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Khokhar S, Rani D, Rathod A, Nathiya V, Kapoor A. Bimanual phacoemulsification for subluxated cataractous lens. Indian J Ophthalmol 2024; 72:126-127. [PMID: 38131583 PMCID: PMC10841795 DOI: 10.4103/ijo.ijo_1188_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: 05/07/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 12/23/2023] Open
Abstract
Bimanual phacoemulsification has been established as a safe and efficacious means of nuclear emulsification in the past. This case report presents the use of this technique in a man in his early forties, who had subluxated cataractous lenses in both eyes. The technique allowed for effective nuclear emulsification within a closed chamber, providing better control over intraocular events. The report emphasizes the safety and effectiveness of bimanual phacoemulsification in cataract extraction, even in challenging cases like a subluxated lens.
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Affiliation(s)
- Sudarshan Khokhar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Deeksha Rani
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Aishwarya Rathod
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Venkatesh Nathiya
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Anirudh Kapoor
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
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Lubiński W, Kirkiewicz M, Podborączyńska-Jodko K. Clinical results after microincision biaxial cataract surgery and implantation of an Incise intraocular lens. Int Ophthalmol 2017; 38:1977-1983. [PMID: 28803418 PMCID: PMC6153898 DOI: 10.1007/s10792-017-0686-0] [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: 04/18/2017] [Accepted: 08/07/2017] [Indexed: 10/30/2022]
Abstract
PURPOSE To evaluate clinical outcomes after uncomplicated microincision biaxial cataract surgery and implantation of Incise intraocular lens (IOL). METHODS This study included 47 eyes of 29 patients (mean age 62.2 ± 8.6 years), who underwent 1.4-mm biaxial cataract surgery with implantation of the Incise IOL (Bausch and Lomb). At third month, surgically induced astigmatism (SIA) was calculated. Three, 6 and 12 months postoperatively, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), corrected near visual acuity (CNVA) LogMAR ETDRS, spherical equivalent refraction (SER), photopic distance corrected contrast sensitivity (CS) with and without glare (85 cd/m2) (CSV-1000) were assessed. One year after surgery, late complications were assessed and subjects were questioned for subjective symptoms. RESULTS Mean of SIA was equal 0.29 ± 0.16 D. Three months postoperatively: mean UDVA improved from 0.83 to 0.04 (p < 0.001), CDVA from 0.58 to -0.05 (p < 0.001) and CNVA from 0.58 to -0.02 (p < 0.001) and all were stable during 1-year follow-up. Three months postoperatively, the mean SER was equal 0.07 ± 0.61 D and was within ±0.5 D in 79%, and within 1 D in 88% of eyes. During follow-up period, corrected CS with and without glare for distance was found to be within normal limits. The only late complication was posterior capsule opacification (PCO). Subjective quality of vision was very high; none of patients complained about glare. CONCLUSIONS Biaxial cataract surgery with implantation of the Incise IOL provided excellent clinical outcomes by minimizing SIA, stable refraction and low incidence of PCO.
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Affiliation(s)
- Wojciech Lubiński
- Clinic of Ophthalmology, Pomeranian Medical University, al. Powstańców Wielkopolskich 72, 70-111, Szczecin, Poland.
| | - Marta Kirkiewicz
- Clinic of Ophthalmology, Pomeranian Medical University, al. Powstańców Wielkopolskich 72, 70-111, Szczecin, Poland
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Alio JL, Grzybowski A, El Aswad A, Romaniuk D. Refractive lens exchange. Surv Ophthalmol 2014; 59:579-98. [DOI: 10.1016/j.survophthal.2014.04.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 04/16/2014] [Accepted: 04/22/2014] [Indexed: 10/25/2022]
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Nanavaty MA, Spalton DJ, Gala KB, Dhital A, Boyce J. Fellow-eye comparison of posterior capsule opacification between 2 aspheric microincision intraocular lenses. J Cataract Refract Surg 2013; 39:705-11. [PMID: 23608567 DOI: 10.1016/j.jcrs.2012.12.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Revised: 12/13/2012] [Accepted: 12/14/2012] [Indexed: 11/17/2022]
Abstract
PURPOSE To compare posterior capsule opacification (PCO) between 2 microincision hydrophilic intraocular lenses (IOLs) and with a conventional spherical hydrophobic IOL. SETTING St. Thomas' Hospital, London, United Kingdom. DESIGN Prospective randomized comparative study. METHODS A microincision Acri.Smart 36A (negatively aspheric) or Akreos MI-60 (aspherically neutral) IOL was randomized to the first eye of patients with the alternative IOL implanted in the fellow eye within 3 weeks. Postoperatively, 100% and 9% logMAR corrected distance visual acuity (CDVA) were assessed. Retroillumination photographs were analyzed using the posterior capsule opacity software system. The data on PCO scores were compared with those of a conventional spherical hydrophobic IOL (Acrysof SN60AT). RESULTS One hundred percent CDVA was significantly better at 12 months and 9% CDVA was better at 6, 12, and 24 months (P<.05) with the negatively aspheric IOL. One eye in each group with microincision IOLs developed capsule phimosis at 1 month. Neodymium:YAG capsulotomies were required by 2 years in 2 eyes with a negatively aspheric IOL and 8 eyes with an aspherically neutral IOL. At 24 months, the mean PCO score remained less than 10% with the conventional spherical IOL, whereas it increased with time in the negatively aspheric IOL (up to 16%) and the aspherically neutral IOL (up to 23%). CONCLUSIONS The negatively aspheric IOL had a better PCO profile than the aspherically neutral IOL. This may be attributed to the difference in the edge design between the IOLs. The microincision IOLs had more PCO than the conventional 1-piece hydrophobic IOL.
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Affiliation(s)
- Mayank A Nanavaty
- Department of Ophthalmology, St. Thomas' Hospital, Kings College, London, United Kingdom.
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Choi YJ, Han KE, Ahn JM, Jeong SH, Lee HK, Seo KY, Kim EK, Kim TI. Comparisons of Clinical Results after Implantation of Three Aspheric Intraocular Lenses. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.2.251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Young Joon Choi
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Eun Han
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Min Ahn
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Se Hwan Jeong
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung Keun Lee
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Kyoung Yul Seo
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Eung Kweon Kim
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Im Kim
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
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Can İ, Ceran BB, Soyugelen G, Takmaz T. Comparison of clinical outcomes with 2 small-incision diffractive multifocal intraocular lenses. J Cataract Refract Surg 2012; 38:60-7. [PMID: 22082752 DOI: 10.1016/j.jcrs.2011.07.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 06/22/2011] [Accepted: 07/25/2011] [Indexed: 10/15/2022]
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Park JH, Lee JS. Clinical Results of Cataract Operation in a Monocular Person. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2012. [DOI: 10.3341/jkos.2012.53.12.1772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jong Ho Park
- Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
| | - Jong Soo Lee
- Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
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Lee KS, Kim JH, Lee J, Kim JY, Kim MJ, Tchah H. Comparison of Clinical Outcomes between Different IOL Sizes after Microincisional Cataract Surgery. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2011. [DOI: 10.3341/jkos.2011.52.11.1281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Kyoung Sub Lee
- Department of Ophthalmology, Asan Medical Center, Ulsan of University College of Medicine, Seoul, Korea
| | - Jae Hyung Kim
- Department of Ophthalmology, Asan Medical Center, Ulsan of University College of Medicine, Seoul, Korea
| | - Jooeun Lee
- Department of Ophthalmology, Asan Medical Center, Ulsan of University College of Medicine, Seoul, Korea
| | - Jae Yong Kim
- Department of Ophthalmology, Asan Medical Center, Ulsan of University College of Medicine, Seoul, Korea
| | - Myoung Joon Kim
- Department of Ophthalmology, Asan Medical Center, Ulsan of University College of Medicine, Seoul, Korea
| | - Hungwon Tchah
- Department of Ophthalmology, Asan Medical Center, Ulsan of University College of Medicine, Seoul, Korea
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Can I, Takmaz T, Bayhan HA, Bostancı Ceran B. Aspheric microincision intraocular lens implantation with biaxial microincision cataract surgery: efficacy and reliability. J Cataract Refract Surg 2010; 36:1905-11. [PMID: 21029899 DOI: 10.1016/j.jcrs.2010.06.057] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 06/02/2010] [Accepted: 06/04/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the efficacy and reliability of a microincision intraocular lens (IOL) and its use in biaxial microincision cataract surgery (MICS). SETTING Atatürk Training and Research Hospital, Ankara, Turkey. DESIGN Prospective clinical study. METHODS A microincision IOL (Akreos MI60) was implanted after cataract extraction by the biaxial MICS technique. Over a postoperative follow-up of 12 months or more, visual acuity, contrast sensitivity, surgically induced astigmatism (SIA), corneal and ocular aberrations, and early and late complications were recorded. RESULTS The IOLs were implanted in the capsular bag in all 100 eyes. The mean final incision size was 1.82 mm ± 0.09 (SD). Postoperatively, the mean corrected distance visual acuity was 0.06 ± 0.10 logMAR; the mean spherical equivalent, -0.48 ± 0.91 diopter (D); and the mean calculated SIA, 0.20 ± 0.22 D. Contrast sensitivity with and without glare was within normal limits. There was no statistically significant difference in the root mean square of total corneal aberrations between preoperatively and postoperatively. Ocular wavefront analysis 3 months postoperatively showed mean values of 0.15 ± 0.2 μm for spherical aberration, 0.38 ± 0.16 μm for higher-order aberrations, 0.18 ± 0.14 μm for coma, and 0.14 ± 0.08 μm for trefoil. The 4 cases (4.0%) of membranous anterior chamber reaction resolved with treatment. None of the 20 eyes (20.0%) with posterior capsule opacification required neodymium:YAG capsulotomy. All IOLs remained well centered. CONCLUSION The aspheric microincision IOL was safely implanted through a 1.8 mm or smaller incision during biaxial MICS and gave good postoperative outcomes.
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Affiliation(s)
- Izzet Can
- Atatürk Training and Research Hospital, 2nd Ophthalmology Department, Ankara, Turkey.
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Astigmatic neutrality in biaxial microincision cataract surgery. J Cataract Refract Surg 2009; 35:1555-62. [PMID: 19683152 DOI: 10.1016/j.jcrs.2009.03.048] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Revised: 03/24/2009] [Accepted: 03/26/2009] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess the astigmatic effect of biaxial microincision cataract surgery (MICS) with insertion of an UltraChoice 1.0 Rollable Thinlens intraocular lens (IOL) in a sufficiently powered controlled study. SETTING Queen Elizabeth Hospital, South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, Australia. METHODS Consecutive patients having biaxial MICS were evaluated prospectively. Keratometry was performed preoperatively and postoperatively. Vector analysis of the alteration in the keratometric cylinder was compared with that in control eyes not having surgery but having keratometry over a similar time frame. RESULTS There were 76 eyes in the surgical group and 74 in the control group. The right-hand incision used for IOL insertion had a mean external opening width of 2.00 mm and a mean internal width of 1.89 mm. The left-hand incision measured a mean of 1.49 mm and 1.46 mm, respectively. There was no statistically significant difference between the surgical group and the routine variability in keratometry in the untreated control group in surgically induced astigmatism (surgical group, 0.57 diopter [D] +/- 0.05 [SEM]; control group, 0.54 +/- 0.06 D; P =.660) or the degree of mean calculated flattening effect at the right-hand incision (0.01 +/- 0.06 D and -0.05 +/- 0.05 D, respectively; P = .405) or at the left-hand incision (-0.06 +/- 0.05 D and 0.03 +/- 0.06 D, respectively; P = .283). CONCLUSION Biaxial MICS with insertion of IOL through a temporal incision of 2.0 mm offers prospects of astigmatic neutrality in cataract surgery.
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Lee SY, Chung JL, Hong JP, Seo KY, Kim EK, Kim TI. Comparative Study of Two Aspheric, Aberration-Free Intraocular Lenses in Cataract Surgery. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2009. [DOI: 10.3341/jkos.2009.50.10.1520] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sang Yeop Lee
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University, College of Medicine, Seoul, Korea
| | - Jae Lim Chung
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University, College of Medicine, Seoul, Korea
| | - Jin Pyo Hong
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University, College of Medicine, Seoul, Korea
| | - Kyoung Yul Seo
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University, College of Medicine, Seoul, Korea
| | - Eung Kweon Kim
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University, College of Medicine, Seoul, Korea
| | - Tae Im Kim
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University, College of Medicine, Seoul, Korea
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Möglich M, Häberle H, Pham D, Wirbelauer C. Aberrationskorrigierte Intraokularlinse für die mikroinzisionale Kataraktchirurgie (MICS). Ophthalmologe 2008; 106:899-904. [DOI: 10.1007/s00347-008-1846-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Agarwal A, Kumar DA, Jacob S, Agarwal A. In vivo analysis of wound architecture in 700 μm microphakonit cataract surgery. J Cataract Refract Surg 2008; 34:1554-60. [DOI: 10.1016/j.jcrs.2008.05.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2008] [Accepted: 05/13/2008] [Indexed: 10/21/2022]
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Abstract
PURPOSE To evaluate spherical aberration and visual function after microincision cataract surgery using the ThinOptX rollable intraocular lens. DESIGN Prospective, comparative, and interventional case series. METHODS SettingSingle-centre institutional practice. This prospective study evaluated 58 patients with cataracts who underwent bimanual microphaco cataract surgery in both eyes. A ThinOptX lens was introduced into one eye and an Alcon Acrysof lens, as a control, into the other. One month after cataract surgery, the corneal, whole-eye, and internal spherical aberration, and contrast sensitivity in both eyes were measured. We also measured the spherical aberration in artificial model eyes bearing Acrysof and ThinOptX lenses. Two-sided paired t-test was used for assessing all data. RESULTS The root mean square (RMS) for both whole-eye and internal spherical aberrations was smaller in eyes bearing ThinOptX (P=0.03 and P=0.07, respectively). Although there was no statistically significant difference in the RMS for internal spherical aberration between ThinOptX- and Acrysof-bearing eyes, according to the Zernike polynomial expansion, all human and model eyes bearing ThinOptX registered negative internal spherical aberration in Z(4,0) and Z(6,0). On the other hand, all human and model eyes bearing Acrysof registered positive internal spherical aberration in Z(4,0) and Z(6,0). The ThinOptX lens yielded slightly higher contrast sensitivity in all cycles. CONCLUSION As the ThinOptX lens is designed for negative spherical aberration, we encountered smaller whole spherical aberrations and higher contrast sensitivity than with the Acrysof lens. The implantation of ThinOptX IOL after microincision cataract surgery yielded good visual function.
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Affiliation(s)
- M Ouchi
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
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Agarwal A, Jacob S, Agarwal A. Combined microphakonit and 25-gauge transconjunctival sutureless vitrectomy. J Cataract Refract Surg 2007; 33:1839-40; author reply 1840. [DOI: 10.1016/j.jcrs.2007.06.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Accepted: 06/29/2007] [Indexed: 10/22/2022]
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Crema AS, Walsh A, Yamane Y, Nosé W. Comparative study of coaxial phacoemulsification and microincision cataract surgery. One-year follow-up. J Cataract Refract Surg 2007; 33:1014-8. [PMID: 17531696 DOI: 10.1016/j.jcrs.2007.02.035] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2006] [Accepted: 02/05/2007] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate the amount of ultrasound (US) used, best corrected visual acuity (BCVA), and corneal endothelial cell loss in bimanual microincision cataract surgery (MICS) and coaxial phacoemulsification. SETTING Department of Ophthalmology, Universidade Gama Filho, Rio de Janeiro, Brazil. METHODS A prospective randomized study included 30 patients (60 eyes) with bilateral cataract. All patients had coaxial phacoemulsification in 1 eye and MICS in the fellow eye. The US time and the effective US time were measured intraoperatively. The BCVA and central endothelial cell loss were evaluated in both groups over a 1-year follow-up. The results between the 2 groups were compared. RESULTS The total US time was lower in the coaxial phacoemulsification group than in the MICS group; the means were 0.50 minutes +/- 0.33 (SD) and 0.82 +/- 0.39 minutes, respectively. The mean US power was similar between groups (mean 10.1% +/- 3.76% and 10.0% +/- 4.0%, respectively). The BCVA was similar between the groups from 24 hours to 1 year. The mean central corneal endothelial cell loss at 3 months was 4.66% +/- 6.10% in the coaxial phacoemulsification group and 4.45% +/- 5.06% in the MICS group and at 1 year, 6.00% +/- 6.72% and 8.82% +/- 7.39%, respectively. The only significant difference in the postoperative results between the 2 groups was central endothelial cell loss at the 1-year follow-up. CONCLUSIONS The US time was longer in the MICS group than in the in the coaxial phacoemulsification group, but the mean US power was similar between groups. The BCVA was also similar between groups; however, the MICS group had more central endothelial cell loss at the 1-year follow-up.
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Affiliation(s)
- Armando Stefano Crema
- Department of Ophthalmology, Gama Filho University, Rua Vinicius de Moraes 179, Rio de Janeiro, Brazil.
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Dada T, Mandal S, Aggarwal A, Gadia R. Microincision cataract surgery in a vitrectomized eye. J Cataract Refract Surg 2007; 33:577-9. [PMID: 17397727 DOI: 10.1016/j.jcrs.2006.10.074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2006] [Accepted: 10/30/2006] [Indexed: 12/01/2022]
Abstract
Phacoemulsification after vitrectomy is associated with several intraoperative problems. We describe the use of bimanual microincision cataract surgery using an 18-gauge needle as the irrigating chopper combined with silicone oil removal in a vitrectomized eye. This technique may offer a safe alternative to standard phacoemulsification in such cases.
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Affiliation(s)
- Tanuj Dada
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
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Prakash P, Kasaby HE, Aggarwal RK, Humfrey S. Microincision bimanual phacoemulsification and Thinoptx® implantation through a 1.70 mm incision. Eye (Lond) 2006; 21:177-82. [PMID: 16710439 DOI: 10.1038/sj.eye.6702153] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To prospectively assess the efficacy of bimanual phacoemulsification and implantation of Thinoptx, an injectable intraocular lens (IOL), inserted through 1.70 mm clear corneal incision. SETTING Department of Ophthalmology, Southend Hospital NHS Trust, UK. METHODS A total of 50 eyes of 49 randomly selected patients with cataracts had microincision clear corneal bimanual phacoemulsification (MICS) with implantation of Thinoptx IOL in the capsular bag. All patients underwent full preoperative assessment. Postoperative assessment was carried out at 3 and 6 weeks and at 15 months. RESULTS In all 50 cases the IOL was inserted through 1.70 mm clear corneal incision. The mean best-corrected visual acuity was 0.02 (6/6-1) at 6 weeks and was 0.17 (6/10) at the final follow-up. The mean final surgically induced astigmatism at 6 weeks was 0.0106. Coloured haloes around artificial lights were perceived by 69.23% of patients at 6 weeks and by 61.29% at the final follow-up. One patient underwent IOL exchange for this. Posterior capsular opacification was noticed in 31.26% at 6 weeks and in 64.51% at 15 months. Anterior capsular opacification was noticed in 5.26% at 6 weeks and in 16.12% at 15 months. In one patient the IOL had to be exchanged because of tilt and displacement of the IOL due to anterior capsular phimosis. CONCLUSIONS We conclude Thinoptx can be safely inserted through 1.70 mm incision used for bimanual phacoemulsification. Distance and near visual acuity achieved with this IOL is satisfactory. There is no significant change in keratometric astigmatism following this procedure. However, posterior capsular opacification rate was significantly higher with this IOL. Haloes around light sources were significant.
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Affiliation(s)
- P Prakash
- Department of Ophthalmology, Southend Hospital NHS Trust, Prittlewell Chase, Westcliff on Sea, Essex, UK.
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Assaf A, El-Moatassem Kotb AM. Feasibility of bimanual microincision phacoemulsification in hard cataracts. Eye (Lond) 2006; 21:807-11. [PMID: 16680107 DOI: 10.1038/sj.eye.6702356] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The purpose of this work was to assess the feasibility of bimanual phacoemulsification in hard cataracts of N3+ using WhiteStar technology of Soveriegn (Advanced Medical Optics, Santa Ana, CA, USA). SETTING Ain-Shams University Hospitals, Ophthalmology Department, Cairo, Egypt. DESIGN A randomized prospective noncomparative study. METHODS A randomized prospective study of 33 consecutive cases (N3+ or more) was conducted, phacoemulsification using a bimanual microincision technique using the Sovereign with WhiteStar technology phacoemulsification machine. One phaco mode was used in all eyes. The ultrasound power was set at 30-25% according to the hardness of the nuclei, duty cycle of 33%, flow rate of 20-28 cm3/min, and vacuum of 240 mmHg. Occlusion mode was on. Nine eyes received rollable intraocular lenses (IOL) of ThinOptx, whereas 24 eyes had been implanted with hydrophobic acrylic foldable IOL (Sensar OptiEdge SA40e of AMO) through a third incision. Study parameters were effective phacotime (EPT), presence of wound burn, degree of immediate postoperative iritis, amount of infusion solution used, and total operating time. RESULTS The mean EPT was 4.3 s with an average ultrasound used of 5.7%. The mean operating time was 11 min and 20 s. Although the nuclear hardness was of grade 3 or above (in a scale of 5), there were no cases of thermal burn; P=0.005. Only three eyes suffered postoperative iritis 2+, which resolved within 1 week on topical steroids, statistically nonsignificant, P=0.2. The amount of infusion solution was less than that used in conventional coaxial phaco. This technique induced considerably less corneal astigmatism than surgery using conventional corneal incisions. CONCLUSIONS Hard cataracts of N3 or more could be safely removed through an incision of 1.4 mm incision using bimanual micro-phaco.
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Affiliation(s)
- A Assaf
- Department of Ophthalmology, Ain-Shams University, Nasr City, Cairo, Egypt
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Abstract
PURPOSE OF REVIEW This review examines the current status of accommodation restoration concepts with reference to the recent, published peer-reviewed literature with an emphasis on physiological aspects of accommodation and presbyopia. RECENT FINDINGS The mechanisms of accommodation and the causes of presbyopia are described. The physiological amenability of the accommodative structures in the presbyopic eye to accommodation restoration is discussed. General theoretical concepts of accommodation restoration are introduced. The methods that have been used to assess accommodation restoration, including the use of animal models, drug stimulated accommodation, subjective near-vision tests and objective measurements, are reviewed. SUMMARY While physiological and clinical evidence supports the notion that accommodation can be restored to the presbyopic eye, progress in this potentially exciting area is hindered by the scarcity of good, large-scale clinical studies using objective measurement techniques to evaluate the outcomes of accommodation restoration concepts.
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Affiliation(s)
- Mitchell P Weikert
- Baylor College of Medicine, 6565 Fannin, NC-205, Houston, TX 77030, USA.
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Abstract
PURPOSE OF REVIEW This review provides an update of recent advances in understanding the quality and functional significance of contrast sensitivity for the clinician regarding cataract, intraocular lenses and refractive surgery that goes beyond the measurement of visual acuity. RECENT FINDINGS New American National Standards Institute standards for contrast sensitivity based on linear sine-wave gratings are discussed that promise rapid advances of understanding and quantifying visual quality and function by unifying clinical results reported using contrast sensitivity. Increased sensitivity of linear sine-wave gratings over proposed bull's-eye radial gratings is discussed. Digital-image-processing software uses contrast sensitivity data to process images to help understand the quality of what the patient sees. Contrast sensitivity measurement is compared with wavefront aberrometry. Contrast sensitivity measures the total visual system quality in terms of contrast, whereas wavefront aberrometry measures the optical quality in terms of spatial distortion. Both measurements are needed to more fully understand the quality of vision. SUMMARY Recent advances provide the clinician with an awareness of why the new contrast-sensitivity standards are based on linear sine-wave gratings and how image-processing software can be used to better understand the quality of functional vision of the patient.
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Affiliation(s)
- Jorge Alió
- Instituto Oftalmológico de Alicante Vissum Corporation and the Department of Ophthalmology, Miguel Hernández University, 03016 Alicante, Spain.
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Cinhüseyinoglu N, Celik L, Yaman A, Arikan G, Kaynak T, Kaynak S. Microincisional cataract surgery and Thinoptx rollable intraocular lens implantation. Graefes Arch Clin Exp Ophthalmol 2005; 244:802-7. [PMID: 16315046 DOI: 10.1007/s00417-005-0158-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2005] [Revised: 08/23/2005] [Accepted: 09/19/2005] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Microincisional cataract surgery is a safe procedure with a very short learning period for an experienced cataract surgeon and rollable ultrathin intraocular lenses eliminate the need for enlargement of corneal incision. The purpose of the study was to evaluate the safety and efficacy of cataract surgery through a corneal microincision and implantation of rollable ultrathin intraocular lenses. The setting was Dokuz Eylul University Medical Faculty, Ophthalmology Department, Izmir, Turkey and SSK Okmeydani Hospital, Ophthalmology Clinic, Istanbul, Turkey. PATIENTS AND METHODS Ninety eyes in 85 patients were operated on through clear corneal microincisions with sleeveless phacoemulsification and rollable intraocular lenses were implanted. Forty-six of the patients were men and 39 were women between the ages of 27 and 83, with a mean of 51 years. Two eyes had atrophic senile macular degeneration, 4 eyes had nonspecific retinal pigment epithelial changes with chorioretinal atrophy, and 4 patients had diabetes mellitus without retinopathy. Three eyes had posterior capsular opacifications of unknown etiology. Two eyes had primary open angle glaucoma (PAAG) with cup to disc ratios of about 0.5. Three eyes had dense nuclear sclerosis of grade 4 with very low visibility of retinal structures. Other patients had no ocular or systemic pathology other than nuclear/corticonuclear cataract of grade 2-3. Uncorrected and best spectacle-corrected distance and near visual acuities, keratometric values, and refractive status were noted preoperatively and 1 week, 1 month, and 6 months postoperatively. Statistical analysis of keratometric changes between preoperative and postoperative findings was performed using the paired samples t test. RESULTS At 6 months postoperatively, 1 patient had a best spectacle-corrected visual acuity (BSCVA) of 0.2, the patient with atrophic senile macular degeneration. The rest of the eyes achieved a BSCVA of 0.63 or better. At 6 months postoperatively, 55 (61.11%) eyes had uncorrected visual acuities (UCVA) equal to or better than 0.8 and 83 (92.22%) eyes had BSCVA equal to or better than 0.8 according to the Snellen chart. The mean postoperative corneal astigmatisms at 1 week, 1 month, and 6 months were 0.69+/-0.43 D, 0.66+/-0.46 D and 0.65+/-0.48 D respectively. Statistical analysis revealed a significant change in corneal astigmatisms at the 1st week visit (p<0.05), but not at the 1st and 6th month visits (p>0.05) compared with preoperative findings. CONCLUSION Based on the limited data in the literature and in this study, it is not possible to make concrete decisions about the benefits and disadvantages of the ThinOptx IOL for longer durations. Intraoperatively, this IOL apparently eliminates the need for enlargement of the corneal incision during implantation. However, the statistical insignificance of induced astigmatisms after microincisions and classical phacoincisions should also be taken into consideration. We conclude that ThinOptx IOL is a pioneering intraocular lens implant that will contribute to the exciting future of cataract refractive surgical procedures. However, both clinical and laboratory investigations are needed to clearly describe the long-term effectiveness of this new rollable IOL.
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25
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Kojima T, Kaga T, Watanabe M, Uda K, Naito N, Saito Y, Ichikawa K. Clinical evaluation of the arched blade for cataract surgery. ACTA ACUST UNITED AC 2005; 83:306-11. [PMID: 15948782 DOI: 10.1111/j.1600-0420.2005.00419.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the efficacy of the arched blade for making clear corneal incisions in cataract surgery. METHODS This prospective study comprised 112 eyes of 74 patients scheduled for cataract surgery. Temporal clear corneal incisions were made with either a 3.2-mm conventional flat blade or the arched blade. The choice of knife was randomly assigned. Two surgeons, one with substantial cataract surgery experience and the other with less experience, performed the surgery. Corneal topography and aberration were examined pre- and postoperatively. The degree of surgically induced astigmatism (SIA) and high order aberration was analysed. The self-sealing ability of the wound was also compared between both blades. RESULTS For the less experienced surgeon, the degree of SIA was significantly higher with the 3.2-mm flat blade than with the 3.2-mm arched blade as measured at any time during postoperative follow-up. For the more experienced surgeon, the degree of high order aberration increased significantly with the 3.2-mm flat blade. The incision's self-sealing ability was significantly better when the wound was made with the arched blade rather than with the flat blade. CONCLUSION The arched blade proved to be effective in reducing surgically induced astigmatism and high order aberration in cataract surgery, particularly when used by the less experienced surgeon. Using the arched blade should lead to better wound self-sealing and, therefore, safer surgical results.
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Affiliation(s)
- Takashi Kojima
- Department of Ophthalmology, Social Insurance Chukyo Hospital, Aichi, Japan.
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Abstract
PURPOSE OF REVIEW Bimanual microincisional cataract surgery has recently become a procedure of interest among cataract surgeons, and a number of trials have shown its potential as a minimally invasive cataract surgery. The purpose of this review is to examine the studies that have been published to date and to evaluate the potential of bimanual phacoemulsification as a method of cataract extraction. RECENT FINDINGS Recent studies have reinforced the safety of bimanual phacoemulsification. In particular, recently published studies have focused on evaluating various phacoemulsification technologies and their safety when used in bimanual phacoemulsification. Newly developed rollable hydrophilic acrylic ThinOptX lenses have been shown to be implantable in 2.2-mm incisions safely with good visual outcomes. SUMMARY Bimanual phacoemulsification has been a potential technique for a number of years, but only recently have the technology, software, and technique advanced sufficiently to make bimanual phacoemulsification a feasible method of cataract extraction. Although the main disadvantage to bimanual phacoemulsification remains the lack of intraocular lenses that can fit through microincisions, necessitating the enlargement of corneal wounds for intraocular lens implantation, bimanual phacoemulsification has a number of advantages over traditional small-incision phacoemulsification. Theses advantages have been a source of interest for cataract surgeons and surgical companies who are now developing technologies that will permit the performance of truly microincisional cataract surgery.
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Affiliation(s)
- Tania Paul
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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27
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Chang DF. 400 mm Hg High-Vacuum Bimanual Phaco Attainable with the Staar Cruise Control Device. J Cataract Refract Surg 2004; 30:932-3. [PMID: 15093667 DOI: 10.1016/j.jcrs.2004.02.063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dogru M, Honda R, Omoto M, Fujishima H, Yagi Y, Tsubota K, Kojima T, Matsuyama M, Nishijima S, Yagi Y. Early visual results with the rollable ThinOptX intraocular lens. J Cataract Refract Surg 2004; 30:558-65. [PMID: 15050249 DOI: 10.1016/j.jcrs.2003.12.027] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2003] [Indexed: 11/23/2022]
Abstract
PURPOSE To prospectively assess the clinical and visual outcomes of phacoemulsification and implantation of a rollable intraocular lens (IOL) with a thin optic and compare the results with those of implantation of a foldable acrylic IOL. SETTING Department of Ophthalmology, Tokyo Dental College, Ichikawa General Hospital, Ichikawa, Chiba, Japan. METHODS Sixteen consecutive eyes of 8 patients (4 women, 4 men) with corticonuclear cataract had small-incision clear corneal phacoemulsification with implantation of a rollable ThinOptX IOL (ThinOptX Inc.) in the capsular bag. Twenty eyes of 10 age- and sex-matched patients (5 women, 5 men) with the same diagnosis had phacoemulsification and intracapsular implantation of an AcrySof foldable acrylic IOL (MA60BM, Alcon). The patients' refractive status and uncorrected and best corrected distance visual acuities were assessed preoperatively and 1 week and 1, 3, and 6 months after surgery. The uncorrected and best corrected near acuities were measured before and 6 months after surgery. Contrast visual acuity was measured with variable contrast charts 1, 3, and 6 months after surgery, and the results in the 2 IOL groups were compared. Anterior segment photography, intraocular pressure (IOP) measurement, specular microscopy, and fundoscopy were done before surgery and at 1, 3, and 6 months. RESULTS The final best corrected distance acuity was better than 20/25 in all eyes with a ThinOptX IOL and 18 eyes (90%) with an AcrySof IOL. The best corrected near acuity was better than 20/40 in 12 eyes (75%) and 14 eyes (70%), respectively. The mean contrast acuity with charts 2 and 3 was significantly higher in the ThinOptX group than in the AcrySof group at all examinations (P<.05). The final mean postoperative induced astigmatism was 0.06 diopter (D) +/- 0.50 (SD) and 0.25 +/- 0.68 D, respectively (P>.05). There were no differences in IOP or corneal endothelial cell density between the 2 groups at any examination. No intraoperative or postoperative complications occurred. CONCLUSIONS ThinOptX IOL implantation provided best corrected near and distance visual acuities comparable to those provided by the AcrySof IOLs. The significantly higher contrast acuities attained after implantation of the ThinOptX lens may be attributable to its ultrathin properties.
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Affiliation(s)
- Murat Dogru
- Department of Ophthalmology, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan.
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Abstract
PURPOSE To describe the principles upon which present day cataract treatment success resides. DESIGN Literature review and collective experience of the authors. RESULTS Surgical removal remains the standard treatment for cataract now and in the foreseeable future. Ultrasound cataract removal with a foldable "in-the-bag" intraocular lens with a truncated edge treated for dysphotopsia best correlates with core treatment principles, as we now understand them. Improving refractive results is an important trend. The worldwide burden of this problem is immense. CONCLUSIONS While results for treatment of cataracts are excellent today, improvements in safety and refraction precision are needed. Other approaches are desperately needed to stem the worldwide tide of cataract related ocular dysfunction.
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Affiliation(s)
- Randall J Olson
- Department of Ophthalmology, University of Utah, Salt Lake City, Utah 84132, USA.
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