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Ciorba AL, Teusdea A, Roiu G, Cavalu DS. Particularities of Cataract Surgery in Elderly Patients: Corneal Structure and Endothelial Morphological Changes after Phacoemulsification. Geriatrics (Basel) 2024; 9:77. [PMID: 38920433 DOI: 10.3390/geriatrics9030077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/02/2024] [Accepted: 06/06/2024] [Indexed: 06/27/2024] Open
Abstract
The aim of this study was to evaluate the influence of ultrasounds used in phacoemulsification during cataract surgery on the corneal structure and morphology in patients over 65 years. We compared the outcomes of phacoemulsification techniques in terms of corneal cell morphology in 77 patients over 65 years old and 43 patients under 65 years old. Corneal cell density, central corneal thickness and hexagonality were measured preoperatively and post-surgery (at 1 and 4 weeks) by specular microscopy. The effect of gender, axial length and anterior chamber depth on the parameters of corneal endothelium were evaluated. In both groups, a progressive decrease in endothelial cells was observed, starting from the first week post-surgery until the fourth postoperative week. The central corneal thickness increased in both groups with maximum values at the first week postoperatively, while their initial values were restored in the fourth week post-surgery, with no statistical difference between groups. Statistically significant differences were noticed in terms of cell hexagonality in the group over 65, showing smaller hexagonality at all preoperative and postoperative time points compared to group under 65. Our result highlights the importance of routine specular microscopy performed before surgery, regardless the age of the patients, with caution and careful attention to the phaco power intensity, ultrasound energy consumption and intraoperative manipulation of instruments, as well as proper use of viscoelastic substances to reduce corneal endothelium damage, especially in elderly patients.
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Affiliation(s)
- Adela Laura Ciorba
- Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, University of Oradea, P-ta 1 Decembrie 10, 410087 Oradea, Romania
| | - Alin Teusdea
- Faculty of Environmental Protection, University of Oradea, 26 Gen. Magheru Street, 410048 Oradea, Romania
| | - George Roiu
- Faculty of Medicine and Pharmacy, University of Oradea, P-ta 1 Decembrie 10, 410087 Oradea, Romania
| | - Daniela Simona Cavalu
- Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, University of Oradea, P-ta 1 Decembrie 10, 410087 Oradea, Romania
- Faculty of Medicine and Pharmacy, University of Oradea, P-ta 1 Decembrie 10, 410087 Oradea, Romania
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Giglio R, Vinciguerra AL, Inferrera L, Tognetto D. Phacoemulsification Wound Burn and Its Management. Case Rep Ophthalmol 2024; 15:303-309. [PMID: 38590942 PMCID: PMC11001284 DOI: 10.1159/000537741] [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: 02/02/2023] [Accepted: 02/05/2024] [Indexed: 04/10/2024] Open
Abstract
Introduction The production of ultrasonic energy during phacoemulsification is associated with heat generation that could damage ocular tissues, particularly at the corneoscleral wound site. Case Presentation This study presents an 89-year-old patient with senile hypermature cataract and Fuchs endothelial dystrophy developing severe thermal corneoscleral injury during phacoemulsification. At presentation, visual acuity was finger count at 40 cm and there was a 1 × 2-mm area of corneal melting at the corneal tunnel with diffuse corneal oedema. After 1 month, a temporal circular corneal patch graft was applied to the corneal burn. A penetrating keratoplasty was performed 16 months after the first surgery. Conclusion Corneal surgery, including lamellar patch grafts and full-thickness penetrating grafts, could be used, when necessary, to restore the cornea's integrity. These procedures could eliminate corneal scarring, decrease astigmatism, and improve vision in patients with phacoemulsification burns.
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Affiliation(s)
- Rosa Giglio
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Alex Lucia Vinciguerra
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Leandro Inferrera
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Daniele Tognetto
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
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Ungricht EL, Harris JT, Jensen NR, Barlow WR, Murri MS, Olson RJ, Pettey JH. Effect of low and passive flow on OVD thermal properties during phacoemulsification. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023; 58:507-512. [PMID: 35868436 DOI: 10.1016/j.jcjo.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 06/03/2022] [Accepted: 06/23/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To study the thermal properties and response magnitude of a forced-infusion phacoemulsification machine on 4 ophthalmic viscosurgical devices (OVDs). DESIGN Experimental study. METHODS A phacoemulsification tip, thermocouple, and gauge were placed into an artificial anterior chamber with balanced saline solution (BSS) or approximately 0.1 mL of OVD. Once the thermocouple measured a consistent temperature, the pedal was engaged for 60 seconds; then the tip was removed. The machine was cooled for 5 minutes and flushed with BSS to return to baseline. This was repeated 10 times for each OVD. The research consisted of 2 scenarios: vacuum-blocked flow rate and low aspiration flow rate. RESULTS All OVDs showed greater temperature changes than BSS. In the vacuum-blocked scenario, these increases were statistically significant. The medium viscosity dispersive OVD (DiscoVisc) reached temperatures exceeding 60°C. In the low-flow scenario, HEALON5 and DisCoVisc were significantly different at 5 seconds and only HEALON5 at 10 seconds. No temperature increases over BSS were greater than 1.0°C. CONCLUSIONS The dispersive, cohesive, and viscoadaptive OVDs demonstrated higher temperature changes than BSS but did not reach the threshold for corneal incision contracture. The study team verified the need for at least a minimal flow rate before ultrasound, which is especially evident in the first 10 seconds, because a flow rate of only 20 mL/minute mitigated OVD-related thermal effects. Understanding thermal responses enables corneal incision contracture risk reduction.
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Affiliation(s)
- Emilie L Ungricht
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT; University of Utah School of Medicine, Salt Lake City, UT
| | - Jacob T Harris
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT; University of Utah School of Medicine, Salt Lake City, UT
| | - Nathan R Jensen
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT; University of Utah School of Medicine, Salt Lake City, UT
| | - William R Barlow
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT
| | - Michael S Murri
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT
| | - Randall J Olson
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT
| | - Jeff H Pettey
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT.
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Zacharias J. In vitro analysis of clinically relevant aspects of a polymer-coated phacoemulsification tip vs a traditional tip. J Cataract Refract Surg 2023; 49:1264-1269. [PMID: 37464557 PMCID: PMC10664810 DOI: 10.1097/j.jcrs.0000000000001267] [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: 08/23/2022] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE To compare the in vitro incisional temperature, acoustic energy, transient cavitation, and turbulence of the polymer-coated hybrid phacoemulsification tip with the balanced tip. SETTING Pasteur Ophthalmology Clinic, Vitacura, Santiago, Chile. DESIGN Laboratory study. METHODS The Centurion Vision System with Active Sentry handpiece was used with tips operated in torsional mode, and stroke was normalized. For thermal measurements, controlled loads were applied over the tip sleeve simulating the pressure applied at the expected level of the corneal incision. Heat generated was recorded on a blackbody filmstrip using infrared imaging. A directional hydrophone provided 360° mapping of acoustic pressure. Cavitation patterns with increasing ultrasound power were imaged with high-speed video recording. Particle image velocimetry was used to evaluate turbulence, streaming, and bubble formation. RESULTS The temperature rise for the hybrid and balanced tips was lower than with the control mini-flared Kelman tip ( P ≤ .0001). The hybrid tip generated reduced acoustic output compared with the balanced tip. Ultrasound threshold for cavitation was higher for the hybrid vs balanced tip (55% vs 25%). Fluid turbulence was more evident with the balanced tip compared with the hybrid tip at all flow conditions when normalized for stroke at 60% and 80% power for balanced and hybrid tip, respectively. CONCLUSIONS The polymer-coated hybrid tip showed reduced heat generation compared with the control mini-flared Kelman tip and had lower acoustic output, lower cavitation, and lower turbulence compared with the balanced tip, suggesting potential for improved clinical safety.
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Affiliation(s)
- Jaime Zacharias
- From the Pasteur Ophthalmology Clinic, Vitacura, Santiago, Chile
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Evaluation of the Corneal Endothelium Following Cataract Surgery in Diabetic and Non-Diabetic Patients. Diagnostics (Basel) 2023; 13:diagnostics13061115. [PMID: 36980422 PMCID: PMC10047116 DOI: 10.3390/diagnostics13061115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 03/17/2023] Open
Abstract
The aim of this study was to evaluate the influence of phacoemulsification cataract surgery on the state of the corneal endothelium in diabetic versus non-diabetic patients. We compared the corneal cell morphology in 48 diabetics with good glycemic control and 72 non-diabetic patients before and after uneventful phacoemulsification. Corneal cell density, central corneal thickness, and hexagonality were measured preoperatively and post-surgery (at 1 and 4 weeks) by specular microscopy. The effect of age, gender, axial length, and anterior chamber depth on the parameters of the corneal endothelium were evaluated. We noticed a drop in the endothelial density in both groups postoperatively: a mean endothelial cell loss of 472.7 ± 369.1 in the diabetic group was recorded versus 165.7 ± 214.6 mean loss in the non-diabetic group after the first week. A significant increase in central corneal thickness was also noticed in both groups one week after phacoemulsification, but no statistical significance after 4 weeks in the diabetic group. In terms of cell hexagonality, statistically significant differences were noticed after 4 weeks in both groups. Overall, a significant difference between diabetic and non-diabetic population was noticed in terms of corneal endothelial cell loss after uneventful phacoemulsification cataract surgery. Routine specular microscopy and HbA1c evaluation is recommended before cataract surgery, while intraoperative precautions and high monitorisation in terms of pacho power intensity and ultrasound energy, along with a proper application of the dispersive viscoelastic substances are essential to reduce the risk of endothelial damage.
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Ashena Z, Holmes C, Nanavaty MA. Pericardium Patch Graft for Severe Corneal Wound Burn. J Curr Ophthalmol 2021; 33:342-344. [PMID: 34765825 PMCID: PMC8579793 DOI: 10.4103/joco.joco_195_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose: To report a novel management technique using pericardial patch graft for severe corneal wound burn following phacoemulsification of dense cataract with shallow anterior chamber (AC) and overfilled AC with viscoelastic. Methods: Case report. Results: A 46-year-old patient with a shallow AC and dense cataract, who underwent phacoemulsification using “soft shell” technique had severe wound burn which was refractory to conventional management with corneal suturing and placing bandage contact lens. He underwent Tutoplast® (Innovative Ophthalmic Products, Inc., Costa Mesa, CA, USA) pericardium patch graft, which fully resorbed and resolved the wound leak over 6 weeks, leaving a well-healed corneal wound. Conclusion: Pericardium patch graft is a safe and effective technique to manage extensive phaco wound burn which is refractory to conventional management options.
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Affiliation(s)
- Zahra Ashena
- Sussex Eye Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | | | - Mayank Ambarish Nanavaty
- Sussex Eye Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom.,Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
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Abstract
This 75-year-old woman had phacomorphic angle closure, dense nuclear sclerosis, deep set eye, miotic pupil and tight corneal wound during phacoemulsification. Phacoemulsification wound burn was noted at the end of surgery. Tenon was harvested from the inferior conjunctiva, placed over the gape and anchored by two radial corneoscleral 10-0 nylon. Ten days later, anterior optical coherence tomography showed good wound apposition and sutures were removed with visual recovery to 20/25 (6/7.5) without astigmatism.
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Affiliation(s)
- Hana A Mansour
- Ophthalmology, American University of Beirut Faculty of Medicine, Beirut, Lebanon
| | - Ahmad M Mansour
- Ophthalmology, American University of Beirut Faculty of Medicine, Beirut, Lebanon
- Ophthalmology, Rafic Hariri University Hospital, Lebanon
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Kabbara SW, Heczko J, Ta B, Bernhisel A, Barlow W, Zaugg B, Olson RJ, Pettey J. Determining optimal ultrasound percent on time with long-pulse torsional phacoemulsification. Can J Ophthalmol 2019; 54:395-398. [PMID: 31109482 DOI: 10.1016/j.jcjo.2018.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 07/06/2018] [Accepted: 07/13/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the optimum percent on time for the most efficient lens fragment removal using long-pulse torsional ultrasound (US). DESIGN In vitro laboratory study. METHODS Porcine lens nuclei were incubated in formalin for 2 hours and then cut into 2 mm cubes. Phacoemulsification was performed using the Centurion® Vision System and Infiniti OZil handpiece with the balanced tip. Vacuum was set at 500 mm Hg, aspiration rate at 50 mL/min, and intraocular pressure (IOP) at 50 mm Hg. Pulse rate was 26 pulses/second. Studied parameters were percent power: 60%, 80%, and 100%, and percent on times: 50%, 60%, 70%, and 80%. Efficiency was the total time for a cube to be emulsified. Chatter was the number of times the lens fragment bounced off the tip. RESULTS There was no significant difference in efficiency between 50%, 60%, and 70 % on-time settings (p = 0.17 and 0.08, respectively); however, there was significant increase in efficiency when the on time was increased from 70% to 80% (p = 0.03). Increasing power from 60% to 100% showed a statistically significant efficiency increase (p = 0.001). There was no significant change in chatter with increasing on time; however, there was a statistically significant increase in chatter with every power level increase. CONCLUSION Increasing on-time percent does not improve efficiency under torsional long-pulse US. There is no significant change in chatter with increasing on-time percent. Increasing power increases efficiency despite chatter increase. Long-pulse US does not appear to influence torsional action in a clinically meaningful way.
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Affiliation(s)
| | - Joshua Heczko
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT
| | - Brian Ta
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT
| | - Ashlie Bernhisel
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT
| | - William Barlow
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT
| | - Brian Zaugg
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT
| | - Randall J Olson
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT
| | - Jeff Pettey
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT..
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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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Nair S, Nair RU. Wound and surface temperatures in vivo in torsional and longitudinal modalities of ultrasound in coaxial microincisional cataract surgery. Clin Ophthalmol 2017; 11:249-255. [PMID: 28184151 PMCID: PMC5291324 DOI: 10.2147/opth.s123222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND To study phacoemulsification probe shaft/wound and corneal surface/tip temperatures in vivo during longitudinal, torsional and combined phacoemulsification modes and their relationship to machine parameters. DESIGN This was a prospective study at Chaithanya Eye Hospital and Research Institute, Trivandrum, India (tertiary). PARTICIPANTS Twenty-two eyes of 22 patients were randomized into six groups depending on the grade of nuclear sclerosis (NS) and the type of ultrasound used: Group 1, torsional in NS2; Group 2, torsional in NS3; Group 3, torsional with intermittent longitudinal in NS2; Group 4, torsional with intermittent longitudinal in NS3; Group 5, longitudinal in NS2; Group 6, longitudinal in NS3. METHODS Patients underwent phacoemulsification by torsional, longitudinal or combined modalities. A thermal camera was used to measure phaco probe temperatures. MAIN OUTCOME MEASURES The mean probe shaft and tip temperatures were documented for different ultrasound modalities. RESULTS The mean shaft and tip temperatures were: Group 1, 29.22°C±0.71°C and 28.4°C±0.88°C; Group 2, 32.12°C±0.62°C and 31.88°C±0.84°C; Group 3, 30.25°C±0.71°C and 29.35°C±0.62°C; Group 4, 31.95°C±0.65°C and 32.01°C±1.31°C; Group 5, 23°C and 27.6°C and Group 6, 23°C and 29.68°C, respectively. In all groups using longitudinal ultrasound, the phaco tip surface temperatures were higher than the shaft temperatures, except in Group 3. Shaft temperatures were higher than tip temperatures in cases using torsional phaco, except in Group 4. The mean temperature difference between groups was significant only for shaft temperatures (P=0.001). On thermal imaging, for torsional phaco, the rise in temperature of the probe from shaft to tip was dependent on the amplitude of ultrasound applied (P=0.009). CONCLUSION The shaft temperatures were higher than over the phaco tip during torsional phacoemulsification.
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Affiliation(s)
- Swapna Nair
- Department of Cataract and Refractive Surgery
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Henriksen BS, Gardiner G, Garff K, Gupta I, Stagg BC, Zaugg B, Pettey JH, Barlow WR, Olson RJ. Thermal evaluation of two phacoemulsification systems. Can J Ophthalmol 2016; 51:14-8. [PMID: 26874153 DOI: 10.1016/j.jcjo.2015.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/09/2015] [Accepted: 10/28/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To compare thermal profiles of new transversal ultrasound power modulation to torsional ultrasound in an artificial chamber and cadaver eye. DESIGN Laboratory investigation. METHODS John A. Moran Eye Center Laboratories, University of Utah, Salt Lake City, Utah, was the study setting. Temperature increase after 30 seconds was measured at the needle midshaft in an artificial chamber and at maximal friction point in a cadaver eye. Ellips FX (transverse) was tested at 100% power, as was Signature with micropulse settings (6 milliseconds on and off). OZil (torsional only) was tested at 100% power in the artificial chamber and cadaver eye. Runs were completed with aspiration blocked. Temperature was continuously measured on the phacoemulsification sleeve using a microthermistor probe connected to the BAT-10 multipurpose thermometer, with an accuracy of ±0.1°C. RESULTS Transversal FX had a greater temperature increase than micropulse (p < 0.001) and torsional (p < 0.001). Micropulse had a greater temperature increase than torsional (p < 0.001). The cadaver eye had a greater temperature increase than the artificial chamber for torsional (p < 0.001). CONCLUSIONS Higher heat accumulation and potential for incisional burn occurred with the cadaver model than with the artificial chamber, suggesting the need for caution when using 100% torsional ultrasound with aspiration blocked. Transversal FX generated more heat than was reported originally. Further study is needed to determine the incidence of incisional burn with varied power settings for this new model. Micropulse generated more heat than previous reports, but the increased efficiency is likely to negate potentially increased incisional burn risk.
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Affiliation(s)
- Bradley S Henriksen
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Gareth Gardiner
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Kevin Garff
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Isha Gupta
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Brian C Stagg
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Brian Zaugg
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Jeff H Pettey
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - William R Barlow
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Randall J Olson
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah.
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13
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Gardiner GL, Garff K, Gupta I, Kramer GD, Farukhi MA, Stagg BC, Zaugg B, Olson RJ. Effect of pulsing ultrasound on phacoemulsification efficiency. J Cataract Refract Surg 2015; 41:2560-4. [PMID: 26703507 DOI: 10.1016/j.jcrs.2015.06.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 06/02/2015] [Accepted: 06/08/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate pulse type technology used to remove lens fragments during phacoemulsification. SETTING John A. Moran Eye Center Laboratories, University of Utah, Salt Lake City, Utah, USA. DESIGN Experimental study. METHODS Lens nuclei soaked in 10 mL of 10% neutral buffered formalin for 2 hours were placed in 10 mL of balanced salt solution. Lenses were cut into 2 mm × 2 mm cubes; no more than 36 hours later, cubes were randomly selected for testing. Two aspiration and 2 vacuum settings were assessed at moderate- and high-flow and vacuum (30 mL/min and 300 mm/Hg, low-flow vacuum; 50 mL/min and 500 mm/Hg, high-flow vacuum), with continuous 50 milliseconds on and off (long pulse) and 6 milliseconds on and off (micropulse) ultrasound. RESULTS There was a significant difference in efficiency favoring micropulse compared with combined long pulse and continuous pulse in high-flow vacuum at 80% power (P = .018) and between combined long pulse and continuous pulse versus micropulse in high-flow vacuum at 20% power (P = .019). Low-flow vacuum micropulse was more efficient than continuous (19.7%) (P < .0001) and long pulse (22.7%) (P < .0001). Continuous and long pulses were not significantly different from one other. There was a significant difference in chatter rates between high-flow vacuum and low-flow vacuum when all results were compared (P < .0001), with no additional significant differences found. CONCLUSION Micropulse technology was better than continuous and long pulse at moderate but not high-flow and vacuum settings. At the higher setting, chatter was observed less often, with all modalities more efficient than the lower setting.
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Affiliation(s)
- Gareth L Gardiner
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Kevin Garff
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Isha Gupta
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Gregory D Kramer
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - M Aabid Farukhi
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Brian C Stagg
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Brian Zaugg
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Randall J Olson
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.
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Haldar K, Saraff R. Closure technique for leaking wound resulting from thermal injury during phacoemulsification. J Cataract Refract Surg 2015; 40:1412-4. [PMID: 25135531 DOI: 10.1016/j.jcrs.2014.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 02/16/2014] [Accepted: 02/19/2014] [Indexed: 10/24/2022]
Abstract
UNLABELLED We describe a method of wound closure with a conjunctival flap in cases of wound burn. A fornix-based conjunctival flap is raised to adequately cover the wound. Then, a single horizontal mattress suture with 10-0 monofilament nylon is passed to appose the wound. The conjunctival flap is hinged to the corneal end of the loop so the conjunctival flap covers the wound when the suture is tied. The wound is thus sealed by conjunctiva with optimum suture tension. This suture was applied in 5 patients with clear corneal incisions who developed wound burn during phacoemulsification. All had an uneventful recovery with a sealed wound from the first postoperative day and satisfactory visual outcomes with low residual astigmatism at the final refraction. FINANCIAL DISCLOSURE Neither author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Keshab Haldar
- From the Rotary Narayana Nethralaya, Kolkata, India.
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Robinson MS, Olson RJ. Simple approach to prevent capsule tear-out during capsulorhexis creation in hypermature cataracts. J Cataract Refract Surg 2015; 41:1353-5. [DOI: 10.1016/j.jcrs.2015.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 03/16/2015] [Accepted: 03/18/2015] [Indexed: 10/23/2022]
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Jensen JD, Kirk KR, Gupta I, Ronquillo C, Farukhi MA, Stagg BC, Pettey JH, Olson RJ. Determining optimal ultrasound off time with micropulse longitudinal phacoemulsification. J Cataract Refract Surg 2015; 41:433-6. [PMID: 25661139 DOI: 10.1016/j.jcrs.2014.12.033] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 07/24/2014] [Accepted: 07/30/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate the optimum off time for the most efficient removal of lens fragments using micropulse ultrasound (US). SETTING John A. Moran Eye Center Laboratories, University of Utah, Salt Lake City, Utah, USA. DESIGN Experimental study. METHODS Porcine lens nuclei were soaked in formalin for 2 hours and then cut into 2.0 mm cubes using the Signature US machine with a bent 0.9 mm phaco tip with a 30-degree bevel. The on time was 7 milliseconds (ms), and the off time was varied from 2 to 20 ms in 2 ms steps. Phacoemulsification efficiency (time for fragment removal) and chatter (number of times the fragment bounced from the tip) were measured. RESULTS A nonsignificant linear increase in efficiency was observed with 2 to 6 ms of off time (R(2) = .87, P = .24). A significant linear decrease in efficiency was observed with 6 to 20 ms (R(2) = .74, P = .006). CONCLUSIONS With micropulse longitudinal US, 6 to 7 ms of off time was as efficient as shorter off times; longer off times (8 to 20 ms) showed decreased efficiency. Chatter was minimal and statistically similar throughout. To maximize phacoemulsification US efficiency, an off-time setting of 6 ms is recommended. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Jason D Jensen
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Kevin R Kirk
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Isha Gupta
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Cecinio Ronquillo
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - M Aabid Farukhi
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Brian C Stagg
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Jeff H Pettey
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Randall J Olson
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.
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Zacharias J. Thermal characterization of phacoemulsification probes operated in axial and torsional modes. J Cataract Refract Surg 2015; 41:208-16. [DOI: 10.1016/j.jcrs.2014.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 06/24/2014] [Accepted: 06/25/2014] [Indexed: 11/26/2022]
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Kirk KR, Ronquillo C, Jensen JD, Zaugg B, Barlow WR, Stagg BC, Pettey JH, Olson RJ. Optimum on-time duty cycle for micropulse technology. J Cataract Refract Surg 2014; 40:1545-8. [PMID: 25135547 DOI: 10.1016/j.jcrs.2014.02.033] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 02/14/2014] [Accepted: 02/17/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the optimum on time for the most efficient removal of lens fragments using micropulsed ultrasound (US). SETTING John A. Moran Eye Center Laboratories, University of Utah, Salt Lake City, Utah, USA. DESIGN Experimental study. METHODS Twenty porcine lens nuclei were soaked in formalin for 2 hours and then divided into 2.0 mm cubes. Using an US machine with a 0.9 mm bent and a 30-degree bevel tip, the on time was varied every millisecond (ms) from 2 ms to 10 ms with the off time kept constant at 10 ms. Efficiency (time to lens removal) and chatter (number of lens fragment repulsions from the tip) were determined. RESULTS The most efficient phacoemulsification was achieved with an on time of 6 ms. On times shorter than 6 ms were significantly less efficient (R2=.82, P=.04). Greater on times did not result in a significant difference in efficiency (R2=.03, P=.78) but did appear to have more chatter events when comparing 9 to 10 ms with 2 to 8 ms (P<.0001). CONCLUSIONS With micropulsed longitudinal US, a 6 ms on time was equally as efficient as longer on times, while shorter on times (2 to 5 ms) had decreased efficiency. At 9 ms and 10 ms on time, significantly more chatter was noted. Therefore, to maximize phacoemulsification, an on-time setting of 6 ms is recommended. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Kevin R Kirk
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Cecinio Ronquillo
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Jason D Jensen
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Brian Zaugg
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - William R Barlow
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Brian C Stagg
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Jeff H Pettey
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Randall J Olson
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.
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Helvacioglu F, Sencan S, Yeter C, Tunc Z, Uyar MO. Outcomes of torsional microcoaxial phacoemulsification using tips with 30-degree and 45-degree aperture angles. J Cataract Refract Surg 2014; 40:362-8. [DOI: 10.1016/j.jcrs.2013.07.051] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Revised: 07/29/2013] [Accepted: 07/30/2013] [Indexed: 10/25/2022]
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Barlow WR, Pettey J, Olson RJ. The Ultrachopper tip: a wound temperature study. Can J Ophthalmol 2013; 48:512-5. [PMID: 24314413 DOI: 10.1016/j.jcjo.2013.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 05/02/2013] [Accepted: 05/17/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE To determine the thermal characteristics of the Ultrachopper and its thermal properties in varied viscosurgical substances. DESIGN Experimental study. PARTICIPANTS Not applicable. METHODS The Ultrachopper (Alcon, Inc) tip with the Infiniti (Alcon, Inc) handpiece was attached to a thermistor and placed in a test chamber filled with either an ophthalmic viscosurgical device (OVD) or balanced salt solution (BSS). The thermistor allowed for continuous monitoring of temperature from baseline and the change that occurred over 60 seconds of continuous run time. RESULTS Mean maximum temperature in each OVD exceeded 50°C over the first 25 seconds of continuous run time. The mean maximum temperature was statistically significantly higher with all OVDs (p < 0.0001) when compared with BSS. A small but statistically significant difference in mean maximum temperature was shown between Healon 5 (AMO, Inc) and Viscoat (Alcon, Inc) (p < 0.05). The linear increase in temperature was statistically significantly different with all OVDs compared with BSS (p < 0.0001). CONCLUSIONS The thermal properties of the Ultrachopper tip demonstrate a heat-generating capacity that achieves published thresholds for risk for wound burn.
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Affiliation(s)
- William R Barlow
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah.
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A comparison of cataract surgical practices in Canada and the United States. Can J Ophthalmol 2012; 47:131-9. [DOI: 10.1016/j.jcjo.2012.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 10/23/2011] [Accepted: 11/02/2011] [Indexed: 11/23/2022]
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