgeries were uneventful. Before intraocular lens implantation, the mean incision size was 2.24 ± 0.06 mm in both groups (P = 0.75). In terms of corneal endothelial cell density, neither preoperative (I vs II: 2304.1 ± 122.5 cell/mm2 vs 2315.6 ± 83.1 cell/mm2, P = 0.80) nor postoperative (I vs II: 2264.1 ± 124.3 cell/mm2 vs 2270.3 ± 89.9 cell/mm2, P = 0.98) differences between the groups were statistically significant. The mean endothelial cell density loss was 1.7% ± 1.6% and 2.0% ± 1.4% in groups I and II, respectively. Furthermore, no significant differences between groups I and II were found preoperatively (P = 0.40) and postoperatively (P = 0.68) in central pachymetry. With surgery, the mean increase in central pachymetry was 28.1 ± 23.6 μm and 24.0 ± 24.0 μm in groups I and II, respectively (P = 0.1). Conclusion Ellips™ FX transversal and OZil® IP torsional phacoemulsification modes are safe for performing cataract surgery, inducing minimal corneal thickness and endothelial changes.
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Affiliation(s)
- Ahmed Assaf
- Ophthalmology Department, Ain Shams University, Cairo, Egypt
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Lim SA, Hwang HB, Kim HS. Comparison of Clinical Outcomes Between Torsional Phacoemulsification of Infiniti® and Longitudinal Phacoemulification of Stellaris® Through 2.2 mm Microincision. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.10.1508] [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)
- Sung A Lim
- Department of Ophthalmology & Visual Science College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyung Bin Hwang
- Department of Ophthalmology & Visual Science College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Seung Kim
- Department of Ophthalmology & Visual Science College of Medicine, The Catholic University of Korea, Seoul, Korea
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Endothelial cell loss: Biaxial small-incision torsional phacoemulsification versus biaxial small-incision longitudinal phacoemulsification. J Cataract Refract Surg 2012; 38:1918-24. [DOI: 10.1016/j.jcrs.2012.06.051] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 06/21/2012] [Accepted: 06/22/2012] [Indexed: 11/18/2022]
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Ugurbas SC, Caliskan S, Alpay A, Ugurbas SH. Impact of intelligent phacoemulsification software on torsional phacoemulsification surgery. Clin Ophthalmol 2012; 6:1493-8. [PMID: 23055669 PMCID: PMC3460720 DOI: 10.2147/opth.s35283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of this study was to compare phacoemulsification energy parameters during torsional phacoemulsification with or without the use of intelligent phacoemulsification (IP) software. Methods One hundred and twenty-eight eyes with nuclear grades ranging from 1 to 5 were enrolled in this randomized prospective study. Operated eyes were divided into two groups, ie, those operated on using IP software (Group 1, n = 67) and those operated on without IP software (Group 2, n = 61). The two groups were compared in terms of ultrasound energy level, ultrasound energy time, aspiration time, and amount of fluid used during surgery. Results Operated eyes were further grouped according to soft (grade 1 and 2, n = 37), medium (grade 3, n = 46), and hard (grade 4 and 5, n = 31) nuclear densities. Both the study and the control groups were similar in distribution of nuclear density (P > 0.05). Cumulative dissipated energy was measured as 14.06 ± 9.92 in Group 1 and 14.22 ± 10.99 in Group 2 (P = 0.92). Total ultrasound time was 49 seconds in Group 1 and 52 seconds in Group 2 (P = 0.58). Although the torsional amplitude used was similar (P = 0.86) when IP was either on (71%) or off (68.4%), aspiration time was found to be 4 minutes 17 seconds in Group 1 (P = 0.86) and 5 minutes and 17 seconds in Group 2 (P = 0.007). Total fluid used was measured as 91 cc (P = 0.86) in Group 1 and 109 cc (P = 0.02) in Group 2. Conclusion The new IP software did not cause a difference in ultrasound energy levels. However, the new software was found to be advantageous in regards to fluid use and aspiration time.
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Affiliation(s)
- Silay Canturk Ugurbas
- Department of Ophthalmology, Bulent Ecevit University School of Medicine, Zonguldak, Turkey
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Reuschel A, Bogatsch H, Wiedemann R. Long-Term Comparison of Endothelial Changes Between Torsional and Longitudinal Phacoemulsification. ASIA-PACIFIC JOURNAL OF OPHTHALMOLOGY (PHILADELPHIA, PA.) 2012; 1:152-7. [PMID: 26107331 DOI: 10.1097/apo.0b013e31825385d8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The objective of this study was to evaluate endothelial changes between torsional and longitudinal phacoemulsification 2 years after cataract surgery. DESIGN This was a prospective, randomized, controlled clinical trial. METHODS We enrolled 200 patients with senile cataract between August 2008 and December 2009 for surgery using either torsional (group A, n = 100) or longitudinal (group B, n = 100) phacoemulsification. Outcomes were central endothelial cell density and corrected distance visual acuity (CDVA) 3 months and in this follow-up 2 years after surgery. Statistical evaluation of endothelial cell loss (ECL) was performed according to statistical guidelines by creating a primary analysis (substitution of missing values by the median) and a secondary analysis (actual data). RESULTS The mean age was 71 (SD, 7.3) years. We were able to reexamine 46 patients in group A and 54 in group B 2 years after surgery. The median CDVA before surgery was 0.3 logMAR in group A and 0.35 logMAR in group B, improving to 0 logMAR postoperatively in both groups. The median ECL in the primary analysis was 6.9% after 3 months and 10.3% 2 years after surgery in group A. In group B, we found a loss of 6.6% after 3 months and 8.6% 2 years postoperatively. In the secondary analysis, the loss was 10.0% in group A and 8.5% in group B after 2 years. The difference was statistically not significant. CONCLUSIONS There is no difference between the ECL between torsional and longitudinal phacoemulsification up to 2 years after cataract surgery.
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Affiliation(s)
- Anna Reuschel
- From the *Department of Ophthalmology and †Clinical Trial Centre, University of Leipzig, Leipzig, Germany
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Mahdy MAS, Eid MZ, Mohammed MAB, Hafez A, Bhatia J. Relationship between endothelial cell loss and microcoaxial phacoemulsification parameters in noncomplicated cataract surgery. Clin Ophthalmol 2012; 6:503-10. [PMID: 22536044 PMCID: PMC3334211 DOI: 10.2147/opth.s29865] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess the relationship between postoperative endothelial cell loss and microcoaxial phaco parameters using Ozil IP (Alcon Laboratories, Inc, Fort Worth, TX) in noncomplicated cataract surgery. Methods In this prospective observational study, 120 consecutive cases of cataract patients with different grades of nuclear hardness underwent microcoaxial phacoemulsification through a 2.2-mm clear corneal incision. An Alcon Infinity Vision System with Ozil IP (Alcon Laboratories) was used with an Ozil torsional handpiece and a Kelman-style 45° phacoemulsification tip. Patients underwent preoperative and postoperative central endothelial cell counts. Results The study included 120 cases of age-related cataract whose mean age (standard deviation [SD]) was 59.68 years (9.47). There was a highly statistically significant endothelial cell loss (P < 0.001). The endothelial cell loss ranged 11–1149 cells/mm2 with a median (interquartile range) of 386 cells/mm2 (184.5–686 cells/mm2). The percentage of postoperative ECLoss% ranged from 0.48% to 47.8% with a median (interquartile range) of 15.4% (7.2% to 26.8%). A significant positive correlation was found between the ECLoss% and different phaco parameters. The Spearman’s rank-order correlation coefficient values, rho, (ρ) were as follows: CDE (ρ = 0.425), aspiration time (ρ = 0.176), and volume (ρ = 0.278). Also, ECLoss% was significantly correlated with the grade of nuclear opalescence (Kendall’s tau τ = 0.42). Conclusion Microcoaxial phacoemulsification was efficient in removing noncomplicated cataracts; however a statistically significant endothelial cell loss was noted, especially with increased nuclear hardness. This endothelial cell loss was mostly related to the increased cumulative dissipated energy (CDE), aspiration time, and volume of balanced salt solution used.
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Intraoperative performance and postoperative outcome comparison of longitudinal, torsional, and transversal phacoemulsification machines. J Cataract Refract Surg 2012; 38:234-41. [DOI: 10.1016/j.jcrs.2011.08.035] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Revised: 08/21/2011] [Accepted: 08/23/2011] [Indexed: 11/20/2022]
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Lawless M, Hodge C. Femtosecond Laser Cataract Surgery: An Experience From Australia. ASIA-PACIFIC JOURNAL OF OPHTHALMOLOGY (PHILADELPHIA, PA.) 2012; 1:5-10. [PMID: 26107010 DOI: 10.1097/apo.0b013e31823ff9de] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Cataract surgery remains the most widely performed intraocular procedure throughout the world. Safety and accuracy of the procedure are paramount and techniques should remain under constant review. Recently, the introduction of the femtosecond laser to assist cataract surgery has provided ophthalmologists with an exciting tool that may further improve outcomes. We review the existing literature, discuss the potential implications for a variety of stakeholders and discuss our initial experience with the femtosecond laser.
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Affiliation(s)
- Michael Lawless
- From the *Vision Eye Institute, Chatswood; and †Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Length and frequency of intraoperative occlusive events with new torsional phacoemulsification software. J Cataract Refract Surg 2011; 37:1785-90. [PMID: 21856112 DOI: 10.1016/j.jcrs.2011.04.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2010] [Revised: 04/02/2011] [Accepted: 04/21/2011] [Indexed: 11/23/2022]
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Fakhry MA, El Shazly MI. Torsional ultrasound mode versus combined torsional and conventional ultrasound mode phacoemulsification for eyes with hard cataract. Clin Ophthalmol 2011; 5:973-8. [PMID: 21792288 PMCID: PMC3141862 DOI: 10.2147/opth.s22879] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose To compare torsional versus combined torsional and conventional ultrasound modes in hard cataract surgery regarding ultrasound energy and time and effect on corneal endothelium. Settings Kasr El Aini hospital, Cairo University, and International Eye Hospital, Cairo, Egypt. Methodology Ninety-eight eyes of 63 patients were enrolled in this prospective comparative randomized masked clinical study. All eyes had nuclear cataracts of grades III and IV using the Lens Opacities Classification System III (LOCS III). Two groups were included, each having an equal number of eyes (49). The treatment for group A was combined torsional and conventional US mode phacoemulsification, and for group B torsional US mode phacoemulsification only. Pre- and post-operative assessments included best corrected visual acuity (BCVA), intraocular pressure (IOP), slit-lamp evaluation, and fundoscopic evaluation. Endothelial cell density (ECD) and central corneal thickness (CCT) were measured preoperatively, 1 day, 7 days, and 1 month postoperatively. All eyes were operated on using the Alcon Infiniti System (Alcon, Fort Worth, TX) with the quick chop technique. All eyes were implanted with AcrySof SA60AT (Alcon) intraocular lens (IOL). The main phaco outcome parameters included the mean ultrasound time (UST), the mean cumulative dissipated energy (CDE), and the percent of average torsional amplitude in position 3 (%TUSiP3). Results Improvement in BCVA was statistically significant in both groups (P < 0.001). Comparing UST and CDE for both groups revealed results favoring the pure torsional group (P = 0.002 and P < 0.001 for UST; P = 0.058 and P = 0.009 for CDE). As for %TUSiP3, readings were higher for the pure torsional group (P = 0.03 and P = 0.01). All changes of CCT, and ECD over time were found statistically significant using one-way ANOVA testing (P < 0.001). Conclusion Both modes are safe in hard cataract surgery, however the pure torsional mode showed less US energy used.
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Affiliation(s)
- Mohamed A Fakhry
- Department of Ophthalmology, Kasr El Aini Hospital, Cairo University, Cairo, Egypt.
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