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Lundberg B. Corneal endothelial changes seven years after phacoemulsification cataract surgery. Int Ophthalmol 2024; 44:169. [PMID: 38587565 PMCID: PMC11001711 DOI: 10.1007/s10792-024-03044-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/18/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE To evaluate long-term postoperative corneal changes after phacoemulsification cataract surgery. METHODS Twenty patients who participated in a previous study regarding corneal endothelial changes after phacoemulsification cataract surgery were examined after 7 years. The patients were divided in three groups based on their initial increase in central corneal thickness day one after the surgery: < 5% increase, 6-20% increase and ≥ 20% increase. The primary outcome measures were corneal endothelial cell loss (ECL), endothelial cell count (ECC) and endothelial morphology. RESULTS After 7 years, a difference in cell loss between the groups was observed, except for groups 1 and 2. Endothelial cell count (ECC) differed significantly between groups 1 and 3 at 3 months. At 7 years, there was no difference in ECC between the three groups. Cell loss was found exclusively in group 1 between 3 months and 7 years. Endothelial cell morphology showed a converging pattern between 3 months and 7 years. CONCLUSION After phacoemulsification cataract surgery, long-term ECC and morphology appear to converge towards a comparable steady state regardless of initial corneal swelling and endothelial cell loss.
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Affiliation(s)
- Björn Lundberg
- Department of Clinical Science/Ophthalmology, Umeå University, 901 85, Umeå, Sweden.
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Jaiswal K, Rathi R, Jain A, Gaur A, Nema N. Visual Outcome and Complications in White Mature Cataracts after Phacoemulsification. Middle East Afr J Ophthalmol 2023; 30:129-135. [PMID: 39444991 PMCID: PMC11495291 DOI: 10.4103/meajo.meajo_100_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 05/15/2024] [Accepted: 05/17/2024] [Indexed: 10/25/2024] Open
Abstract
PURPOSE To identify risk factors and perioperative complications and assess postoperative visual outcome in patients of white mature cataracts undergoing phacoemulsification surgery. METHODS This cross-sectional study was conducted on 46 patients of white mature cataract undergoing phacoemulsification. Preoperatively, a detailed ocular examination was done, and anterior chamber depth (ACD) and lens thickness (LT) were measured on ultrasound biomicroscopy. Intraoperative and postoperative complications (on days 1, 7, and 30) and best-corrected visual acuity on postoperative day 30 were noted. RESULTS The mean age of patients was 60.78 ± 9.001 years. The study group consisted of 41.3% of males and 58.7% of females. 8 (19.56%) cases encountered complications during phacoemulsification surgery. The intraoperative complications were capsulorhexis-related in 5 (10.86%) patients, posterior capsular rent in 2 (4.3%) patients, and 1 (2.17%) case had zonular dialysis. There was no difference in mean ACD and LT in cases who developed complications and those who underwent uneventful surgery (P > 0.05). The commonly observed postoperative complications on day 1 were corneal edema (41.3%), anterior chamber flare (45.65%), and cells (39.13%) which resolved with routine topical medications. All patients showed a significant reduction in postoperative intraocular pressure (P < 0.001). A total of 37 (80.43%) eyes regained vision between 6/6 and 6/9 postoperatively (P < 0.001). CONCLUSION Phacoemulsification surgery is safe in white mature cataract that results in significant visual improvement. Common intraoperative complications are capsule related, while frequently encountered postoperative complications are corneal edema and anterior chamber reaction. Preoperative ACD and LT have no role in predicting intraoperative complications.
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Affiliation(s)
- Komal Jaiswal
- Department of Ophthalmology, Sri Aurobindo Medical College and Post Graduate Institute, Indore, Madhya Pradesh, India
| | - Rishabh Rathi
- Department of Ophthalmology, Sri Aurobindo Medical College and Post Graduate Institute, Indore, Madhya Pradesh, India
| | - Amisha Jain
- Department of Ophthalmology, Sri Aurobindo Medical College and Post Graduate Institute, Indore, Madhya Pradesh, India
| | - Ashish Gaur
- Department of Preventive and Social Medicine, Sri Aurobindo Medical College and Post Graduate Institute, Indore, Madhya Pradesh, India
| | - Nitin Nema
- Department of Ophthalmology, Sri Aurobindo Medical College and Post Graduate Institute, Indore, Madhya Pradesh, India
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Evaluation of Ocular Biometric Parameters Following Cataract Surgery. REPORTS 2023. [DOI: 10.3390/reports6010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: The aim of this study was to highlight the structural changes in patients with cataract following surgery and the repercussions on the anterior pole. Methods: A total of 83 patients diagnosed with cataract who underwent uneventful phacoemulsification was included. Every patient was examined one week prior to and two weeks after the surgery. Pre- and postoperative assessment included examination of the anterior and posterior segment, keratometry, and optical biometry. Results: The pre- vs. postoperative axial length (AL) mean difference was 0.07 ± 0.18 mm (p < 0.001).The mean difference of the postoperative anterior chamber depth (ACD) vs. preoperative ACD values (1.11 ± 0.50 mm) was also statistically significant (p < 0.001). The linear regression function postoperative central corneal thickness (CCT) = 0.9004 × (preoperative CCT) + 0.0668, where it characterized a reduced positive correlation (R2) of 68.89% between the postoperative CCT and preoperative CCT. The mean pre-/post-operative differences in the K1 values were 0.08 ± 0.38 D, with a statistically significant difference between the two datasets (p = 0.0152). The mean pre/postoperative difference in the K2 values was 0.002 ± 0.58 D (p = 0.4854). Conclusions: ACD deepened significantly postoperatively. Regarding AL, there was a decrease after surgery, and a very good positive correlation between the post and preoperative values. The CCT values decreased with age. The 2.2-mm corneal incision during cataract surgery resulted in a relatively small postoperative residual astigmatism.
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Lee D, Agron E, Keenan T, Lovato J, Ambrosius W, Chew EY. Visual acuity outcomes after cataract surgery in type 2 diabetes: the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study. Br J Ophthalmol 2022; 106:1496-1502. [PMID: 34625432 PMCID: PMC8683570 DOI: 10.1136/bjophthalmol-2020-317793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 05/23/2021] [Indexed: 11/04/2022]
Abstract
AIMS To evaluate visual acuity (VA) outcomes of cataract surgery, and factors associated with good visual outcomes, among a population with diabetes. METHODS Participants with type 2 diabetes enrolled in The Action to Control Cardiovascular Risk in Diabetes (ACCORD) study and ACCORD-eye substudy. 1136 eyes of 784 ACCORD participants receiving cataract surgery during follow-up (2001-2014) were included. Of these, 362 eyes had fundus photographs gradable for diabetic retinopathy. The main outcome measure was the achievement of postoperative VA of 20/40 or better. RESULTS In the sample of 1136 eyes, 762 eyes (67.1%) achieved good visual outcome of 20/40 or better. Factors predictive of good visual outcome were higher level of educational attainment (college vs some high school, OR 2.35 (95% CI 1.44 to 3.82)), bilateral cataract surgery (OR 1.55 (1.14 to 2.10)) and preoperative VA (20/20 or better vs worse than 20/200, OR 10.59 (4.07 to 27.54)). Factors not significantly associated (p>0.05) included age, sex, race, smoking, diabetes duration, blood pressure, lipid levels and haemoglobin A1C (HbA1C). In the subsample of 362 eyes, absence of diabetic retinopathy was associated with good visual outcome (OR 1.73 (1.02 to 2.94)). CONCLUSION Among individuals with diabetes, two-thirds of eyes achieved good visual outcome after cataract surgery. Notable factors associated with visual outcome included preoperative VA and diabetic retinopathy, but not HbA1C, underscoring that while certain ocular measures may help evaluate visual potential, systemic parameters may not be as valuable. Sociodemographic factors might also be important considerations. Although the current visual prognosis after cataract surgery is usually favourable, certain factors still limit the visual potential in those with diabetes.
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Affiliation(s)
- Debora Lee
- Division of Epidemiology and Clinical Applications, National Eye Institute, Bethesda, Maryland, USA
| | - Elvira Agron
- Division of Epidemiology and Clinical Applications, National Eye Institute, Bethesda, Maryland, USA
| | - Tiarnan Keenan
- Division of Epidemiology and Clinical Applications, National Eye Institute, Bethesda, Maryland, USA
| | - James Lovato
- Department of Statistics, Wake Forest University Division of Public Health Sciences, Winston-Salem, North Carolina, USA
| | - Walter Ambrosius
- Department of Statistics, Wake Forest University Division of Public Health Sciences, Winston-Salem, North Carolina, USA
| | - Emily Y Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, Bethesda, Maryland, USA
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Kim MS, Moon JH, Lee MW, Cho KH. Analysis of postoperative intraocular pathologies in patients with mature cataracts. PLoS One 2022; 17:e0263352. [PMID: 35100315 PMCID: PMC8803149 DOI: 10.1371/journal.pone.0263352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/16/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose To examine the prevalence and risk factors of intraocular pathologies after mature cataract surgery. Methods The medical records of 115 patients (115 eyes) diagnosed with brunescent or white cataracts, who underwent surgery at a single primary center between January 2018 and August 2021 were retrospectively reviewed. Dense cataracts precluded preoperative fundus examination in all eyes; however, patients with fundus examination results within 3 months after cataract surgery were included. Logistic regression analyses were performed to identify factors associated with intraocular pathologies. Results Intraocular pathologies were observed in 37 eyes (32.2%) 11.8 ± 13.9 days postoperatively. The most common abnormalities were drusen (6.1%), myopic degeneration (5.2%) and diabetic retinopathy (4.3%). Intraocular pathology in the fellow eye was associated with posterior segment pathology in mature cataract eyes (odds ratio, 47.72; P < 0.001). Conclusions The prevalence of each intraocular pathology found after mature cataract surgery was unremarkable. This study provides clinically useful evidence for clinicians to explain the risk of posterior segment pathology in patients with mature cataracts.
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Affiliation(s)
- Min Seok Kim
- Moon’s Eye Clinic, Suwon, Gyeonggi-do, South Korea
| | | | | | - Kwan Hyuk Cho
- Moon’s Eye Clinic, Suwon, Gyeonggi-do, South Korea
- * E-mail:
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Sarkar S, Bardoloi N. A new technique of phacoemulsification without hydroprocedures. KERALA JOURNAL OF OPHTHALMOLOGY 2021. [DOI: 10.4103/kjo.kjo_60_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Hook and flip technique: for phacoemulsification in non-rotating nuclei and posterior polar cataracts. Int Ophthalmol 2018; 39:1219-1223. [PMID: 29704132 DOI: 10.1007/s10792-018-0928-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 04/13/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE We put forward a physical levitation method to hook and flip the chopped nuclear fragments that could not be solely drawn by vacuum during phacoemulsification, due to various reasons such as a non-rotating nuclei or posterior polar cataracts where hydrodissection was unsuccessful or contra-indicated, respectively. METHOD A Sinskey hook is insinuated through the crack of the divided nuclei into a plane behind the nuclear pie to 'hook and flip' the chopped piece, heading it towards the phacoemulsification probe. This simple step disassembles the nuclear chunk, thereby creating space to facilitate the dismantling of the rest of the fragments. The remnant epinuclear cushion guards the posterior capsule, mitigating the chances of serious intra-operative complications. RESULT We have employed this technique in 17 eyes during similar situations. No specific intra-operative complications were observed; all surgeries were uneventful. A Sinskey hook utilised for this step ensures safety and familiarity, none encountered posterior capsular rent. This technique not only eases the surgery, but also decreases the anticipated intra-operative and post-operative complications. CONCLUSION 'Hook and flip technique' thus proves useful whenever dismantling difficulties are encountered during phacoemulsification.
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Ianchulev T, Chang DF, Koo E, MacDonald S, Calvo E, Tyson FT, Vasquez A, Ahmed IIK. Microinterventional endocapsular nucleus disassembly: novel technique and results of first-in-human randomised controlled study. Br J Ophthalmol 2018; 103:176-180. [PMID: 29669780 PMCID: PMC6362801 DOI: 10.1136/bjophthalmol-2017-311766] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 02/23/2018] [Accepted: 03/22/2018] [Indexed: 11/25/2022]
Abstract
Aim To assess the safety and efficacy of microinterventional endocapsular nuclear fragmentation in moderate to severe cataracts. Methods This was a prospective single-masked multisurgeon interventional randomised controlled trial (ClinicalTrials.gov NCT02843594) where 101 eyes of 101 subjects with grade 3‒4+ nuclear cataracts were randomised to torsional phacoemulsification alone (controls) or torsional phacoemulsification with adjunctive endocapsular nuclear fragmentation using a manual microinterventional nitinol filament loop device (miLOOP group). Outcome measures were phacoemulsification efficiency as measured by ultrasound energy (cumulative dispersed energy (CDE) units) and fluidics requirements (total irrigation fluid used) as well as incidence of intraoperative and postoperative complications. Results Only high-grade advanced cataracts were enrolled with more than 85% of eyes with baseline best corrected visual acuity (BCVA) of 20/200 or worse in either group. Mean CDE was 53% higher in controls (32.8±24.9 vs 21.4±13.1 with miLOOP assistance) (p=0.004). Endothelial cell loss after surgery was low and similar between groups (7‒8%, p=0.561) One-month BCVA averaged 20/27 Snellen in miLOOP eyes and 20/24 in controls. No direct complications were caused by the miLOOP. In two cases, capsular tears occurred during IOL implantation and in all remaining cases during phacoemulsification, with none occurring during the miLOOP nucleus disassembly part of the procedure. Conclusions Microinterventional endocapsular fragmentation with the manual, disposable miLOOP device achieved consistent, ultrasound-free, full-thickness nucleus disassembly and significantly improved overall phaco efficiency in advanced cataracts. Trial registration number NCT02843594
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Affiliation(s)
- Tsontcho Ianchulev
- New York Eye and Ear Infirmary, Icahn School of Medicine at Mount Sinai, New York, NY 1183, USA
| | - David F Chang
- Department of Ophthalmology, UCSF School of Medicine, San Francisco, California, USA
| | - Edward Koo
- Department of Ophthalmology, UCSF School of Medicine, San Francisco, California, USA
| | - Susan MacDonald
- Department of Ophthalmology, Tufts School of Medicine, Boston, Massachusetts, USA
| | | | | | | | - Iqbal Ike K Ahmed
- Department of Ophthalmology, University of Toronto, Toronto, Ontario, Canada.,Trillium Health Partners and Credit Valley Eye Care, Mississauga, Ontario, Canada
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Impact of Ophthalmic Surgeon Experience on Early Postoperative Central Corneal Thickness After Cataract Surgery. Cornea 2017; 36:541-545. [PMID: 28358768 DOI: 10.1097/ico.0000000000001175] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE To assess the impact of surgeon experience on early postoperative central corneal thickness (CCT) in eyes that have undergone phacoemulsification-based cataract surgery. METHODS One hundred sixty eyes underwent phacoemulsification-based cataract surgery performed by an experienced surgeon (n = 110; senior group) or a surgically less experienced ophthalmic assistant (n = 50; junior group), using the divide-and-conquer or tilt-and-tumble technique for cataractous lens extraction. The primary endpoint was postoperative corneal edema 2 hours after surgery, determined by pachymetry-based CCT. RESULTS Mean age of patients was 71.5 ± 9.1 years. Mean CCT at postoperative hour 2 was 622.8 ± 69.3 μm: an increase of 14.3% ± 10.8 from 545.3 ± 33.7 μm preoperatively (P = 0.0028). Mean CCT at postoperative hour 2 and postoperative corneal edema were significantly higher for the junior group than the senior group, with mean respective increases of 105.8 ± 81.4 μm (19.3% ± 14.2%) and 66.4 ± 3.7 μm (12.3% ± 8.3%), P = 0.0001. After adjustment for confounding factors, surgical experience was the only factor significantly associated with corneal edema: β = 39.58; SD = 11.05; P = 0.0005. Other intergroup differences observed included significantly longer mean operating and mean ultrasound times in the junior group than in the senior group. A final corneal suture was used more frequently in the senior than in the junior group, at rates of 32.7% and 2.0%, respectively, P < 0.0001. CONCLUSIONS Greater surgical experience was found to be associated with reduced early postoperative corneal edema, shorter operative time, and shorter ultrasound time. This suggests that beyond mastering the initial learning curve of phacoemulsification, surgical experience enables faster and safer surgery.
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Chang DF. Does femtosecond laser-assisted cataract surgery improve corneal endothelial safety? The debate and conundrum. J Cataract Refract Surg 2017; 43:440-442. [PMID: 28532925 DOI: 10.1016/j.jcrs.2017.04.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Choi H, Eom Y, Kang SY, Song JS, Kim HM. Incidence of Complications in Cataract Surgery according to the Availability of Partial Coherence Laser Interferometry. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2017. [DOI: 10.3341/jkos.2017.58.7.804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hannuy Choi
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Youngsub Eom
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Su-Yeon Kang
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Jong Suk Song
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Hyo Myung Kim
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
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Caglar C, Batur M, Eser E, Demir H, Yaşar T. The Stabilization Time of Ocular Measurements after Cataract Surgery. Semin Ophthalmol 2016; 32:412-417. [DOI: 10.3109/08820538.2015.1115089] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Cagatay Caglar
- Ophthalmology Department, Faculty of Medicine, Hitit University, Corum, Turkey
| | - Muhammed Batur
- Department of Ophthalmology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Eray Eser
- Ophthalmology Clinic, Canakkale State Hospital, Canakkale, Turkey
| | - Habip Demir
- Department of Ophthalmology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Tekin Yaşar
- Department of Ophthalmology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
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13
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Park H, Kim JS, Choi HS, Kim SJ, Park JS. Clinical Results after Phacoemulsification in Mature Cataract. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.6.891] [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)
- Hoon Park
- Department of Ophthalmology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Ju Sang Kim
- Department of Ophthalmology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Hwa Su Choi
- Department of Ophthalmology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Sung Jin Kim
- Department of Ophthalmology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Jong Seok Park
- Department of Ophthalmology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
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Femtosecond laser–assisted compared with standard cataract surgery for removal of advanced cataracts. J Cataract Refract Surg 2015; 41:1833-8. [DOI: 10.1016/j.jcrs.2015.10.040] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 12/18/2014] [Accepted: 01/23/2015] [Indexed: 11/17/2022]
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Lam D, Rao SK, Ratra V, Liu Y, Mitchell P, King J, Tassignon MJ, Jonas J, Pang CP, Chang DF. Cataract. Nat Rev Dis Primers 2015; 1:15014. [PMID: 27188414 DOI: 10.1038/nrdp.2015.14] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cataract is the leading cause of reversible blindness and visual impairment globally. Blindness from cataract is more common in populations with low socioeconomic status and in developing countries than in developed countries. The only treatment for cataract is surgery. Phacoemulsification is the gold standard for cataract surgery in the developed world, whereas manual small incision cataract surgery is used frequently in developing countries. In general, the outcomes of surgery are good and complications, such as endophthalmitis, often can be prevented or have good ouctomes if properly managed. Femtosecond laser-assisted cataract surgery, an advanced technology, can automate several steps; initial data show no superiority of this approach over current techniques, but the results of many large clinical trials are pending. The greatest challenge remains the growing 'backlog' of patients with cataract blindness in the developing world because of lack of access to affordable surgery. Efforts aimed at training additional cataract surgeons in these countries do not keep pace with the increasing demand associated with ageing population demographics. In the absence of strategie that can prevent or delay cataract formation, it is important to focus efforts and resources on developing models for efficient delivery of cataract surgical services in underserved regions. For an illustrated summary of this Primer, visit: http://go.nature.com/eQkKll.
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Affiliation(s)
- Dennis Lam
- State Key Laboratory of Ophthalmology, and Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou 510060, China.,C-MER (Shenzhen), Dennis Lam Eye Hospital, Shenzhen, China
| | | | - Vineet Ratra
- C-MER (Shenzhen), Dennis Lam Eye Hospital, Shenzhen, China
| | - Yizhi Liu
- State Key Laboratory of Ophthalmology, and Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou 510060, China
| | - Paul Mitchell
- Department of Ophthalmology, Centre for Vision Research, Westmead Hospital, University of Sydney, Sydney, Australia
| | - Jonathan King
- Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | | | - Jost Jonas
- Department of Ophthalmology, Ruprecht-Karls-University, Heidelberg, Germany
| | - Chi P Pang
- Department of Ophthalmology &Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - David F Chang
- Department of Ophthalmology, University of California, San Francisco, California, USA
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Moya Romero JO, Morfín Avilés L, Salazar López E. Cirugía manual de catarata con incisión pequeña bajo anestesia tópica/intracameral por residentes. REVISTA MEXICANA DE OFTALMOLOGÍA 2014. [DOI: 10.1016/j.mexoft.2014.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Retrochop technique for rock-hard cataracts. J Cataract Refract Surg 2013; 39:826-9. [PMID: 23688870 DOI: 10.1016/j.jcrs.2013.03.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 02/11/2013] [Accepted: 02/14/2013] [Indexed: 11/21/2022]
Abstract
UNLABELLED We describe a recently developed chopper, the retrochopper, and a technique for managing black and brunescent cataracts. The technique enables the surgeon to effectively disassemble the nucleus and perform a safe procedure with a short learning curve. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Aslan L, Aksoy A, Aslankurt M, Ozdemir M. Lens capsule-related problems in patients undergoing phacoemulsification surgery. Clin Ophthalmol 2013; 7:511-4. [PMID: 23507672 PMCID: PMC3597254 DOI: 10.2147/opth.s42758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This study aimed to compare lens capsule-related problems in mature versus non-mature senile cataracts in patients undergoing phacoemulsification surgery. METHODS A total of 295 patients with senile cataract were divided into two groups according to lens maturation: 105 patients with mature senile cataract comprised Group 1 (study group) and the remaining 190 with non-mature senile cataract comprised Group 2 (control group). Prior to surgery, ophthalmological examination was undertaken. Patients' best-corrected visual acuity and intraocular pressure were measured and a slit-lamp examination and funduscopy performed. All examination data were recorded and any capsule-related problems during surgery were also recorded. Patient files were reviewed retrospectively and compared between groups. Fisher's exact test was used in the statistical analysis. RESULTS In Group 1, the capsule-related problems found were: inability to complete capsulorhexis (seven eyes [6.6%]), posterior capsular perforation (three eyes [2.8%]), and conversion to extracapsular surgery (one eye [0.9%]). A posterior capsular perforation was seen in one eye (1%) in the control group. An intraocular lens was inserted into the sulcus in six eyes (5.7%) and one anterior chamber (0.9%) in Group 1 and into the sulcus in one eye (0.5%) of Group 2. The lens was inserted into the capsular bag in all other patients. CONCLUSION Delaying surgery in patients with cataracts creates a high risk for capsule-related surgical complications. Although capsule dyes make capsulorhexis easier, capsulorhexis is the most problematic phase of phacoemulsification in mature cataracts.
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Affiliation(s)
- Lokman Aslan
- Ophthalmology Department, Faculty of Medicine, Kahramanmaraş Sutcu Imam University, Kahramanmaraş, Turkey
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Srivastava S, Vasavada AR, Vasavada VA, Vasavada VA. Real-time intraoperative high-speed imaging during phacoemulsification. J Cataract Refract Surg 2012; 38:1519-25. [PMID: 22841426 DOI: 10.1016/j.jcrs.2012.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Revised: 03/24/2012] [Accepted: 03/28/2012] [Indexed: 10/28/2022]
Abstract
We describe the use of high-speed imaging during phacoemulsification in a clinical scenario. Images captured during surgery at high frame rates are converted into a slow-motion film to view and analyze various surgical steps. This technique highlights events that are not captured in a normal-speed video recording. It has obvious applications for understanding surgical techniques and technology.
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Vasavada AR, Raj SM. Multilevel chop technique. J Cataract Refract Surg 2011; 37:2092-4. [DOI: 10.1016/j.jcrs.2011.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 07/27/2011] [Accepted: 07/29/2011] [Indexed: 10/15/2022]
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Wilczynski M, Supady E, Loba P, Synder A, Omulecki W. Results of coaxial phacoemulsification through a 1.8-mm microincision in hard cataracts. Ophthalmic Surg Lasers Imaging Retina 2011; 42:125-31. [PMID: 21210578 DOI: 10.3928/15428877-20101223-04] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2010] [Accepted: 10/28/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To assess the results of coaxial phacoemulsification through 1.8-mm coaxial microincision cataract surgery (C-MICS) phacoemulsification with foldable intraocular lens implantation in eyes with hard cataracts in comparison to eyes with soft cataracts. PATIENTS AND METHODS Group 1 consisted of 40 eyes of 40 patients with hard cataracts (grade ≥ 4, Lens Opacities Classification System III scale) and group 2 consisted of 45 eyes of 45 patients with non-mature cataracts (grade ≤ 2, Lens Opacities Classification System III scale). All surgeries were performed by two experienced surgeons under topical and intracameral anesthesia. Examinations were performed preoperatively and 1 month after the surgery. Examined parameters included distance-corrected visual acuity (DCVA), autorefractometry, keratometry, tonometry, endothelial cell counts, and biomicroscopy of the anterior and posterior segment. Surgically induced astigmatism was calculated with vector analysis. RESULTS Mean DCVA was 0.16 ± 0.16 preoperatively and 0.92 ± 0.21 postoperatively in group 1 (P < .05) and 0.62 ± 0.18 preoperatively and 0.97 ± 0.08 postoperatively in group 2 (P < .05). Mean surgically induced astigmatism was 0.48 ± 0.44 in group 1 and 0.53 ± 0.38 in group 2 (P > .05). Mean endothelial cell loss was 11.37% ± 12.87% in group 1 and 2.87% ± 9.66% in group 2 (P < .05). CONCLUSION Although density of cataract has an unfavorable influence on early postoperative corneal endothelial cell loss, it did not significantly influence final DCVA and surgically induced astigmatism. C-MICS is a safe and effective method of treatment of cataracts, including cataracts with hard nuclei, and usually leads to good functional outcomes.
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Galan A, Tavolato M, Babighian S. Grading the surgical difficulty of cataract phacoemulsification. Ophthalmic Surg Lasers Imaging Retina 2009; 40:361-5. [PMID: 19634739 DOI: 10.3928/15428877-20096030-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To propose a new grading system to preoperatively evaluate the difficulty of phacoemulsification surgery according to the anatomic condition of a patient's eye. PATIENTS AND METHODS In this prospective case series, a grading system covering the entire cataract spectrum was developed and field-tested in 400 consecutive patients undergoing phacoemulsification. For each eye, nine anatomic parameters were evaluated and a level of severity was assigned. The system identifies five levels of surgical difficulty based on the combined degree of severity of each parameter considered. RESULTS Preoperative score and intraoperative difficulty closely corresponded in the first 400 test cases. Analysis using the Fleiss-Cohen kappa coefficient showed substantial agreement between preoperative and intraoperative scores (k value = 0.76; 95% confidence interval = 0.71 to 0.81). CONCLUSION A grading system of the preoperative difficulties of each phacoemulsification procedure is provided. This system is easy to complete and interpret and can be transmitted to the surgeon, patient, and anyone who may subsequently examine the case.
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Affiliation(s)
- Alessandro Galan
- Department of Ophthalmology, Hospital Sant'Antonio, Padova, Italy
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Agrawal V, Upadhyay J. Validation of scoring system for preoperative stratification of intra-operative risks of complications during cataract surgery: Indian multi-centric study. Indian J Ophthalmol 2009; 57:213-5. [PMID: 19384016 PMCID: PMC2683435 DOI: 10.4103/0301-4738.49396] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM To validate a system that uniformly and objectively assesses the risk of complications of cataract surgery performed with phacoemulsification technique in individual patients preoperatively. MATERIALS AND METHODS Outcome analysis of patient data entered into a standardized protocol. The data sheet was analyzed at a single center in terms of the risk assessed preoperatively and the incidence of surgical complications. This study did not assess the final visual outcome of eyes with complications. Each patient was categorized into a risk group according to the number of points scored. Group 1 (no added risk) 0 points, Group 2 (low risk) 1-2 points, Group 3 (moderate risk) 3-5 points, Group 4 (high risk) 6 points or more. RESULTS The number of eyes in each risk group was 2894 in Group 1 (44.1%), 1881 in Group 2 (28.6%), 1575 in Group 3 (23.9%), and 214 in Group 4 (3.3%). A total of 6564 eyes were assessed, of these 3669 eyes (55.9%) had a minimum of one risk factor and were thus not "routine". The group-specific events of complications were Group 1, 46 (1.6%), Group 2, 108 (5.7%), Group 3, 168 (10.7%), and Group 4, 69 (32.2%). The total incidence of complications was 5.7%. The group-specific rate of intraoperative complications increased through the risk groups ( P < 0.001). CONCLUSION The study validates a scoring system that is predictive of intraoperative complications. This system uses information that is readily available from the preoperative history and assessment of the patient.
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Affiliation(s)
- Vinay Agrawal
- Pramukhswami Eye Hospital, Chunabhatti, Mumbai, India.
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Bhattacharya D. Nuclear management in manual small incision cataract surgery by snare technique. Indian J Ophthalmol 2008; 57:27-9. [PMID: 19075405 PMCID: PMC2661526 DOI: 10.4103/0301-4738.44498] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Manual small incision cataract surgery has evolved into a popular method of cataract surgery in India. However, in supra hard cataract, bringing out the whole nucleus through the sclerocorneal flap valve incision becomes difficult. A bigger incision required in such cataracts loses its value action, as the internal incision and corneal valve slips beyond the limbus into sclera. Struggling with the supra hard cataracts through a regular small incision. Phacofracture in the anterior chamber becomes a useful option in these cases. In the snare technique, a stainless steel wire loop when lassoed around the nucleus in the anterior chamber constricts from the equator, easily dividing the hardest of the nuclei into two halves. The wire loop constricts in a controlled way when the second cannula of snare is pulled. The divided halves can easily be brought out by serrated crocodile forceps. This nuclear management can be safely performed through a smaller sclerocorneal flap valve incision where the corneal valve action is retained within the limbus without sutures, and the endothelium or the incision is not disturbed. However, the technique requires space in the anterior chamber to maneuver the wire loop and anterior chamber depth more than 2.5 mm is recommended. Much evidence to this wonderful technique is not available in literature, as its popularity grew through live surgical workshops and small interactive conferences.
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Yuzbasioglu E, Helvacioglu F, Tugcu B, Terzi N, Keskinbora K. The results of cataract nigra cases operated with the mini-nuc technique. Int Ophthalmol 2008; 29:451-7. [PMID: 18923815 DOI: 10.1007/s10792-008-9265-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2007] [Accepted: 09/22/2008] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to evaluate the efficacy and safety of the mini-nuc technique for the removal of brunescent and black cataracts. A prospective study was carried out in 33 eyes of 33 patients with cataract nigra operated with the mini-nuc technique between April 2002 and June 2003. Slit-lamp examinations, intraocular pressure (IOP) measurements, and best-corrected visual acuity (BCVA) were assessed pre- and postoperatively. Accompanying systemic diseases were noted. Intraoperative and postoperative complications were evaluated. Unilateral eyes of 33 patients (18 male [54.5%], 15 female [45.5%]) aged between 65 and 90 years (mean 72 years) were operated with the mini-nuc technique. Preoperative BCVA values varied between light perception and 0.2 in the Snellen chart. Intraocular lenses (IOL) were implanted into all of the patients (27 in-the-bag [81.8%], four to sulcus [12.1%], and two with scleral fixation [6.1%]). During the surgery, five patients (15.15%) had zonular dialysis and two (6.1%) had posterior capsule rupture and vitreous loss. Postoperatively, three (9.1%) rises in IOP, two (6.1%) hyphema, and one (3%) IOL subluxation were observed. At the first day visit, the mean of the uncorrected visual acuities (UCVA) was 0.5 in the Snellen chart. At the third month visit, the mean BCVA was observed to be 0.8. The residual mean astigmatism was 0.75 D against the rule. The mini-nuc technique was effective in removing brunescent and black cataracts with a low rate of serious complications. The mini-nuc technique, which is also performed with a small incision and without sutures, might be an alternative to phacoemulsification in cases of cataract nigra.
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Affiliation(s)
- Erdal Yuzbasioglu
- Department of Ophthalmology, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, 4. Levent, Konaklar mahallesi Sogut sok. Koza sitesi, 14. blok D:16 Besiktas, Istanbul, 34330, Turkey.
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Safety and efficacy of manual small incision cataract surgery for brunescent and black cataracts. Eye (Lond) 2008; 23:1155-7. [PMID: 18566610 DOI: 10.1038/eye.2008.190] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
AIMS To evaluate the safety, visual outcome and complications of manual small incision cataract surgery (MSICS) in the treatment of patients with brunescent and black cataract (BBC). METHODS In a non-randomised interventional case series, 102 consecutive patients with BBC underwent cataract extraction by MSICS, with staining of the anterior capsule by trypan blue. RESULTS Of the 102 eyes with BBC, MSICS was performed through superior scleral tunnel (SST) in 31 eyes (30.4%) and through temporal scleral tunnel (TST) in 71 eyes (69.6%). The main intraoperative complication was posterior capsule rupture in two patients (2.0%). Postoperatively, 20 eyes (19.6%) developed corneal oedema. Mild iritis was seen in six eyes (5.9%) and moderate iritis with fibrin membrane formation occurred in three eyes (2.9%). On the 40th postoperative day, 80 patients (78.4%) achieved uncorrected visual acuity of 6/18 or better, and 99 (97.1%) had best-corrected visual acuity of 6/18 or better. Patients in the SST group had significantly higher postoperative astigmatism compared to those in the TST group (-1.08 D vs -0.72 D, P=0.017). CONCLUSION MSICS with trypan blue staining of the anterior capsule is a safe and effective method of cataract extraction for patients with BBC.
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M Miller K, D Olson M. In water thermal imaging comparison of the Alcon legacy and AMO sovereign phacoemulsification systems. Open Ophthalmol J 2008; 2:20-6. [PMID: 19478926 PMCID: PMC2687103 DOI: 10.2174/1874364100802010020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2008] [Revised: 01/17/2008] [Accepted: 01/20/2008] [Indexed: 11/22/2022] Open
Abstract
Purpose: To compare the temperature profiles of 2 popular phacoemulsification units under similar operating conditions in water. Methods: The phacoemulsification probes of the Sovereign WhiteStar and Legacy AdvanTec were capped with water-filled test chambers and imaged side-by-side using a thermal camera. The highest temperature of each chamber was measured at several time points after power application. Testing was performed under conditions capable of producing a corneal burn. The Legacy was operated in pulse mode at 15 Hz; a 50% duty cycle; and console power settings of 10, 30, 50 and 100%. The Sovereign was operated at the same console settings in WhiteStar C/F pulse mode at 56 Hz and a 33% duty cycle. Results: Under all conditions (powers of 10, 30, 50 and 100%; with or without irrigation/aspiration flow; and with or without sleeve compression), the Sovereign generated higher temperatures than the Legacy. At irrigation/aspiration flow rates ≥ 5 cc/min, the temperature profiles of the 2 units were indistinguishable. Conclusion: The Sovereign WhiteStar ran hotter than the Legacy AdvanTec under a variety of controlled low flow operating conditions. The Sovereign WhiteStar is more likely than the Legacy AdvanTec to produce a corneal burn under low flow conditions.
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Affiliation(s)
- Kevin M Miller
- Jules Stein Eye Institute and the Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
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Barsam A, Heatley CJ, Sundaram V, Toma NMG. A retrospective analysis to determine the effect of independent treatment centres on the case mix for microsurgical training. Eye (Lond) 2007; 22:687-90. [PMID: 17277752 DOI: 10.1038/sj.eye.6702718] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AIM To determine the effect of Independent Sector Treatment Centres (ISTC) on microsurgical training. METHODS A novel scoring protocol for stratification of cases suitable for microsurgical training was devised. This scoring protocol was applied to all patients who underwent cataract surgery on a single consultant dedicated training list between September and November 2004. These patients are representative of patients remaining on the waiting list after ISTC selection, that is, the residual case mix. Patients who underwent cataract surgery on the same consultant list in the same period in 2003 were also analysed when there was no ISTC or other waiting list initiative in operation. RESULTS Data was available for 129 patients. Seventy three patients underwent cataract surgery between September and November 2003 and 56 patients underwent cataract surgery in the same period in 2004. Using the devised scoring protocol, the mean score in the 2003 group was 1.08 +/-1.75 (range, 0.0-10.5) and for the 2004 group the mean score was 2.31 +/-2.65 (range, 0.0-4.5). A Mann-Whitney test showed that there was a statistically significant difference between the scores in the two groups (P=0.0009). With Independent Sector Treatment Centre implementation the percentage of cases suitable only for consultants increased fourfold. CONCLUSION The decrease in suitable cases for training as shown in this study is likely to have serious consequences on microsurgical training in the UK. We recommend that the results of this study are considered in any current or future plans for ISTC continuation and expansion.
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Affiliation(s)
- A Barsam
- Department of Ophthalmology, Queen Elizabeth II Hospital, Howlands, Welwyn Garden City, UK.
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Davison JA. Comparison of Ultrasonic Energy Expenditures and Corneal Endothelial Cell Density Reductions During Modulated and Non-Modulated Phacoemulsification. Ophthalmic Surg Lasers Imaging Retina 2007; 38:209-18. [PMID: 17552387 DOI: 10.3928/15428877-20070501-05] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To compare the Legacy 20000 Advantec continuous and Infiniti hyperpulse modes (Alcon Laboratories, Fort Worth, TX) with respect to average power, machine-measured phacoemulsification time, total stopwatch real time spent within the phacoemulsification process, balanced salt solution (BSS) volume, and corneal endothelial cell density losses. PATIENTS AND METHODS A background study was done of consecutive patients operated on with the Legacy (n = 60) and Infiniti (n = 40) machines programmed with identical parameters and using the continuous mode only. A primary study of another set of consecutive cases was operated on using the Legacy (n = 87) and Infiniti (n = 94) with the same parameters, but using the hyperpulse mode during quadrant removal with the Infiniti. Measurements for each set included average power and phacoemulsification time with corneal endothelial cell densities, BSS volume, and time spent in the phacoemulsification process. RESULTS Similarities were found in the background study for average power percent and average minutes of phacoemulsification time. In the primary study, similarities were found for total minutes in the phacoemulsification process, BSS usage, and ECD losses, and differences were found for average power percent (P< .001) and machine-measured phacoemulsification minutes (P< .001). CONCLUSIONS The Legacy and Infiniti performed similarly in continuous mode. With the Infiniti hyperpulse mode, a total ultrasonic energy reduction of 66% was noted. The machines required the same amount of total stopwatch measured time to accomplish phacoemulsification and produced the same 5% corneal endothelial cell loss. Therefore, clinically, these two machines behave in a comparable manner relative to safety and effectiveness.
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Affiliation(s)
- James A Davison
- Wolfe Eye Clinic, 309 East Church Street, Marshalltown, IA 50158, USA
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Robbie SJ, Muhtaseb M, Qureshi K, Bunce C, Xing W, Ionides A. Intraoperative complications of cataract surgery in the very old. Br J Ophthalmol 2006; 90:1516-8. [PMID: 16899530 PMCID: PMC1857515 DOI: 10.1136/bjo.2006.098764] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To identify whether the risk of an intraoperative complication of phakoemulsification cataract surgery increases with age. METHODS 1441 consecutive patients undergoing phakoemulsification cataract surgery were assessed preoperatively, and data on the occurrence of intraoperative complications were collected prospectively. Data were entered into a computerised database, and logistic regression was used to examine evidence of an association between age and the risk of an intraoperative complication. In addition, the rates of intraoperative complications were compared between patients > or =88 years and those <88 years, and between patients > or =96 years and those <96 years. RESULTS No significant association was found between age and the risk of an intraoperative complication. The authors found little evidence that patients > or =88 years were at a greater risk of an intraoperative complication than those <88 years, or that those > or =96 years are at increased risk; however, numbers were small. CONCLUSIONS These results suggest that age alone is not a major risk factor for any intraoperative complications occurring during phakoemulsification cataract surgery. This has implications not just for tailoring the risk of complications occurring to individual patients but also for meaningful comparisons between national complication rates and those of individual surgeons, and better selection of cases suitable for instruction.
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Affiliation(s)
- S J Robbie
- Moorfields Eye Hospital, Duke-Elder Diagnosis and Treatment Centre, St George's Hospital, London, UK.
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Habib MS, Bunce CV, Fraser SG. The role of case mix in the relation of volume and outcome in phacoemulsification. Br J Ophthalmol 2005; 89:1143-6. [PMID: 16113369 PMCID: PMC1772833 DOI: 10.1136/bjo.2005.070235] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIM The authors previously demonstrated a decrease in complication rate with an increase in volume of cases performed by a surgeon. All studies of volume and outcome are potentially hampered by the issue of case mix, in that some lower volume surgeons may in fact do fewer cases because they have more complex patients. This study was designed to assess the influence of case mix on the volume-outcome relation in phacoemulsification surgery that had previously been demonstrated. METHODS This study took place wholly in Sunderland Eye Infirmary. 667 cases from between 1996 and 2001 were randomly selected from the operative lists of the six surgeons involved in a previous study. The case complexity was assessed using a potential difficulty score (PDS) devised from preoperative data predictive of potential surgical difficulty. The PDS was validated by a retrospective analysis of a sample of 100 cases. RESULTS 528 complete sets of notes were retrieved. The overall PDS scores ranged from 1 to 6. There was a difference between the proportions of patients with each PDS value (p=0.015) in the two groups, which suggested that the low volume surgeons were doing potentially more difficult cases. The median PDS for each volume group were the same (=1.0). Retrospective validation analysis of the PDS score revealed higher mean and median values in complicated cases compared to uncomplicated cases. CONCLUSION This follow up study re-emphasises the importance of case mix adjustment in comparative assessment of healthcare quality. These results may explain in part the trend previously demonstrated of lower complication rates for higher volume surgeons.
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Affiliation(s)
- M S Habib
- Sunderland Eye Infirmary, Queen Alexandra Road, Sunderland, SR2 9HP, UK
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Lundberg B, Jonsson M, Behndig A. Postoperative corneal swelling correlates strongly to corneal endothelial cell loss after phacoemulsification cataract surgery. Am J Ophthalmol 2005; 139:1035-41. [PMID: 15953433 DOI: 10.1016/j.ajo.2004.12.080] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2004] [Accepted: 12/21/2004] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate postoperative corneal swelling as a predictor of corneal endothelial cell loss after phacoemulsification cataract surgery. DESIGN Prospective observational case series. METHODS Thirty patients planned for routine phacoemulsification cataract surgery were included. Ultrasonic pachymetry and specular microscope endothelial photography of the central and nasal portions of the cornea and Orbscan II slit-scan tomography were performed preoperatively and the day after surgery. The 30 patients were selected from 41 patients based on their increase in central corneal thickness: the first 10 cases with a <5% increase, the first 10 with a 6% to 20% increase, and the first 10 with a > or =20% increase. The same measurements were repeated after 1, 2, and 3 months. The primary outcome measures were corneal endothelial cell loss and increase in pachymetry. Several other parameters were also registered, including age, degree of cataract, visual acuity, phacoemulsification time and energy, total operation time, and the amount of infusion fluid used. RESULTS The central corneal swelling at postoperative day 1 was strongly correlated with the central corneal endothelial cell loss at 3 months (R(2) = 0.785, P < .001). CONCLUSIONS In this series, with large variations in the corneal swelling at the first postoperative day, the degree of permanent corneal endothelial damage was reflected in the degree of early postoperative corneal swelling. Measuring the difference in pachymetry at postoperative day 1 is a useful way to assess the effects on the corneal endothelium exerted by the phacoemulsification procedure.
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Affiliation(s)
- Björn Lundberg
- Department of Clinical Science/Ophthalmology, Umeå University Hospital, SE-901 85 Umeå, Sweden
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Muhtaseb M, Kalhoro A, Ionides A. A system for preoperative stratification of cataract patients according to risk of intraoperative complications: a prospective analysis of 1441 cases. Br J Ophthalmol 2004; 88:1242-6. [PMID: 15377542 PMCID: PMC1772356 DOI: 10.1136/bjo.2004.046003] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To devise a simple, robust scoring system for assessing the risk of intraoperative complications in patients undergoing cataract surgery. METHODS 1441 consecutive patients undergoing phacoemulsification cataract surgery were assessed preoperatively according to weighted criteria. According to the points of risk they accumulated using this system, the patients were preoperatively allocated to one of four risk groups. Data were prospectively collected on the occurrence of intraoperative complications and entered into a computerised database. The total rate of intraoperative complications for each risk group as well as the rate of each reported complication for each risk group were calculated. RESULTS The rate of intraoperative complications increased in frequency through the risk groups: 1 = 4.32%, 2 = 7.45%, 3 = 13.48%, and 4 = 32.00% (p<0.001). Furthermore, the following complications also increased in frequency through the risk groups in their own right (p<0.05 in each case): posterior capsule rupture, vitreous loss, incomplete capsulorrhexis, zonule dehiscence, wound burn/leak, and lost nuclear fragment into vitreous cavity. CONCLUSION These results suggest that candidates for cataract surgery can be simply and uniformly assessed preoperatively and categorised to a "risk group" according to their risk of intraoperative complications. This allows for: (1) individualised counselling on the chances of operative complications, (2) meaningful comparisons between national complication rates and those of individual units or surgeons, and (3) better selection of cases suitable for instruction.
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Affiliation(s)
- M Muhtaseb
- Department of Ophthalmology, Moorfields Eye Hopsital at St George's Hospital, Blackshaw Road, London SW17 0QT, UK.
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Ermisş SS, Oztürk F, Inan UU. Comparing the efficacy and safety of phacoemulsification in white mature and other types of senile cataracts. Br J Ophthalmol 2004; 87:1356-9. [PMID: 14609833 PMCID: PMC1771891 DOI: 10.1136/bjo.87.11.1356] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To compare the intraoperative difficulty and postoperative outcome in patients who have white mature cataract in one eye and other types of senile cataract in the other eye undergoing clear corneal phacoemulsification and foldable intraocular lens implantation. METHODS 82 patients who had white mature cataract in one eye, posterior subcapsular, cortical, nuclear, or mixed type cataract in the other eye were enrolled in this prospective study. Postoperative outcomes, intraoperative difficulties related to capsulorhexis, and phacoemulsification were analysed between the two groups of eyes. Postoperative examinations were done at 1 day, 1 week, 1 and 3 months. RESULTS Postoperative visual acuity, central corneal thickness, intraocular pressure, and rate of posterior capsule rupture were not significantly different between the two group of eyes (p>0.05). Mean effective phaco time, frequency of postoperative corneal oedema and posterior capsular plaque were found to be significantly higher in the mature cataract group (p<0.05). CONCLUSIONS A one stage, 5 mm continuous capsulorhexis was achieved using trypan blue and generous amounts of retentive viscoelastic agent in eyes with white mature cataract. Intraoperative difficulties and postoperative outcome of clear corneal incision phacoemulsification surgery and foldable intraocular lens implantation were similar in white mature and other types of senile cataract. Topical anaesthesia in phacoemulsification of eyes with white mature cataract is safe and well tolerated.
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Affiliation(s)
- S S Ermisş
- Department of Ophthalmology, School of Medicine, University of Afyon Kocatepe, Afyon, Turkey.
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Condon GP. Cataract surgical problem: Reply. J Cataract Refract Surg 2003. [DOI: 10.1016/s0886-3350(03)00152-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Vasavada AR, Goyal D, Shastri L, Singh R. Corticocapsular adhesions and their effect during cataract surgery. J Cataract Refract Surg 2003; 29:309-14. [PMID: 12648642 DOI: 10.1016/s0886-3350(02)01527-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE To identify the types of corticocapsular adhesions by their preoperative clinical appearance and evaluate the difficulties they pose during cataract surgery. SETTING Iladevi Cataract & IOL Research Center, Ahmedabad, India. METHODS Seventy-six eyes with age-related senile cataract scheduled for phacoemulsification were identified as having corticocapsular adhesions. Preoperatively, the eyes were assessed at the slitlamp to determine the type of corticocapsular adhesions present. During surgery, the surgeon graded nucleus rotation after single-site cortical-cleaving hydrodissection as easy, difficult, or not possible. Additional multiquadrant-focal hydrodissection was performed. The surgeon's impressions of the presence of corticocapsular adhesions and visualization of the furry surface of the epinucleus were noted. RESULTS Corticocapsular adhesions were confirmed in 86.84% of eyes. Equatorial corticocapsular adhesions alone or in combination were present in 72 eyes (94.74%) eyes, anterior corticocapsular adhesions in 40 (52.74%), and posterior corticocapsular adhesions in 42 (56.26%). Rotation of nucleus was not possible in 47.37% eyes, difficult in 39.47%, and easy in 13.16%. CONCLUSIONS The surgeon should perform a thorough preoperative slitlamp evaluation in extreme gaze with a fully dilated pupil. Equatorial corticocapsular adhesions, which were present in most eyes, made nucleus rotation difficult. Additional multiquadrant and focal cortical-cleaving hydrodissection helped separate the adhesions and achieve successful rotation.
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Vasavada AR, Singh R, Apple DJ, Trivedi RH, Pandey SK, Werner L. Effect of hydrodissection on intraoperative performance: randomized study. J Cataract Refract Surg 2002; 28:1623-8. [PMID: 12231323 DOI: 10.1016/s0886-3350(01)01252-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the effect of hydrodissection on intraoperative performance during phacoemulsification of age-related nuclear cataracts. SETTING Iladevi Cataract & IOL Research Centre, Ahmedabad, India, and Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS In a prospective study, 86 eyes were randomly assigned to have multiquadrant hydrodissection (+HD, n = 48) or no hydrodissection (-HD, n = 38) during phacoemulsification of a grade 1 to 3 nuclear cataract. Excluded were patients with grade 4 or 5 nuclear sclerosis, a poorly dilating pupil, or associated ocular/systemic disease. Parameters assessed were nucleus and cortex removal time, the amount of fluid used for cortex removal, and the total amount of fluid used. The ease of nucleus rotation and cortical cleanup was also evaluated and graded subjectively as very easy, difficult, or very difficult. Data were analyzed using the Student t test and the chi-square test. RESULTS The mean nucleus removal time was 355 seconds +/- 237 (SD) and 474 +/- 212 seconds in the +HD and -HD groups, respectively (P =.09). The mean cortex removal time was significantly less in the +HD group than in the -HD group (79 +/- 51 seconds and 220 +/- 222 seconds, respectively) (P =.007). Significantly less fluid (43%) was used for cortex removal in the +HD group than in the -HD group (mean 70 +/- 45 mL and 123 +/- 82 mL, respectively) (P =.013), and significantly less total fluid (35%) was used in the +HD group (312 +/- 132 mL and 422 +/- 80 mL, respectively) (P =.002). Nucleus rotation was easy in all eyes in the +HD group; 68.43% of eyes in the -HD group failed to achieve rotation (P =.001). Cortex removal was very easy in 52.08% of eyes in the +HD group and easy in 47.90%; it was easy in 52.63% in the -HD group, difficult in 36.84%, and very difficult in 10.52%. CONCLUSION The use of multiquadrant cortical-cleaving hydrodissection made removal of the lens nucleus and cortex easier and faster during phacoemulsification of age-related nuclear cataracts.
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Affiliation(s)
- Abhay R Vasavada
- Iladevi Cataract & IOL Research Centre, Memnagar, Ahmedabad, India.
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Abstract
The technique of lens nucleus phacoemulsification has revolutionized cataract surgery. However, the production of ultrasound energy is associated with heat generation that can result in damage to ocular tissue, in particular the corneoscleral wound site. Thermal damage to the corneoscleral wound site may result in difficulty with wound closure and consequent risk of wound leakage, as well as damage to the adjacent corneal stroma and endothelium, fistula formation, and the induction of high degrees of post-operative astigmatism. The loss of adequate flow of irrigation fluid around the phacoemulsification tip is the key factor in the development of phacoemulsification-induced thermal injury. Use of excessive ultrasound power and production of excessive frictional forces generated by contact of the vibrating phacoemulsification needle with the irrigation sleeve are also factors involved. In the event of a "phacoburn," a specialized "gape suture" may help minimize surgically-induced astigmatism. The degree of induced astigmatism tends to wane over time; astigmatic keratotomy is an option in the setting of high degrees of residual astigmatism.
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