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Ibarz-Barberá M, Orts-Vila P, Martínez-Galdón F, Martín-García N, Tañá-Rivero P. Surgical Efficiency Comparison Between Two Phacoemulsification Systems. Clin Ophthalmol 2024; 18:1095-1102. [PMID: 38707769 PMCID: PMC11066661 DOI: 10.2147/opth.s453899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/26/2024] [Indexed: 05/07/2024] Open
Abstract
Purpose To assess the surgical efficiency in cataract surgery comparing two phacoemulsification systems. Methods Prospective, consecutive-comparative study in a two-site private practice. Three hundred and one eyes undergoing standard or femtosecond laser-assisted (FLACS) cataract surgery with either the R-Evo Smart (BVI, Waltham, USA) and/or the Centurion Vision System (Alcon, Fort Worth, USA). Preoperative eye characteristics (degree of cataract using the lens opacities classification system LOCS III grading) and intraoperative outcomes (total ultrasound time and total estimated fluid aspirated/drainage bag weighting) were registered in all cases. Results One hundred and fifty-five eyes undergone cataract surgery with the R-Evo Smart and 146 eyes with the Centurion Vision System phacoemulsification systems. Mean cataract grade was 3.07 ± 0.78 and 2.96 ± 0.85 for the R-Evo Smart and Centurion Vision System groups, respectively (p = 0.12). Mean total ultrasound time was 18.99 ± 12.85 and 40.24 ± 21.91 seconds for the R-Evo Smart and Centurion Vision System groups, respectively (p < 0.01). Mean total estimated fluid aspirated/drainage bag weighting was 53.00 ± 14.56 g and 54.33 ± 14.88 cc for the R-Evo Smart and Centurion Vision System groups, respectively (p = 0.21). Considering non-FLACS surgery (98 eyes with the R-Evo Smart and 63 eyes with the Centurion Vision System), mean cataract grade was 2.95 ± 0.74 and 2.97 ± 0.91 for the R-Evo Smart and Centurion Vision System groups, respectively (p = 0.44). Mean total ultrasound time was 19.96 ± 11.20 and 42.84 ± 28.35 seconds for the R-Evo Smart and Centurion Vision System groups, respectively (p < 0.01). Mean total estimated fluid aspirated/drainage bag weighting was 55.95 ± 14.76 g and 55.97 ± 13.62 cc for the R-Evo Smart and Centurion Vision System groups, respectively (p = 0.49). No adverse events were found in the two groups of eyes. Conclusion The objective measurement of surgical efficiency through total ultrasound time during lens removal and fluid consumption during both lens removal and irrigation/aspiration proved R-Evo Smart to be an efficient phacoemulsification platform, in comparison with the current standard of care Centurion Vision System.
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Affiliation(s)
| | - Paz Orts-Vila
- Cataract and Refractive Surgery Department, Alicante, Spain
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Wu B, Ding X, Li S, Huo D, Zhang F, Liang W, Li L, Dou Z. Mechanical protective effect of lens anterior capsule disc on corneal endothelial cells during femtosecond laser-assisted cataract surgery in a rabbit model. BMC Ophthalmol 2023; 23:166. [PMID: 37076866 PMCID: PMC10114485 DOI: 10.1186/s12886-023-02918-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/11/2023] [Indexed: 04/21/2023] Open
Abstract
PURPOSE To evaluate the effects of a novel technique using an isolated lens anterior capsule disc (LACD) to protect corneal endothelial cells in rabbit eyes during femtosecond laser-assisted cataract surgery. METHODS Experimental study. 40 rabbits were divided into endothelium-protected (experimental) and control groups, with 20 rabbits in each group. In the experimental group, after femtosecond laser capsulotomy, the isolated capsule disc was lifted to the corneal endothelium by an ophthalmic viscosurgical device. The endothelium was damaged for 1 min with an ultrasonic probe. The control group underwent the same surgery, except that the disc was removed immediately after capsulorhexis. Corneal endothelioscopy was performed preoperatively and on postoperative days (PODs) 3 and 7 to observe endothelial cell counts (ECC) and endothelial cell loss rate. Central corneal thickness (CCT) was measured before and at PODs 1, 3 and 7. RESULTS There were 3.59%±1.88% (p < 0.001) and 2.92%±2.14% (p < 0.001) loss of ECC in experimental group at POD3 and POD7, respectively, while those in the control group were 11.62%±7.43% and 10.34%±5.77%, respectively. On POD 1, the difference in central corneal thickness was significant(P = 0.019) between the two groups. At POD 3 and POD 7, CCT was not significantly different (P = 0.597;0.913) between the two groups. CONCLUSIONS The isolated LACD technique significantly reduced damage to the endothelium caused by ultrasonic energy and protects corneal endothelial cells during phacoemulsification.
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Affiliation(s)
- Bowen Wu
- Aier School of Ophthalmology, Central South University, No.932, Lushan South Road, Changsha, Hunan province, China
| | - Xue Ding
- Beijing Aier-Intech Eye Hospital, Beijing, China
| | - Shaowei Li
- Aier School of Ophthalmology, Central South University, No.932, Lushan South Road, Changsha, Hunan province, China.
- Beijing Aier-Intech Eye Hospital, Beijing, China.
- Institute of Corneatology in Aier Eye Hospital, Beijing, China.
| | - Dongmei Huo
- Beijing Aier-Intech Eye Hospital, Beijing, China
| | - Fan Zhang
- Aier School of Ophthalmology, Central South University, No.932, Lushan South Road, Changsha, Hunan province, China
| | - Weiyan Liang
- Tianjin University Aier Eye Hospital, Tianjin, China
| | - Ling Li
- Beijing Aier-Intech Eye Hospital, Beijing, China
- Institute of Corneatology in Aier Eye Hospital, Beijing, China
| | - Zexia Dou
- Beijing Aier-Intech Eye Hospital, Beijing, China
- Institute of Corneatology in Aier Eye Hospital, Beijing, China
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Dewan T, Malik PK, Tomar P. Comparison of effective phacoemulsification time and corneal endothelial cell loss using three different ultrasound frequencies: A randomized controlled trial. Indian J Ophthalmol 2022; 70:1180-1185. [PMID: 35326010 PMCID: PMC9240574 DOI: 10.4103/ijo.ijo_2163_21] [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] [Indexed: 11/05/2022] Open
Abstract
Purpose Comparison of three ultrasound (US) frequencies for phacoemulsification of hard cataracts to determine a frequency that makes phacoemulsification more efficacious and safer. Methods A randomized controlled trial was undertaken at a medical college and hospital. In total, 207 patients with grade 5.6-6.9 (LOCS III) senile cataract were randomized into three groups. Group I underwent phacoemulsification with 28-kHz frequency, group II with 42-kHz frequency, and group III with 53-kHz frequency. The effective phacoemulsification time (EPT) and estimated fluid usage (EFU) were compared intraoperatively. The endothelial cell parameters were analyzed for 6 months. Results The groups were matched for age (P = 0.467), gender (P = 0.497), nuclear grade (P = 0.321), and anterior chamber depth (P = 0.635). The EPT and EFU were significantly lower in group III, compared to group II and group I, with P < 0.0001 and P < 0.0001, respectively. Postoperatively, the endothelial cell density (ECD) was significantly higher in group III at 1 month (P < 0.0001), 3 months (P < 0.0001), and 6 months (P < 0.0001). The percentages of ECD loss were also significantly lower in group III; the difference was statistically significant (P < 0.0001) up to 6 months postoperatively. Conclusion Higher frequency ultrasound was associated with a lower EPT and EFU as well as better endothelial preservation than lower frequencies in hard cataracts.
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Affiliation(s)
- Taru Dewan
- Department of Ophthalmology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Praveen K Malik
- Department of Ophthalmology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Preeti Tomar
- Department of Ophthalmology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
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Chee SP, Yang Y, Wong MHY. Randomized Controlled Trial Comparing Femtosecond Laser-Assisted with Conventional Phacoemulsification on Dense Cataracts. Am J Ophthalmol 2021; 229:1-7. [PMID: 33662301 DOI: 10.1016/j.ajo.2020.12.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/22/2020] [Accepted: 12/26/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE To compare the benefit of femtosecond laser-assisted cataract surgery (FLACS) versus phacoemulsification (PE) and 2 fragmentation patterns in managing dense cataracts. DESIGN Randomized controlled trial. METHODS Patients with nuclear opacity (NO) grade >5 (Lens Opacities Classification System III) were enrolled at the Singapore National Eye Centre. Patients who were unsuitable for FLACS, whose corneal endothelial cell count (ECC) was <1,500 cells/mm2, or had cataracts with additional complexities were excluded from the study. Eyes were randomized to PE, 600 μm grid (FLACSg), or 16-segment fragmentation (FLACS16) in 2:1:1 ratio. The Victus (Bausch & Lomb) laser platform and in situ phacoemulsification chop technique was used. Data for patient demographics, preoperative, and 1 month postoperative best-corrected visual acuity (BCVA), ECC, effective phacoemulsification time (EPT), and perioperative complications were collected. Outcome measurements were the loss of ECC at 1 month and EPT. RESULTS Ninety-three patients were randomized to PE (48), FLACSg (22), and FLACS16 (23). Majority were Chinese (87; 93.5%). Mean age was 74.3 ± 8.8 years of age. Cataracts were mostly graded as NO 5-6 (49; 61.3%). EPT among treatment arms was not different (P = .097, one-way ANOVA) but was significantly higher for NO >6 than NO <6 (P < .001, general linear model). ECC loss was significantly less in FLACSg than in PE (P = .018, Bonferroni correction). Mean 1-month postoperative LogMAR BCVA (0.23 ± 0.20) was significantly better than preoperative BCVA (1.02 ± 0.85; P < .001, paired t test) but not different between PE and FLACS. CONCLUSIONS FLACSg but not FLACS16 significantly lowered the mean ECC loss during phacoemulsification in dense cataracts.
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Affiliation(s)
- Soon-Phaik Chee
- Singapore National Eye Centre, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Cataract Research Team, Singapore Eye Research Institute, Singapore; Department of Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore.
| | | | - Melissa H Y Wong
- Singapore National Eye Centre, Singapore; Cataract Research Team, Singapore Eye Research Institute, Singapore; Department of Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
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Comparison of effective phacoemulsification time and corneal endothelial cell loss using 2 ultrasound frequencies. J Cataract Refract Surg 2019; 45:1285-1293. [PMID: 31371150 DOI: 10.1016/j.jcrs.2019.04.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 03/19/2019] [Accepted: 04/15/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE To compare 2 ultrasound (US) frequencies for phacoemulsification for moderate to hard cataract to determine a frequency that makes phacoemulsification safer and more efficacious. SETTING Post Graduate Institute of Medical Education and Research, New Delhi, India. DESIGN Randomized controlled trial. METHODS Patients with grade 4.0 to 6.9 senile cataract were randomized to 2 groups. Group A had lower frequency (28 kHz) phacoemulsification, and Group B had higher frequency (42 kHz) phacoemulsification. The effective phacoemulsification time (EPT) and estimated fluid usage (EFU) were compared intraoperatively. The endothelial parameters were assessed over 1 year. RESULTS Both groups comprised 80 patients. The groups were matched for age (P = .533), sex (P = .263), and nuclear grade (nuclear color, P = .496; nuclear opalescence, P = .622). Group B had significant reductions in EPT (P = .008) and EFU (P = .004) compared with Group A. Postoperatively, the endothelial cell density (ECD) was significantly higher in Group B at 1 month (P = .004), 3 months (P = .003), 6 months (P = .004), 9 months (P = .002), and 1 year (P = .003). The percentages of ECD loss were also significantly lower in Group B; the difference was statistically significant up to 1 year postoperatively even after adjustments for age, grade of cataract, EPT, and EFU. CONCLUSION Higher frequency phacoemulsification was associated with a lower EPT and EFU as well as better endothelial preservation than a lower frequency.
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Rouhbakhshzaeri M, Rabiee B, Azar N, Ghahari E, Putra I, Eslani M, Djalilian AR. New ex vivo model of corneal endothelial phacoemulsification injury and rescue therapy with mesenchymal stromal cell secretome. J Cataract Refract Surg 2019; 45:361-366. [PMID: 30527441 PMCID: PMC6409103 DOI: 10.1016/j.jcrs.2018.09.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 09/07/2018] [Accepted: 09/26/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE To develop a reproducible ex vivo model of corneal endothelial cell injury using phacoemulsification in porcine eyes and to evaluate the effects of mesenchymal stromal cell secretome in this injury model. SETTING Department of Ophthalmology, University of Illinois at Chicago, Illinois, USA. DESIGN Experimental study. METHODS A corneal endothelial injury model was optimized using different powers and durations of ultrasound energy inside ex vivo porcine eyes. Conditioned media from corneal mesenchymal stem cells was collected under serum-free conditions from passages 4 to 6. Immediately after the phacoemulsification injury, the anterior chamber fluid was replaced with unconditioned media or conditioned media and incubated at 37°C for 4 hours. At the end, endothelial cell viability was evaluated using trypan blue staining and analyzed with ImageJ software. RESULTS Using specific parameters (50% power for 30 seconds), phacoemulsification inside fresh porcine eyes led to a consistent level of endothelial cell injury. Incubation with corneal mesenchymal stromal cell-conditioned media after the injury significantly reduced endothelial cells loss compared with unconditioned media (mean 1.29% ± 0.91% [SD] and 5.33% ± 3.24%, respectively, P < .05). CONCLUSIONS Phacoemulsification inside fresh porcine eyes provided a reproducible model to study endothelial cell injury. Treatment with corneal mesenchymal stromal cell secretome after injury appeared to significantly enhance the survival of corneal endothelial cells. This might provide a new strategy for preventing corneal endothelial cell loss after phacoemulsification or other endothelial injuries. Further in vivo studies are necessary to determine the therapeutic potential.
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Affiliation(s)
- Majid Rouhbakhshzaeri
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Illinois, USA
| | - Behnam Rabiee
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Illinois, USA
| | - Nathalie Azar
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Illinois, USA
| | - Elham Ghahari
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Illinois, USA
| | - Ilham Putra
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Illinois, USA
| | - Medi Eslani
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Illinois, USA
| | - Ali R Djalilian
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Illinois, USA.
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Tsorbatzoglou A, Módis L, Kertész K, Németh G, Berta A. Comparison of Divide and Conquer and Phaco-Chop Techniques during Fluid-Based Phacoemulsification. Eur J Ophthalmol 2018; 17:315-9. [PMID: 17534809 DOI: 10.1177/112067210701700306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To determine whether, similar to ultrasound phaco-emulsification, applied energy and surgery time decrease using phaco-chop nucleus fragmentation method compared to divide and conquer technique using the fluid-based system. METHODS This prospective, comparative, randomized clinical study included patients with cataract who were randomly assigned to use either standard divide and conquer technique (25 eyes of 25 patients, Group 1) or Nagahara phaco-chop maneuver (25 eyes of 25 patients, Group 2) during fluid-based phaco-emulsification. Surgical parameters were recorded and patients were examined 1 day, 10 days, and 1 month after surgery. Statistical analyses were performed using the paired test of Wilcoxon. RESULTS Fluid-based time, mean fluid-based magnitude, effective fluid-based time, and the number of pulses were significantly less using phaco-chop technique compared to divide and conquer method (p<0.001). Surgery time was similar using the two nucleofractis techniques (p=0.97). Visual acuities showed no statistical differences between the two groups (p>0.05). CONCLUSIONS Nuclear fragmentation can be performed with Nagahara phaco-chop technique using the fluid-based system as well. The applied fluid-based energy decreases compared to divide and conquer method. However, surgery time is not reduced due to the difficulties reaching the full occlusion necessary to hold the nucleus during the chop maneuver.
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Affiliation(s)
- A Tsorbatzoglou
- Department of Ophthalmology, Medical and Health Science Center, Univ of Debrecen, Debrecen, Hungary.
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Kim YN, Lee JA, Kim JY, Kim MJ, Tchah HW. Clinical Effects of an Improved Pump Reaction Rate and Automatic Occlusion Sensing System in Phacoemulsification. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.11.1017] [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)
- You Na Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Ah Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Yong Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Myoung Joon Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hung Won Tchah
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Deshpande A, Smith GWG, Smith AJ. Biofouling of surgical power tools during routine use. J Hosp Infect 2015; 90:179-85. [PMID: 25922337 DOI: 10.1016/j.jhin.2015.03.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 03/04/2015] [Indexed: 02/05/2023]
Abstract
Surgical power tools (SPTs) are frequently used in many surgical specialties such as dentistry, orthopaedics, ophthalmology, neurology, and podiatry. They have complex designs that may restrict access to cleaning and sterilization agents and frequently become contaminated with microbial and tissue residues following use. Due to these challenges, surgical power tools can be considered the weak link in the decontamination cycle and present a potential for iatrogenic transmission of infection. We aimed to review the existing literature on the decontamination of surgical power tools and associated iatrogenic transmission of infection. A search of the medical literature was performed using Ovid online using the following databases: Ovid Medline 1950-2014, Embase 1980-2014, and EBM Reviews Full Text--Cochrane DSR, ACP Journal Club, and Dare. Despite challenges to decontamination processes, reported episodes of iatrogenic infection directly linked to SPTs appear rare. This may reflect a true picture but more likely represents incomplete reporting, failure to investigate power tools, or lack of surveillance linking surgical site infections (SSIs) to power tools. Healthcare professionals should be aware of the complexities associated with the decontamination of different SPTs, and should review manufacturers' reprocessing instructions prior to purchase. More clarity is required in the manufacturers' validation of these reprocessing instructions. This particularly applies to the emerging surgical robot systems that present extreme challenges to decontamination between uses. Investigation of cross-infection incidents or SSI surveillance should include an element of assessment of SPT decontamination to further elucidate the contribution of SPTs to skin and soft tissue infections.
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Affiliation(s)
- A Deshpande
- Medical Microbiology Department, Southern General Hospital, Glasgow, UK.
| | - G W G Smith
- Infection and Immunity Group, Glasgow Dental School, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - A J Smith
- Infection and Immunity Group, Glasgow Dental School, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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Zacharias J. Thermal characterization of phacoemulsification probes operated in axial and torsional modes. J Cataract Refract Surg 2015; 41:208-16. [DOI: 10.1016/j.jcrs.2014.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 06/24/2014] [Accepted: 06/25/2014] [Indexed: 11/26/2022]
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Maalej A, Khallouli A, Wathek C, Rannen R. Ozil® versus conventional ultrasound phacoemulsification: a randomized comparative study. Int Ophthalmol 2014; 35:565-8. [PMID: 25155201 DOI: 10.1007/s10792-014-9984-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 07/26/2014] [Indexed: 11/30/2022]
Abstract
The purpose of this study is to compare and assess the performance and the postoperative outcomes of torsional mode and ultrasound (US) mode performed in the phacoemulsification of cataract with different nuclear densities. This is a randomized comparative clinical study. Two groups of 75 eyes (the first operated by Ozil(®) and the second by US) were comparable in age, gender, cataract density, corneal incision size, and intraocular lens type. We assessed peroperative parameters: US time (UST) and cumulative dissipated energy (CDE). Postoperative outcome measures were corneal edema and final best-corrected visual acuity. The UST was significantly lower in the ozil(®) group for all nucleus grades (73.43 s ± 8.3 with US vs. 46.02 s ± 23 with Ozil(®)) (p = 0.0003). The CDE was lower in the Ozil(®) group for grade III and IV cataract (p = 0.005). However, no significant difference was noted for grade II cataract (p = 0.07). Immediate postoperative corneal edema was significantly harder in the US group (p = 0.00002). The mean one month postoperative visual acuity was 0.2 ± 0.03 logMAR and 0.15 ± 0.07 logMAR, respectively, in the US group and the Ozil(®) group (p = 0.06). Ozil(®) mode seems to dissipate less energy in the eye than US mode. The visual outcome at one month is comparable in the two groups.
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Affiliation(s)
- Afef Maalej
- Department of Ophthalmology, Military Hospital of Tunis, Montfleury, 1008, Tunis, Tunisia,
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Assaf A, Roshdy MM. Comparative analysis of corneal morphological changes after transversal and torsional phacoemulsification through 2.2 mm corneal incision. Clin Ophthalmol 2013; 7:55-61. [PMID: 23326184 PMCID: PMC3544352 DOI: 10.2147/opth.s39019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose This paper compares and evaluates the corneal morphological changes occurring after cataract surgery through a 2.2 mm corneal incision. We use two platforms for comparison and evaluation, transversal and torsional phacoemulsification. Patients and methods This study includes 139 consecutive cataractous eyes (nuclear color 2–4, according to the Lens Opacities Classification System III [LOCSIII]) of 82 patients undergoing cataract surgery through a 2.2 mm corneal incision. Two different phacoemulsification platforms were used and assigned randomly: we used the WhiteStar Signature® system with the Ellips™ FX transversal continuous ultrasound (US) mode for group I (mean age: 65.33 ± 6.97 years), and we used the Infiniti® system with the OZil® Intelligent Phaco (IP) torsional US mode for group II (mean age: 64.02 ± 7.55 years). The corneal endothelium and pachymetry were evaluated preoperatively and at 1 month postoperatively. Incision size changes were also evaluated. Results All surgeries were uneventful. Before intraocular lens implantation, the mean incision size was 2.24 ± 0.06 mm in both groups (P = 0.75). In terms of corneal endothelial cell density, neither preoperative (I vs II: 2304.1 ± 122.5 cell/mm2 vs 2315.6 ± 83.1 cell/mm2, P = 0.80) nor postoperative (I vs II: 2264.1 ± 124.3 cell/mm2 vs 2270.3 ± 89.9 cell/mm2, P = 0.98) differences between the groups were statistically significant. The mean endothelial cell density loss was 1.7% ± 1.6% and 2.0% ± 1.4% in groups I and II, respectively. Furthermore, no significant differences between groups I and II were found preoperatively (P = 0.40) and postoperatively (P = 0.68) in central pachymetry. With surgery, the mean increase in central pachymetry was 28.1 ± 23.6 μm and 24.0 ± 24.0 μm in groups I and II, respectively (P = 0.1). Conclusion Ellips™ FX transversal and OZil® IP torsional phacoemulsification modes are safe for performing cataract surgery, inducing minimal corneal thickness and endothelial changes.
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Affiliation(s)
- Ahmed Assaf
- Ophthalmology Department, Ain Shams University, Cairo, Egypt
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Shin KS, Lee JE, Choi SH. Influences on Astigmatism and Corneal Endothelium Using Two Different Incision Sizes and Mode of Phacoemulsification. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.2.237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Kyung Sup Shin
- Department of Ophthalmology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jong Eun Lee
- Department of Ophthalmology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Si Hwan Choi
- Department of Ophthalmology, Chungnam National University School of Medicine, Daejeon, Korea
- Chungnam National University Research Institute for Medical Sciences, Daejeon, Korea
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Reuschel A, Bogatsch H, Wiedemann R. Long-Term Comparison of Endothelial Changes Between Torsional and Longitudinal Phacoemulsification. ASIA-PACIFIC JOURNAL OF OPHTHALMOLOGY (PHILADELPHIA, PA.) 2012; 1:152-7. [PMID: 26107331 DOI: 10.1097/apo.0b013e31825385d8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The objective of this study was to evaluate endothelial changes between torsional and longitudinal phacoemulsification 2 years after cataract surgery. DESIGN This was a prospective, randomized, controlled clinical trial. METHODS We enrolled 200 patients with senile cataract between August 2008 and December 2009 for surgery using either torsional (group A, n = 100) or longitudinal (group B, n = 100) phacoemulsification. Outcomes were central endothelial cell density and corrected distance visual acuity (CDVA) 3 months and in this follow-up 2 years after surgery. Statistical evaluation of endothelial cell loss (ECL) was performed according to statistical guidelines by creating a primary analysis (substitution of missing values by the median) and a secondary analysis (actual data). RESULTS The mean age was 71 (SD, 7.3) years. We were able to reexamine 46 patients in group A and 54 in group B 2 years after surgery. The median CDVA before surgery was 0.3 logMAR in group A and 0.35 logMAR in group B, improving to 0 logMAR postoperatively in both groups. The median ECL in the primary analysis was 6.9% after 3 months and 10.3% 2 years after surgery in group A. In group B, we found a loss of 6.6% after 3 months and 8.6% 2 years postoperatively. In the secondary analysis, the loss was 10.0% in group A and 8.5% in group B after 2 years. The difference was statistically not significant. CONCLUSIONS There is no difference between the ECL between torsional and longitudinal phacoemulsification up to 2 years after cataract surgery.
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Affiliation(s)
- Anna Reuschel
- From the *Department of Ophthalmology and †Clinical Trial Centre, University of Leipzig, Leipzig, Germany
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15
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Stroke dynamics and frequency of 3 phacoemulsification machines. J Cataract Refract Surg 2012; 38:333-42. [DOI: 10.1016/j.jcrs.2011.07.041] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 07/14/2011] [Accepted: 07/14/2011] [Indexed: 11/23/2022]
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Park YG, Chung SH, Joo CK. Comparison of microcoaxial with standard clear corneal incisions in torsional handpiece cataract surgery. ACTA ACUST UNITED AC 2011; 227:55-9. [PMID: 21832823 DOI: 10.1159/000329599] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 05/20/2011] [Indexed: 11/19/2022]
Abstract
AIM To evaluate the effect of torsional handpiece incision size on phacodynamics and endothelial cell loss (ECL) in cataract surgery. DESIGN Prospective, observer-masked study at the Department of Ophthalmology and Visual Science, Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea. PARTICIPANTS This study was conducted on 60 eyes of 60 patients who underwent phacoemulsification. METHODS Cataract surgery was performed on 28 eyes using a 0.9-mm micro 45-degree Kelman ABS (aspiration bypass system) tip through a 2.8-mm standard incision, and on 32 eyes using a 0.9-mm mini-flared 45-degree Kelman ABS tip through a 2.2-mm microcoaxial incision. As main outcome measures, intraoperative phacodynamics (cumulative dissipated energy, CDE, and balanced salt solution, BSS, use), central corneal thickness (CCT) and endothelial cell count (ECC) were investigated. RESULTS The CDE was lower in the microcoaxial incision (2.2-mm) group than in the standard incision (2.8-mm) group (p = 0.038). The ECC loss at 6 months was significantly lower in the microcoaxial incision group than in the standard incision group (p = 0.048). There were no differences in BSS use or CCT between the two groups. CONCLUSIONS Torsional ultrasound phacoemulsification using microcoaxial incision with a mini-flared tip resulted in less energy use and less ECL compared with standard incision with a micro tip.
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Affiliation(s)
- Young-Gun Park
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Ratnarajan G, Packard R, Ward M. Combined occlusion-triggered longitudinal and torsional phacoemulsification during coaxial microincision cataract surgery: Effect on 30-degree mini-flared tip behavior. J Cataract Refract Surg 2011; 37:825-9. [PMID: 21440411 DOI: 10.1016/j.jcrs.2010.11.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 11/16/2010] [Accepted: 11/17/2010] [Indexed: 10/18/2022]
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Lee JE, Choi SH. Comparison of Clinical Results between Ellips and Ozil Modes in Phacoemulsification. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2011. [DOI: 10.3341/jkos.2011.52.10.1161] [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)
- Jong Eun Lee
- Department of Ophthalmology, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Si Hwan Choi
- Department of Ophthalmology, College of Medicine, Chungnam National University, Daejeon, Korea
- Chungnam National University Research Institute for Medical Sciences, Daejeon, Korea
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Reuschel A, Bogatsch H, Barth T, Wiedemann R. Comparison of endothelial changes and power settings between torsional and longitudinal phacoemulsification. J Cataract Refract Surg 2010; 36:1855-61. [PMID: 21029892 DOI: 10.1016/j.jcrs.2010.06.060] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 06/15/2010] [Accepted: 06/15/2010] [Indexed: 11/18/2022]
Abstract
PURPOSE To compare the intraoperative and postoperative outcomes of conventional longitudinal phacoemulsification and torsional phacoemulsification. SETTING Department of Ophthalmology, University of Leipzig, Germany. DESIGN Randomized single-center clinical trial. METHODS Eyes with senile cataract were randomized to have phacoemulsification using the Infiniti Vision System and the torsional mode (OZil) or conventional longitudinal mode. Primary outcomes were corrected distance visual acuity (CDVA) and central endothelial cell density (ECD), calculated according to the Conference on Harmonisation-E9 Guidelines in which missing values were substituted by the median in each group (primary analysis) and the loss was then calculated using actual data (secondary analysis). Secondary outcomes were ultrasound (US) time, cumulative dissipated energy (CDE), and percentage total equivalent power in position 3. Postoperative follow-up was at 3 months. RESULTS The mean preoperative CDVA was 0.41 logMAR in the torsional group and 0.38 logMAR in the longitudinal group, improving to 0.07 logMAR postoperatively in both groups. The mean ECD loss was 7.2% ± 4.6% in the torsional group (72 patients) and 7.1% ± 4.4% in the longitudinal group (76 patients), with no statistically significant differences in the primary analysis (P = .342) or secondary analysis (P = .906). The mean US time, CDE, and percentage total equivalent power in position 3 were statistically significantly lower in the torsional group (98 patients) than in the longitudinal group (94 patients) (P<.001). CONCLUSION The torsional mode was as safe as the longitudinal mode in phacoemulsification for age-related cataract.
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Affiliation(s)
- Anna Reuschel
- Department of Ophthalmology, University of Leipzig, Leipzig, Germany
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Aust SD, Hebdon T, Humbert J, Dimalanta R. Hydroxyl free radical production during torsional phacoemulsification. J Cataract Refract Surg 2010; 36:2146-9. [PMID: 21111319 DOI: 10.1016/j.jcrs.2010.06.063] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 06/16/2010] [Accepted: 06/21/2010] [Indexed: 11/28/2022]
Abstract
PURPOSE To quantitate free radical generation during phacoemulsification using an ultrasonic phacoemulsification device that includes a torsional mode and evaluate tip designs specific to the torsional mode. SETTING Chemistry and Biochemistry Department, Utah State University, Logan, Utah, USA. DESIGN Experimental study. METHODS Experiments were performed using the Infiniti Vision System and OZil handpiece. Hydroxyl radical concentrations in the aspirated irrigation solution during torsional phacoemulsification were quantitated as nanomolar malondialdehyde (nM MDA) and determined spectrophotometrically using the deoxyribose assay. RESULTS The mean free radical production during phacoemulsification with torsional modality at 100% amplitude was 30.1 nM MDA ± 5.1 (SD) using a 0.9 mm 45-degree Kelman tapered ABS tip. With other tip designs intended for use with the torsional modality, free radical production was further reduced when fitted with the 0.9 mm 45-degree Kelman mini-flared ABS tip (13.2 ± 5.6 nM MDA) or the 0.9 mm 45-degree OZil-12 mini-flared ABS tip (14.3 ± 6.7 nM MDA). Although the measurements resulting from the use of the latter 2 tips were not statistically significantly different (P ≈ .25), they were different from those of the tapered tip (P<.0001). CONCLUSIONS The MDA concentration in the aspirated irrigation solution using the torsional modality was approximately one half that reported for the handpiece's longitudinal modality in a previous study using the same bent-tip design (Kelman tapered, P<.0001). The level of MDA was further reduced approximately one half with torsional-specific tips.
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Affiliation(s)
- Steven D Aust
- Chemistry and Biochemistry Department, Utah State University, Logan, Utah 84322-0300, USA.
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Yeniad B, Corum I, Ozgun C. The effects of blunt trauma and cataract surgery on corneal endothelial cell density. Middle East Afr J Ophthalmol 2010; 17:354-8. [PMID: 21180438 PMCID: PMC2991455 DOI: 10.4103/0974-9233.71604] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
PURPOSE This study was designed to investigate the effects of trauma and cataract surgery on corneal endothelial cell density (ECD) in patients with a traumatic cataract due to blunt trauma without globe laceration. MATERIALS AND METHODS In this prospective study, 31 subjects with traumatic cataract (traumatic cataract group) and 30 subjects with a senile cataract (control group) were enrolled. The subjects with traumatic cataract were subdivided into two groups: uncomplicated surgery subgroup (n = 19) in which subjects underwent standard phacoemulsification with intraocular lens implantation and complicated surgery subgroup (n = 12) in which subjects underwent cataract surgery other than standard phacoemulsification. The ECD of the traumatic cataract group and the control group was compared preoperatively and at 3 months or later postoperatively. A P value less than 0.05 was considered statistically significant. RESULTS The ECD in the eyes with traumatic cataract was 13.1% lower than that for healthy eyes preoperatively (P = 0.043). Postsurgical ECD decreased by 16.7% in complicated surgery subgroup and 11.9% in uncomplicated surgery subgroup (P = 0.049) after 3 months postoperatively. The ECD decreased by 10.8% in the control group (P = 0.489). CONCLUSIONS Patients with cataracts due to blunt trauma had a decreased endothelial cell count, which was significantly aggravated by cataract surgery. The loss of corneal endothelium cells due to surgery depends on the surgical approach.
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Affiliation(s)
- Baris Yeniad
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Isik Corum
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Cahit Ozgun
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Wang Y, Xia Y, Zeng M, Liu X, Luo L, Chen B, Liu Y, Liu Y. Torsional ultrasound efficiency under different vacuum levels in different degrees of nuclear cataract. J Cataract Refract Surg 2009; 35:1941-5. [DOI: 10.1016/j.jcrs.2009.05.055] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2009] [Revised: 05/12/2009] [Accepted: 05/26/2009] [Indexed: 11/28/2022]
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Han YK, Miller KM. Heat production: Longitudinal versus torsional phacoemulsification. J Cataract Refract Surg 2009; 35:1799-805. [PMID: 19781477 DOI: 10.1016/j.jcrs.2009.04.046] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Revised: 04/19/2009] [Accepted: 04/29/2009] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the heat production of longitudinal versus torsional phacoemulsification under strict laboratory test conditions. SETTING Department of Ophthalmology, David Geffen School of Medicine at UCLA, and Jules Stein Eye Institute, Los Angeles, California, USA. METHODS Two Infiniti phacoemulsification handpieces were inserted into silicone test chambers filled with a balanced salt solution and imaged serially using a thermal camera. Incision compression was simulated by suspending 25.3 g weights from the silicone chambers. To simulate occlusion of the phacoemulsification tip, the aspiration line was clamped. Peak temperatures were measured 0, 10, 30, 60, and 120 seconds after the commencement of continuous ultrasound power. The 2 handpieces, operating exclusively in longitudinal or torsional modes, were compared 3 ways: (1) using the same power displayed on the instrument console, (2) using identical stroke lengths, and (3) using the same applied energy, a product of stroke length and frequency. RESULTS For all 3 comparisons, torsional phacoemulsification resulted in lower temperatures at each time point. At the same displayed power setting, the scenario most familiar to cataract surgeons, longitudinal phacoemulsification elevated temperatures up to 41.5 degrees C more than torsional phacoemulsification. CONCLUSIONS Torsional phacoemulsification generated less heat than longitudinal phacoemulsification in all 3 comparison tests. Lower operating temperatures indicate lower heat generation within the same volume of fluid, and this may provide additional thermal protection during cataract surgery.
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Affiliation(s)
- Young Keun Han
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, and the Jules Stein Eye Institute, Los Angeles, California 90095-7002, USA
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Rękas M, Montés-Micó R, Krix-Jachym K, Kluś A, Stankiewicz A, Ferrer-Blasco T. Comparison of torsional and longitudinal modes using phacoemulsification parameters. J Cataract Refract Surg 2009; 35:1719-24. [PMID: 19781466 DOI: 10.1016/j.jcrs.2009.04.047] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 03/18/2009] [Accepted: 04/16/2009] [Indexed: 10/20/2022]
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Baradaran-Rafii A, Rahmati-Kamel M, Eslani M, Kiavash V, Karimian F. Effect of hydrodynamic parameters on corneal endothelial cell loss after phacoemulsification. J Cataract Refract Surg 2009; 35:732-7. [PMID: 19304097 DOI: 10.1016/j.jcrs.2008.12.017] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Revised: 12/17/2008] [Accepted: 12/17/2008] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the effect of power, vacuum, and flow rate on endothelial cell loss after phacoemulsification. SETTING Labbafinejad Medical Center Medical Center, Tehran, Iran. METHODS In a prospective randomized clinical trial, phacoemulsification was performed in 2 groups (high vacuum and low vacuum) with 3+ nuclear sclerosis. The stop-and-chop technique was used with the Sovereign machine. Machine parameters during the chop stage were vacuum 400 mm Hg in the high-vacuum group and 200 mm Hg in the low-vacuum group and flow rate, 40 cc/min and 20 cc/min, respectively. Endothelial cell density preoperatively before and 1, 6, and 12 weeks postoperatively were compared. RESULTS Each group comprised 30 eyes. The mean US power was 9.2% +/- 4.3% (SD) in the low-vacuum group and 13.1% +/- 4.6% in the high-vacuum group (P = .001) and the mean phaco time, 1.28 +/- 1.0 minutes and 0.88 +/- 0.6 minutes, respectively (P = .04). Total US energy and total fluid consumed were similar between groups. After 12 weeks, the mean endothelial cell loss was 9.0% +/- 4.0% in the low-vacuum group and 9.6% +/- 4.6% in the high-vacuum group (P = .6). There was a relationship between total US energy and endothelial loss (P<.001); however, total fluid volume was not a significant predictor (P = .19). CONCLUSIONS Vacuum level did not have a significant effect on total US energy or total fluid consumed during phacoemulsification. There was a strong relationship between total US energy and endothelial cell loss but not between total infused fluid and endothelial cell loss.
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Affiliation(s)
- Alireza Baradaran-Rafii
- Department of Ophthalmology and Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University, Tehran, Iran
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Oh TH, Lee SJ, Kim HS. Clinical Outcomes of Cataract Surgery Using Torsional Mode Phacoemulsification and Soft Shell Technique. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2009. [DOI: 10.3341/jkos.2009.50.9.1313] [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)
- Tae-Hoon Oh
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, St. Mary's Hospital, Seoul, Korea
| | - Seung-Jin Lee
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, St. Mary's Hospital, Seoul, Korea
| | - Hyun Seung Kim
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, St. Mary's Hospital, Seoul, Korea
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Chung HJ, Kim HS. Comparison of Clinical Results Between OZil® Mode and Hyperpulse Mode in Phacoemulsification. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2009. [DOI: 10.3341/jkos.2009.50.3.347] [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)
- Hye Jin Chung
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Seung Kim
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Comparison of a torsional handpiece through microincision versus standard clear corneal cataract wounds. J Cataract Refract Surg 2008; 34:2091-5. [PMID: 19027565 DOI: 10.1016/j.jcrs.2008.08.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Accepted: 08/12/2008] [Indexed: 11/21/2022]
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Liu Y, Zeng M, Liu X, Luo L, Yuan Z, Xia Y, Zeng Y. Torsional mode versus conventional ultrasound mode phacoemulsification: randomized comparative clinical study. J Cataract Refract Surg 2007; 33:287-92. [PMID: 17276271 DOI: 10.1016/j.jcrs.2006.10.044] [Citation(s) in RCA: 143] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2006] [Accepted: 10/15/2006] [Indexed: 11/21/2022]
Abstract
PURPOSE To compare the intraoperative and short-term postoperative outcomes of cataract surgery performed with torsional mode and conventional ultrasound mode using the Infiniti Vision System (Alcon Laboratories). SETTING Cataract Service, Zhongshan Ophthalmic Center, Sun-Yat-Sen University, Guangzhou, China. METHODS In this randomized comparative study, 525 eyes were assigned to phacoemulsification by torsional mode or conventional ultrasound (US) mode. The surgery was performed by an experienced surgeon, and the outcomes were evaluated by an examiner who was masked to treatment assignments. Primary outcome measures were US time (UST), cumulative dissipated energy (CDE), and surgical complications. Patients were seen 1, 7, and 30 days after surgery. Postoperative outcome measures were the final best corrected visual acuity (BCVA) and the change in corneal clarity, central corneal thickness (CCT), and endothelial cell count. RESULTS The US group had 262 eyes and the torsional group, 263 eyes. All patients completed the follow-up visits. In the eyes with nucleus density grades of 1, 2, 3, and 4, the mean UST was 10.25 seconds +/- 7.4 (SD), 25.14 +/- 5.5 seconds, 36.45 +/- 8.3 seconds, and 61.44 +/- 17.8, respectively, in the US group and 8.32 +/- 6.8 seconds, 18.45 +/- 7.2 seconds, 29.48 +/- 12.4 seconds, and 48.39 +/- 20.3 seconds, respectively, in the torsional group (P<.001); the mean CDE was 1.25 +/- 0.5, 4.18 +/- 1.2, 8.59 +/- 6.5, and 16.51 +/- 9.6, respectively, in the US group and 0.94 +/- 0.3, 3.13 +/- 2.7, 7.47 +/- 12.6, and 14.08 +/- 8.3, respectively, in the torsional group (P<.001). At 1 day and 7 days, the mean BCVA was 0.23 +/- 0.12 logMAR and 0.00 +/- 0.10 logMAR, respectively, in the US group and 0.18 +/- 0.11 logMAR and -0.08 +/- 0.05 logMAR, respectively, in the torsional group (P<.001). At 30 days, the mean BCVA was -0.10 +/- 0.07 logMAR and -0.12 +/- 0.06 logMAR in the US group and the torsional group, respectively (P>.01). At 1 day and 7 days, the mean CCT was 625 +/- 80 microm and 568 +/- 37 microm, respectively, in the US group and 601 +/- 35 microm and 559 +/- 40 microm, respectively, in the torsional group (P<.001). At 30 days, the mean CCT was 531 +/- 30 microm in the US group and 529 +/- 39 microm in the torsional group (P>.01). At 7 days and 30 days, the mean central corneal endothelial cell count was 2135 +/- 858 cells/mm(2) and 2084 +/- 527 cells/mm(2), respectively, in the US group and 2004 +/- 656 cells/mm(2) and 1953 +/- 615 cells/mm(2), respectively, in the torsional group (P<.001). CONCLUSION The torsional mode may provide more effective lens removal with a lower level of phacoemulsification time and energy.
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Affiliation(s)
- Yizhi Liu
- Zhongshan Ophthalmic Center, Sun-Yat-Sen University, Guangzhou, China.
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Kim M, Lee SH, Lee HY, Chung SK. Comparison of Phacoemulsification Time: Oscillation Device versus Conventional Device. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2007. [DOI: 10.3341/jkos.2007.48.12.1649] [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)
- Min Kim
- Department of Ophthalmology Seoul Adventist Hospital, Seoul, Korea,
| | - Seung Hee Lee
- Department of Ophthalmology Seoul Adventist Hospital, Seoul, Korea,
| | - Hae Young Lee
- Department of Ophthalmology Seoul Adventist Hospital, Seoul, Korea,
| | - Sung Kun Chung
- Department of Ophthalmology and Visual Science, St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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Tsorbatzoglou A, Kertész K, Módis L, Németh G, Máth J, Berta A. Corneal endothelial function after phacoemulsification using the fluid-based system compared to conventional ultrasound technique. Eye (Lond) 2006; 21:727-32. [PMID: 16518360 DOI: 10.1038/sj.eye.6702314] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
AIM To quantitatively assess corneal endothelial changes after phacoemulsification with the fluid-based system compared to conventional ultrasound technique. METHODS This prospective, randomized clinical study included patients with cataract who were randomly assigned either to have phacoemulsification with the fluid-based system (30 eyes of 30 patients--Group 1) or with traditional ultrasound (30 eyes of 30 patients--Group 2). Patients who were available at each follow-up visit (25 eyes in both groups) were enrolled in the statistical analysis. Endothelial function was evaluated by measuring central corneal thickness, central endothelial cell density (ECD), mean cell size, and coefficient of variation in cell size preoperatively, 10 days, 1 and 3 months, and 1 year after surgery. Statistical analyses were performed using two-way repeated measure ANOVA. RESULTS An acute, reversible increase of central corneal thickness (CCT) was found 10 days after surgery, which was similar in both groups (P=0.35). ECD decreased, whereas mean cell size increased significantly immediately after surgery. However, the impairments were finished after 1 month. The alterations were similar in both groups (ECD: P=0.99; mean cell size: P=0.85). The coefficient of variation in cell size remained stable after surgery (P=0.08), and significant difference was not found between groups (P=0.99). The endothelial cell loss (ECL) was 6.5+/-8.4% in Group 1 and 6.5+/-11.7% in Group 2 (P=0.69). CONCLUSIONS Corneal endothelial changes were similar using the fluid-based system compared to the traditional ultrasound technique. The fluid-based method proved to be as safe as conventional ultrasound in cataract surgery.
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Affiliation(s)
- A Tsorbatzoglou
- Department of Ophthalmology, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary.
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Abstract
PURPOSE OF REVIEW Corneal decompensation after cataract surgery can occur in patients with Fuchs' endothelial dystrophy. This paper reviews the pathogenesis of corneal edema in Fuchs' dystrophy, the preoperative and perioperative risk factors for corneal endothelial cell loss during cataract surgery, and indications for cataract surgery alone or cataract surgery combined with keratoplasty for patients with visually significant cataracts and Fuchs' dystrophy. RECENT FINDINGS Accelerated loss of corneal endothelial cells in Fuchs' dystrophy is multifactorial, with apoptosis and altered gene regulation of aquaporin proteins playing a role. Preoperative factors contributing to decreased endothelial cell count include age, sex, diabetes, a history of ocular trauma or inflammation, and contact lens wear. Intra-operative measures shown to protect endothelial cells include the use of the soft-shell viscoelastic technique for very dense cataracts, efficient cataract removal techniques (phaco-chop, use of oscillatory handpiece), and surgery by an experienced surgeon. A triple procedure should be performed with preoperative corneal epithelial decompensation and considered with preoperative pachymetry greater than 640 mum. Otherwise, it is reasonable to attempt cataract surgery alone with proper patient education. SUMMARY Fuchs' dystrophy is a progressive disorder. Cataract surgery in the setting of Fuchs' dystrophy can be performed successfully, especially when the surgeon is aware of the preoperative and intraoperative factors that affect the number of functioning endothelial cells. All patients should be aware of the progressive nature of this disease and the possibility of keratoplasty at some point in their lifetime.
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Affiliation(s)
- Gerami D Seitzman
- Department of Cornea, External Diseases, and Uveitis, Sinai Hospital of Baltimore, Maryland 21215, USA.
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