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Rana K, Bahrami B, van Zyl L, Esterman A, Goggin M. Efficacy of intracameral antibiotics following manual small incision cataract surgery in reducing the rates of endophthalmitis: A meta-analysis. Clin Exp Ophthalmol 2021; 49:25-37. [PMID: 33426771 DOI: 10.1111/ceo.13890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/20/2020] [Accepted: 11/27/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Manual small incision cataract surgery (MSICS) is a widely used technique for cataract surgery in the developing world. Higher rates of postoperative endophthalmitis have been reported with this technique compared with phaco-emulsification. The purpose of this study was to evaluate the efficacy of prophylactic intracameral (IC) antibiotics in reducing the rates of postoperative endophthalmitis following MSICS. METHODS Systematic review and meta-analysis of patients undergoing MSICS. A literature search in PubMed and EMBASE databases was performed to identify studies published from October 1992 to April 2020 evaluating MSICS with a minimum of 500 eyes reported. Two authors independently assessed eligibility, extracted data and assessed the risk of bias. Heterogeneity was assessed using the I2 test. RESULTS Twelve studies enrolling 1 494 307 eyes were included. IC antibiotics were used in 725 324 (48.5%) eyes. The risk ratio of developing endophthalmitis was 2.94 (95% CI, 1.07-8.12; P = .037) in eyes that did not receive IC antibiotics. CONCLUSIONS Routine use of IC antibiotics may help to reduce the rates of endophthalmitis following MSICS and significantly improve the safety of this effective form of cataract surgery.
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Affiliation(s)
- Khizar Rana
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Bobak Bahrami
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Lourens van Zyl
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Adrian Esterman
- Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Michael Goggin
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, South Australia, Australia.,Department of Ophthalmology, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
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Bilateral Phacoemulsification in an African Elephant ( Loxodonta africana). Case Rep Vet Med 2019; 2019:2506263. [PMID: 31380140 PMCID: PMC6652071 DOI: 10.1155/2019/2506263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/19/2019] [Indexed: 11/17/2022] Open
Abstract
A 37-year-old bull African elephant (Loxodonta africana) at the North Carolina Zoo (NCZ) was diagnosed with bilateral cataracts leading to behavioral changes and significant weight loss secondary to functional blindness. On initial examination, a weight loss of 234 kg, a mature cataract in the right eye, and a focal cataract in the left eye were diagnosed. Ultrasound and electroretinography (ERG) indicated normal retinal attachment and both eyes were viable candidates for surgery. After careful planning and behavioral training, the left cataract was surgically removed via phacoemulsification and irrigation/aspiration. The right eye subsequently developed a ventral lens subluxation, and phacoemulsification and irrigation/aspiration were performed six months after the first procedure. Four years after surgery, menace response, palpebral reflex, dazzle reflex, and pupillary light reflexes were present in both eyes. Body weight was 5,515 kg, 88kg more than at the time of the second surgery. This is the first published report of an African bull elephant undergoing bilateral cataract removal using phacoemulsification and irrigation/aspiration. The lack of significant postoperative inflammation and uneventful recovery of the elephant suggests that this surgical procedure along with proper preoperative planning and postoperative medical management can be a safe and effective treatment option for elephants with cataracts.
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Comparison of Cataract Surgery Techniques: Safety, Efficacy, and Cost-Effectiveness. Eur J Ophthalmol 2018; 24:520-6. [PMID: 24366765 DOI: 10.5301/ejo.5000413] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2013] [Indexed: 11/20/2022]
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Singh K, Misbah A, Saluja P, Singh AK. Review of manual small-incision cataract surgery. Indian J Ophthalmol 2017; 65:1281-1288. [PMID: 29208807 PMCID: PMC5742955 DOI: 10.4103/ijo.ijo_863_17] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Cataract surgery has undergone many changes with the size of incision progressively decreasing over time with an incision of 12.0 mm for intracapsular cataract extraction to 2.2–2.8 mm in phacoemulsification. However, phacoemulsification due to high cost and equipment maintenance cannot be employed widely in developing countries. Manual small-incision cataract surgery (MSICS) offers similar advantages with the merits of wider applicability, less time consuming, a shorter learning curve, and lower cost. MSICS can be performed in high-volume setups due to fast technique. Here, we review the various techniques, safety and efficacy of MSICS, and its progress and utility in developing and underdeveloped countries.
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Affiliation(s)
- Kamaljeet Singh
- Department of Ophthalmology, Regional Institute of Ophthalmology, Government M.D. Eye Hospital, Allahabad, Uttar Pradesh, India
| | - Arshi Misbah
- Department of Ophthalmology, Regional Institute of Ophthalmology, Government M.D. Eye Hospital, Allahabad, Uttar Pradesh, India
| | - Pranav Saluja
- Department of Ophthalmology, People's Medical College, Bhopal, Madhya Pradesh, India
| | - Arun Kumar Singh
- Department of Ophthalmology, Regional Institute of Ophthalmology, Government M.D. Eye Hospital, Allahabad, Uttar Pradesh, India
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Eslami Y, Mirmohammadsadeghi A. Comparison of surgically induced astigmatism between horizontal and X-pattern sutures in the scleral tunnel incisions for manual small incision cataract surgery. Indian J Ophthalmol 2016; 63:606-10. [PMID: 26458479 PMCID: PMC4652252 DOI: 10.4103/0301-4738.167113] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Two types of popular scleral tunnel sutures in the manual small incision cataract surgery (MSICS) are horizontal and X-pattern sutures. Surgically induced corneal astigmatism (SIA) is a useful indicator of the suturing effect. Aims: To compare SIA between horizontal and X-pattern sutures in the scleral tunnel incisions for MSICS. Design: Prospective, nonrandomized comparative trial. Materials and Methods: After superior scleral tunnel incision and capsulorhexis, the nucleus was prolapsed into the anterior chamber and delivered. The wound was sutured with either horizontal or X-pattern suture. The simulated keratometry values were derived from the corneal topography preoperatively and 1.5 and 3 months postoperatively. Statistical Analysis: The SIA was calculated by Cartesian coordinates based analysis. Results: Sixty-four patients (32 patients in each group) were included in the study. In the horizontal suture group, the SIA centroid values at 1.5 and 3 months after the surgery were 0.87 × 1° and 1.11 × 180°, respectively, showing induction of against-the-rule astigmatism. In the X-pattern suture group, the SIA centroid values at 1.5 and 3 months after the surgery were 0.61 × 97° and 0.66 × 92°, respectively, showing induction of mild with-the-rule astigmatism. The difference between the amount of SIA at 1.5 and 3 months after surgery was small. Conclusion: In the MSICS, the X-pattern sutures were preferred to the horizontal sutures in the patients without significant preoperative steepening in line with the central meridian of the incision. In the cases with significant preoperative steepening, sutureless surgery or horizontal sutures were preferred. Corneal astigmatism in the patients undergoing MSICS was stable at 1.5 months after the surgery.
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APHAKIC PHACOEMULSIFICATION AND AUTOMATED ANTERIOR VITRECTOMY, AND POSTRETURN MONITORING OF A REHABILITATED HARBOR SEAL (PHOCA VITULINA RICHARDSI) PUP. J Zoo Wildl Med 2015; 46:647-51. [PMID: 26352980 DOI: 10.1638/2014-0245.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A female harbor seal pup rescued along the coast of San Diego on 13 June 2012 was diagnosed with bilateral mature cataracts, apparently congenital, in association with vitreal herniation in the anterior chamber of each eye. The cataracts were surgically removed on 1 August 2012 with single-port aphakic phacoemulsification and automated anterior vitrectomy. Postoperative monitoring during the next several weeks indicated that vision had been functionally repaired and that she could visually orient to and capture live fish in three different environments and in the presence of other animals. Consequently, we equipped the seal with a satellite-linked radio transmitter and returned her to the Pacific Ocean on 21 November 2012, and then monitored her movements until radio contact ended on 2 March 2013. She remained along the San Diego coast from 21 November until 5 December 2012 when she relocated to the Coronado Islands and remained there until 26 December. She then traveled directly to San Clemente Island and remained foraging in the near-shore kelp beds there through 2 March 2013, when radio contact ended. To our knowledge, this is the first published report of cataract treatment in a marine mammal using high-frequency ultrasound to emulsify the lenses followed by suction removal of the emulsified microfragments (i.e., phacoemulsification). Moreover, the rapid postoperative recovery of the seal and its quick acclimation, orientation, navigation, and foraging in marine habitats after return to the Pacific Ocean indicates that these surgical procedures can be safe and effective treatments for cataracts in seals, with substantially reduced postsurgical complications relative to other types of lens fragmentation and removal procedures.
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Kulkarni C, U V. Extra Large Temporal Tunnel Cataract Extraction [ETCE]. J Clin Diagn Res 2014; 8:VC01-VC04. [PMID: 25386505 DOI: 10.7860/jcdr/2014/9704.4798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 06/26/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine the outcomes of extra large temporal sclero-corneal tunnel incision Cataract Surgery. MATERIALS AND METHODS This consecutive case series of eyes undergoing temporal tunnel cataract extraction with tunnel length of 8 to 10 mm was identified retrospectively. Surgical procedure details, follow up, complications, visual and astigmatic outcomes at 6wks were recorded and analysed. RESULTS Ninety six eyes with extra large tunnel incision were identified for analysis from a dataset of 670 manual small incision cataract surgery cases. 58% eyes had NO5 or denser cataracts. Intraoperative complications included, tunnel related problems (1 eye, 1.04%), bleeding into Anterior Chamber (10 eyes, 10.4%), Posterior Capsular Rent (2 eyes, 2.1%). Early postoperative complications included striate keratopathy (7 eyes, 7.3%). The mean Best Corrected Visual Acuity was 6/7.5 (0.1 logMAR) and 98% cases had Best Corrected Visual Acuity of 6/12 (0.3 logMAR) or better at 6wk. The aggregate Surgically Induced Astigmatism was 0.32D at 85(0). CONCLUSION Extra Large Tunnel of length 8 to 10 mm can be self sealing with low SIA. The complication rates and visual outcomes of ETCE are comparable to those of conventional MSICS. This method can be valuable in complicated cases and during learning period.
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Affiliation(s)
| | - Vivekanand U
- Associate Professor, Departmentof Ophthalmology, ASRAM Medical College , Andhra Pradesh, India
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Bayramlar H, Karadag R, Yildirim A, Cakici O, Sari U. Manual tunnel incision cataract surgery with sandwich technique may be a rationale alternative for mature cataracts. Indian J Ophthalmol 2014; 62:896-7. [PMID: 25230972 PMCID: PMC4185176 DOI: 10.4103/0301-4738.141073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Huseyin Bayramlar
- Department of Ophthalmology, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
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Bayramlar H, Karadag R, Yildirim A, Cakici O, Sari U. Manual tunnel incision cataract surgery with sandwich technique in eyes with microcornea. J Cataract Refract Surg 2014; 40:1058. [PMID: 24857457 DOI: 10.1016/j.jcrs.2014.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Indexed: 11/15/2022]
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Bayramlar H, Karadag R, Aydin B, Dag Y. A reasonable option in vitrectomized eyes: manual small incision cataract surgery. Int J Ophthalmol 2014; 7:181. [PMID: 24634888 DOI: 10.3980/j.issn.2222-3959.2014.01.34] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 07/19/2013] [Indexed: 11/02/2022] Open
Affiliation(s)
- Hüseyin Bayramlar
- Department of Ophthalmology, School of Medicine, Istanbul Medeniyet University, Goztepe, Istanbul 34000, Turkey
| | - Remzi Karadag
- Department of Ophthalmology, School of Medicine, Istanbul Medeniyet University, Goztepe, Istanbul 34000, Turkey
| | - Bahri Aydin
- Department of Ophthalmology, School of Medicine, Istanbul Medeniyet University, Goztepe, Istanbul 34000, Turkey
| | - Yaşar Dag
- Department of Ophthalmology, School of Medicine, Istanbul Medeniyet University, Goztepe, Istanbul 34000, Turkey
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Venkatesh R, Chang DF, Muralikrishnan R, Hemal K, Gogate P, Sengupta S. Manual Small Incision Cataract Surgery: A Review. ASIA-PACIFIC JOURNAL OF OPHTHALMOLOGY (PHILADELPHIA, PA.) 2012; 1:113-9. [PMID: 26107133 DOI: 10.1097/apo.0b013e318249f7b9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We aim at reviewing published peer-reviewed studies that evaluate the safety and efficacy of manual small incision cataract surgery (MSICS). Literature searches of the PubMed and the Cochrane Library databases were conducted with no date restrictions; the searches were limited to articles published in English only. All publications with at least level II and III evidence were studied and surgical techniques were analyzed. MSICS was also compared with phacoemulsification and large incision extracapsular cataract surgery (ECCE) with respect to visual outcome, surgery time, cost, intra and postoperative complications and suitability for high volume surgical practices in the developing world.The overall safety profile of MSICS was found to be excellent with intra and postoperative complication rates comparable to phacoemulsification and ECCE. Multiple studies reported the safety and efficacy of MSICS for complicated cases, such as brunescent and white cataract and cataracts associated with phacolytic and phacomorphic glaucoma. Compared to phacoemulsification MSICS was associated with lower and shorter operative times. Visual outcomes were excellent and comparable to phacoemulsification with up to 6 months follow up.The literature provides outcome analysis of a variety of different MSICS techniques. As a whole, MSICS provides excellent outcomes with a low rate of surgical and postoperative complications. Particularly in the developing world, MSICS appears to provide outcomes that are of comparable quality to phacoemulsification at a much lower cost.
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Affiliation(s)
- Rengaraj Venkatesh
- From the *Aravind Eye Hospital, Pondicherry, India; †The University of California, San Francisco, CA; ‡Cambridge Institute of Public Health, University of Cambridge, United Kingdom; §Dr. Gogate's Eye Clinic, Pune; and ¶Vision Research Foundation, Sankara Nethralaya, Chennai, India
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Phacoemulsification versus extracapsular cataract extraction: where do we stand? Curr Opin Ophthalmol 2011; 22:37-42. [DOI: 10.1097/icu.0b013e3283414fb3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kongsap P. Sutureless large-incision manual cataract extraction using the kongsap technique: outcome of a prospective study. Int J Ophthalmol 2010; 3:241-4. [PMID: 22553563 DOI: 10.3980/j.issn.2222-3959.2010.03.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Accepted: 08/28/2010] [Indexed: 11/02/2022] Open
Abstract
AIM To report the short- and medium-term outcomes of sutureless large-incision manual cataract extraction using the Kongsap (SLIMCE-K) technique. METHODS This prospective study included 73 eyes of 73 patients who underwent cataract surgery performed by using the SLIMCE-K technique. The postoperative visual acuity, intraoperative and postoperative complications, and endothelial cell loss were evaluated. A follow-up visit, at least 6 months after the surgery, was included in the study. RESULTS All patients had improved visual acuity after surgery. Uncorrected visual acuity (UCVA) was 6/18 or better in 55 eyes (75.3%) at 1 week postoperatively and in 64 eyes (87.6%) at 6 weeks postoperatively (P=0.09). The best corrected visual acuity (BCVA) was 6/18 or better in 67 eyes (91.8%) at 1 week postoperatively and in 70 eyes (95.9%) at 6 weeks postoperatively. The results remained stable at 3 months and 6 months postoperatively. No significant intraoperative complications were encountered. The endothelial cell loss was 4.8% at the 3-month follow-up examination. CONCLUSION When performed by an experienced surgeon, SLIMCE-K is a safe and effective procedure that can be performed independent of phacoemulsification machines. It can be used in any nuclear grading of cataract hardness that is common in developing countries.
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Affiliation(s)
- Pipat Kongsap
- Department of Ophthalmology, Prapokklao Hospital, Chanthaburi 22000, Thailand
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Kosakarn P. Double nylon loop for manual small-incision cataract surgery. J Cataract Refract Surg 2009; 35:422-4. [PMID: 19251132 DOI: 10.1016/j.jcrs.2008.10.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Revised: 10/21/2008] [Accepted: 10/23/2008] [Indexed: 12/01/2022]
Abstract
Manual small-incision cataract surgery using a double nylon loop technique is described. After capsulorhexis, hydrodissection, and hydrodelamination, the hard core of the nucleus is moved into the anterior chamber and divided into 3 pieces by a double nylon loop. Each piece is removed through a 4.0 to 4.5 mm corneal incision. The technique was safely performed in 120 eyes, with good results and few complications.
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Gogate PM. Small incision cataract surgery: Complications and mini-review. Indian J Ophthalmol 2009; 57:45-9. [PMID: 19075410 PMCID: PMC2661529 DOI: 10.4103/0301-4738.44512] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Accepted: 08/16/2007] [Indexed: 11/25/2022] Open
Abstract
This article reviews the literature on manual small incision cataract surgery (MSICS) and its complications. Various articles on MSICS published in indexed journals were reviewed, as well as the sections on complications of MSICS. The Pubmed search engine on the Internet was used to find out articles published since 1985 on MSICS in any language in indexed journals. Books published by Indian authors and the website of Indian Journal of Ophthalmology were also referred to. MSICS has become very popular technique of cataract surgery in India, and it is often used as an alternative to phacoemulsification. Studies on its efficacy and safety for cataract surgery show that, being a variant of extracapsular cataract surgery, MSICS also has similar intraoperative and postoperative complications. The considerable handling inside the anterior chamber during nucleus delivery increase the chances of iris injury, striate keratitis, and posterior capsular rupture. The surgeon has to be extra careful in the construction of the scleral tunnel and to achieve a good capsulorrhexis. Postoperative inflammation and corneal edema are rare if surgeons have the expertise and patience. The final astigmatism is less than that in the extracapsular cataract surgery and almost comparable to that in phacoemulsification. There is, however, a concern of posterior capsular opacification in the long term, which needs to be addressed. Although MSICS demands skill and patience from the cataract surgeon, it is a safe, effective, and economical alternative to competing techniques and can be the answer to tackle the large backlog of blindness due to cataract.
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Affiliation(s)
- Parikshit M Gogate
- Department of Pediatric Ophthalmology, Community Eye Care, Mohommadwadi, Hadapsar, Pune-411 028, India.
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Ravindra MS. Nucleus management in manual small incision cataract surgery by phacosection. Indian J Ophthalmol 2008; 57:41-3. [PMID: 19075409 PMCID: PMC2661521 DOI: 10.4103/0301-4738.44509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Nucleus management is critical in manual small incision cataract surgery (MSICS), as the integrity of the tunnel, endothelium and posterior capsule needs to be respected. Several techniques of nucleus management are in vogue, depending upon the specific technique of MSICS. Nucleus can be removed in toto or bisected or trisected into smaller segments. The pressure in the eye can be maintained at the desired level with the use of an anterior chamber maintainer or kept at atmospheric levels. In MSICS, unlike phacoemulsification, there is no need to limit the size of the tunnel or restrain the size of capsulorrhexis. Large well-structured tunnels and larger capsulorrhexis provide better control on the surgical maneuvers. Safety and simplicity of MSICS has made it extremely popular. The purpose of this article is to describe nucleus management by phacosection in MSICS.
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Bayramlar H, Hepsen IF, Yilmaz H. Mature cataracts increase risk of capsular complications in manual small-incision cataract surgery of pseudoexfoliative eyes. Can J Ophthalmol 2007. [DOI: 10.3129/can.j.ophthalmol.06-085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Dong X, Chen W, Wang H, Söderberg P. Forceps-guided nuclear cleavage cataract extraction. J Cataract Refract Surg 2002; 28:1320-4. [PMID: 12160798 DOI: 10.1016/s0886-3350(01)01313-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We introduce a manual nuclear fragmentation technique, forceps-guided nuclear cleavage. A 5.5 to 7.0 mm superior scleral incision is started 1.5 mm posterior to the limbus. Two additional 1.0 mm paracenteses are made at 3 and 9 o'clock in clear cornea close to the limbus. A continuous curvilinear capsulorhexis (CCC) is created; in most cases, 4 to 5 radial relaxing incisions are made in the CCC. The anterior and equatorial cortex and epinucleus are removed with 2-handed irrigation/aspiration via the 2 paracenteses with the nucleus in the capsular bag. The nucleus is prolapsed into the anterior chamber. A nucleus hook is inserted via the 3 o'clock paracentesis and applied to the 6 o'clock nuclear equator to hold the nucleus. A nucleus cleaving forceps is inserted through the upper incision to the 12 o'clock equator of the nucleus and advanced to one-third depth of the nucleus. The forceps is relaxed while the nucleus is cleaved in half.
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Affiliation(s)
- Xiuqin Dong
- Cataract Surgery Center, JiNan Municipal Central Hospital, ShanDong, China
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