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Potti S, Reddy Sodum N. Comparison of pupil expansion devices in small pupil phacoemulsification. Indian J Ophthalmol 2024; 72:S664-S668. [PMID: 38389262 PMCID: PMC11338422 DOI: 10.4103/ijo.ijo_1420_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: 05/31/2023] [Revised: 11/11/2023] [Accepted: 12/01/2023] [Indexed: 02/24/2024] Open
Abstract
PURPOSE To study the outcomes of phacoemulsification in small pupils (≤4 mm) using pupil expansion devices at a tertiary eye care center in South India. METHODS The study design is prospective, randomized, comparative, and interventional. Mechanical pupil dilatation with iris retractors (group I), B-HEX ring (group II), and Gupta ring (group III) was compared with respect to pupil size achieved (intraoperative), total surgical time, device addition time, complications, endothelial cell loss, and postoperative best corrected visual acuity. RESULTS Among 36 participants (12 in each group), the mean pupil size, total surgical time, and device addition time were maximum with iris retractors. Intraoperatively, sphincter tear was seen in two eyes in the iris retractors group and one eye in the Gupta ring group. In the B-HEX ring group, only two flanges of the ring could be engaged in two participants, one patient had iris bleeding (during stretching of the iris), and one patient had anterior lens capsular tear. Among all three groups, there was no statistically significant difference in best corrected visual acuity (BCVA), endothelial cell count, and coefficient of variation obtained in the preoperative period, postoperative Day 7 and Day 30, respectively. CONCLUSION In our study, in more than 50% of cases, the cause of small pupil was idiopathic/senile. Among nonidiopathic causes, PXF was the most common association. Although iris retractors are cost-effective and give maximum intraoperative dilatation, there is a need of four additional side ports to be made, thus increasing the total surgical time and device addition time. On the other hand, B-HEX and Gupta ring provide comparable intraoperative dilation and device addition time and also have comparable postoperative outcomes in terms of postoperative pupil size and complications.
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Affiliation(s)
- Sudhakar Potti
- Sankara Eye Hospital, Pedakakani, Guntur, Andhra Pradesh, India
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Kim H, Hwang SH, Eom Y, Nam DH. Improved visibility of illuminated chopper-assisted cataract surgery involving iris challenges. Indian J Ophthalmol 2023; 71:757-762. [PMID: 36872672 PMCID: PMC10229933 DOI: 10.4103/ijo.ijo_2723_22] [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: 10/17/2022] [Revised: 12/04/2022] [Accepted: 12/28/2022] [Indexed: 03/07/2023] Open
Abstract
Purpose The aim of this study was to evaluate the efficacy of the illuminated chopper-assisted cataract surgery in terms of shortening the surgical time and reducing the use of pupil expansion devices in eyes with iris challenges. Methods This was a retrospective case series of a university hospital. Four hundred forty-three eyes of 433 consecutive patients who underwent illuminated chopper-assisted cataract surgery were included in this study. Cases with preoperative or intraoperative miosis, iris prolapse, and intraoperative floppy iris syndrome were included in the iris challenge group. Use of tamsulosin, iris hooks, pupil size, surgical time, and improved visibility (100/surgical time × pupil size) were compared between eyes with and without iris challenges. Mann-Whitney U test, Pearson's Chi-square test, and Fisher's exact test were used for statistical analysis. Results Of 443 eyes, 66 were included in the iris challenge group (14.9%). Tamsulosin use was more common in patients with iris challenges and iris hooks were used more frequently (9.1% vs. 0%, P < 0.001) in patients with iris challenges than in those without iris challenges. Pupil size was smaller in patients with iris challenges (6.01 vs. 7.64 mm, P < 0.001). However, surgical time was not different (16.9 vs. 16.5 min, P = 0.064) between the two groups. As a result, improved visibility was calculated to be higher in patients with iris challenges (1.05 vs. 0.81, P < 0.001). Conclusion In terms of surgical time and improved visibility, using the illuminated chopper simplified cataract surgery involving iris challenges. The use of an illuminated chopper is expected to be a good solution for challenging cataract surgeries.
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Affiliation(s)
- Haram Kim
- Department of Ophthalmology, Gil Medical Center, College of Medicine, Gachon University, Incheon, Korea
| | - Sung Ha Hwang
- Department of Ophthalmology, Gil Medical Center, College of Medicine, Gachon University, Incheon, Korea
| | - Youngsub Eom
- Department of Ophthalmology, Korea University Ansan Hospital, Gyeonggi-Do, Korea
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Dong Heun Nam
- Department of Ophthalmology, Gil Medical Center, College of Medicine, Gachon University, Incheon, Korea
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Perez DM. α 1-Adrenergic Receptors: Insights into Potential Therapeutic Opportunities for COVID-19, Heart Failure, and Alzheimer's Disease. Int J Mol Sci 2023; 24:4188. [PMID: 36835598 PMCID: PMC9963459 DOI: 10.3390/ijms24044188] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 02/22/2023] Open
Abstract
α1-Adrenergic receptors (ARs) are members of the G-Protein Coupled Receptor superfamily and with other related receptors (β and α2), they are involved in regulating the sympathetic nervous system through binding and activation by norepinephrine and epinephrine. Traditionally, α1-AR antagonists were first used as anti-hypertensives, as α1-AR activation increases vasoconstriction, but they are not a first-line use at present. The current usage of α1-AR antagonists increases urinary flow in benign prostatic hyperplasia. α1-AR agonists are used in septic shock, but the increased blood pressure response limits use for other conditions. However, with the advent of genetic-based animal models of the subtypes, drug design of highly selective ligands, scientists have discovered potentially newer uses for both agonists and antagonists of the α1-AR. In this review, we highlight newer treatment potential for α1A-AR agonists (heart failure, ischemia, and Alzheimer's disease) and non-selective α1-AR antagonists (COVID-19/SARS, Parkinson's disease, and posttraumatic stress disorder). While the studies reviewed here are still preclinical in cell lines and rodent disease models or have undergone initial clinical trials, potential therapeutics discussed here should not be used for non-approved conditions.
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Affiliation(s)
- Dianne M Perez
- The Lerner Research Institute, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195, USA
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Dilation devices in cataract surgery. Curr Opin Ophthalmol 2023; 34:71-77. [PMID: 36484211 DOI: 10.1097/icu.0000000000000922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Cataract surgery in the setting of small pupil represent a major challenge and it is associated with a higher risk of complications. When pharmacologic pupil dilation fails, mechanical pupil expansion devices are needed to obtain and maintain sufficient intraoperative mydriasis. The purpose of this review is to assess the pupil expansion devices currently available. RECENT FINDINGS A variety of pupil expansion devices are offered on the market. They differ for design, material, shape, size, cost, and easiness of insertion/removal, nonetheless they all seem to be effective in improving the pupil size and easing the cataract surgery. SUMMARY Mechanical pupil expansion can be effectively achieved with a variety of devices, which are well tolerated and can facilitate cataract surgery in the setting of poor mydriasis.
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Farouk MM, Mounir A, Abozaid MA, Mostafa EM, Abdellah MM. Surgical outcomes of complicated cataract with pediatric trematode granulomatous uveitis. Int J Ophthalmol 2023; 16:354-360. [PMID: 36935794 PMCID: PMC10009598 DOI: 10.18240/ijo.2023.03.04] [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: 02/02/2022] [Accepted: 02/01/2023] [Indexed: 03/06/2023] Open
Abstract
AIM To describe the clinical characteristics and surgical outcomes of complicated cataract with pediatric trematodal granulomatous uveitis (TGU). METHODS Patients of cataract with TGU in the membranous (inactive) stage underwent cataract surgery with intraocular lens (IOL) implantation. Preoperative history and ophthalmic examination were conducted for all cases, whereas Schimphlug imaging and corneal topography were done for some patients. Postoperative follow up was done on the 1st, 2nd, and 5th postoperative days after surgery. Then, it was done at least at one, three, and six months postoperatively. Intraoperative and postoperative complications and the methods of their management were reported. RESULTS Twelve eyes of 12 male children were included in this study ranging from 8 to 16y. The mean best corrected Snellen visual acuity (BCVA) was significantly improved from 0.09±0.06 preoperatively to 0.37±0.11 at the final visit 6mo postoperatively (P<0.001). Schimphlug imaging and corneal topography showed flattening of the anterior surface of the inferior cornea. Intraoperative difficulties and complications included the poor dilatability of the drown down pupil, strong posterior synechia between the anterior lens capsule and the iris at the site of the inferior retrocorneal vascularized membrane and hyphema. All cases underwent primary hydrophobic IOL implantation. CONCLUSION Surgery for this type of cataract is relatively safe and effective. It is associated with some specific difficulties and complications that should be considered during surgery and follow up.
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Affiliation(s)
- Mahmoud M Farouk
- Department of Ophthalmology, Sohag Faculty of Medicine, Sohag University, Sohag 82524, Egypt
| | - Amr Mounir
- Department of Ophthalmology, Sohag Faculty of Medicine, Sohag University, Sohag 82524, Egypt
| | - Mortada Ahmed Abozaid
- Department of Ophthalmology, Sohag Faculty of Medicine, Sohag University, Sohag 82524, Egypt
| | - Engy Mohamed Mostafa
- Department of Ophthalmology, Sohag Faculty of Medicine, Sohag University, Sohag 82524, Egypt
| | - Marwa Mahmoud Abdellah
- Department of Ophthalmology, Sohag Faculty of Medicine, Sohag University, Sohag 82524, Egypt
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Sepulveda-Beltran PA, Levine H, Gibbons AG, Maharaj A, Choi DS, Martinez JD, Correa ZM, Amescua G, Harbour JW. Post-Radiation Cataract Management: Outcomes in Individuals with Uveal Melanoma. CURRENT OPHTHALMOLOGY REPORTS 2022. [DOI: 10.1007/s40135-022-00304-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gowda A, Jie WWJ, Casson R, Chan WO. The safety of intracameral phenylephrine - A systematic review. Surv Ophthalmol 2022; 67:1540-1546. [PMID: 35691387 DOI: 10.1016/j.survophthal.2022.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/28/2022] [Accepted: 06/06/2022] [Indexed: 10/18/2022]
Abstract
Intracameral phenylephrine is commonly used in ophthalmic surgery as an alternative or supplement to mydriatic eye drops; hence, the importance of an evidence-based understanding of its risk-benefit profile is vital. We performed a comprehensive search in the PubMed, Google Scholar and Cochrane databases for published studies and case reports relating to the use of intracameral phenylephrine. Articles from 1958 to 2021 with the following keywords were used: "intracameral phenylephrine", "intracameral mydriatics", "phenylephrine", "pupil dilation", "complications". Intracameral phenylephrine was first used in 2003 as an alternative to topical mydriatics. Since then, it is being increasingly used with a variety of benefits, including rapid onset of mydriasis, and cost-effectiveness. There are various case reports, however, of ocular and systemic complications associated with intracameral phenylephrine such as generation of free radicals, toxic anterior segment syndrome, inconsistent pupillary dilation during surgery, and ventricular fibrillation. Alternatives to intracameral phenylephrine such as iris hooks, a Malyugin ring, intracameral epinephrine, and intracameral tropicamide were compared with intracameral phenylephrine. Intracameral phenylephrine appears to have a good safety profile.
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Affiliation(s)
- Akash Gowda
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia.
| | - Wilson Wong Jun Jie
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia; Tun Hussein Onn National Eye Hospital, Selangor, Malaysia
| | - Robert Casson
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia
| | - Weng Onn Chan
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia
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Kwak J, Han JY, Moon SY, Nam S, Kim JY, Tchah H, Lee H. Relationship Between Tamsulosin Use and Surgical Complications of Cataract Surgery in Elderly Patients: Population-Based Cohort Study. Front Med (Lausanne) 2022; 9:882131. [PMID: 35665322 PMCID: PMC9160597 DOI: 10.3389/fmed.2022.882131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/25/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose Although several previous studies have investigated the relationship between tamsulosin use and surgical complications of cataract surgery, no population-based cohort study has been conducted for the Asian population. We aimed to investigate the relationship between tamsulosin use and surgical complications of cataract surgery in the Korean elderly population. Methods This nationwide population-based retrospective cohort study included elderly patients (≥60 years) who had undergone cataract surgery in the period from 2003 to 2015. Baseline characteristics were age, sex, income, residence, and systemic, and ocular comorbidities (glaucoma, myopia, eye trauma, diabetes mellitus with ophthalmic manifestations, severe cataract, age-related macular degeneration). The exposure of interest was tamsulosin use within 1 year before cataract surgery. Logistic regression model was used to evaluate the relationship of tamsulosin use with surgical complications of cataract surgery. Results The rate of surgical complications of cataract surgery was 0.88% (375/42,539) in the non-tamsulosin group and 0.83% (71/8,510) in the tamsulosin group. The groups showed no significant difference in the risk of surgical complications of cataract surgery in the unadjusted model [odds ratio (OR) = 0.946; 95% confidence interval (CI):0.733–1.220; P = 0.669]. Additionally, tamsulosin use was not significantly associated with surgical complications of cataract surgery in the fully adjusted model accounting for age, income, residence, and systemic and ocular comorbidities (OR = 0.997; 95% CI: 0.749–1.325; P = 0.981). Conclusions The rate or risk of surgical complications of cataract surgery does not change with tamsulosin use. We suggest that better surgical techniques and surgeons' cognizance of the patient's tamsulosin use could improve surgical outcomes, without increasing surgical complications.
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Chung HS, Lee J, Lee H, Kim JY, Tchah H. Evaluation of the Optical Aspects of the Ophthalmic Viscosurgical Device During Femtosecond Laser-Assisted Cataract Surgery. Transl Vis Sci Technol 2022; 11:2. [PMID: 35506930 PMCID: PMC9078068 DOI: 10.1167/tvst.11.5.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose In femtosecond laser-assisted cataract surgery (FLACS), capsulorhexis can be performed with an ophthalmic viscosurgical device (OVD) filled in the anterior chamber. We aimed to investigate changes in the laser properties in various optical aspects, such as focal shifting, reflection, and absorption associated with OVD. Methods Simulation was achieved by calculating the laser power attenuation due to reflection and spot size change using the Gullstrand eye model. Additionally, we calculated the absorption coefficient by measuring the laser power passing through the OVD with a laser meter and evaluated the effect of absorption by the OVD. Results In our simulation, power attenuation due to reflection was a maximum of 0.07%, and power attenuation was 0.08% even when considering the change according to the incident angle. Power attenuation due to the change of the spot size at the focus was 0.005%. Owing to the absorption of the OVD, a power increase of up to 13.5% was required for an anterior chamber depth of 3.0 mm to obtain the same effect as the aqueous humor. Conclusions The main reason for laser power attenuation associated with OVD was laser absorption through the OVD, and could also be caused by laser cavitation bubbles. To complete a safe capsulotomy during FLACS, the laser power should be increased appropriately, considering the absorption by the OVD in the anterior chamber. Translational Relevance The study results can be applied to calculate the optimal femtosecond laser energy to achieve complete capsulotomy during FLACS in the presence of anterior chamber OVD.
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Affiliation(s)
- Ho Seok Chung
- Department of Ophthalmology, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Jinho Lee
- The Research Institute of Natural Science and Department of Physics Education, Gyeongsang National University, Jinju, Korea
| | - Hun Lee
- Department of Ophthalmology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea
| | - Jae Yong Kim
- Department of Ophthalmology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea
| | - Hungwon Tchah
- Department of Ophthalmology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea
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Salviat F, Febbraro JL, Zuber K, Yavchitz A, Moran S, Gatinel D. Evaluation of a uniplanar pupil expansion ring in small-pupil cataract surgery: a feasibility study. Int Ophthalmol 2021; 42:489-496. [PMID: 34655377 DOI: 10.1007/s10792-021-02065-9] [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: 05/28/2021] [Accepted: 09/21/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to evaluate the effectiveness of a disposable uniplanar pupil expansion device in small-pupil cataract surgery. METHODS This is a feasibility study carried out at the Rothschild Foundation, Paris, France. Patients undergoing routine cataract surgery with a dilated pupil size < 6 mm, and who agreed to participate in the study were included. The trial enrolled 25 patients, of whom 21 proceeded to cataract surgery using the pupil expansion device to be evaluated. The pupil diameter was measured at defined stages during the cataract surgery, which was performed by a single surgeon, in a single center setting. The 1st generation Bhattacharjee pupil expansion ring was used if the preoperative pupil size was < 6 mm. Intraoperative and postoperative adverse events were recorded. RESULTS Pupil size immediately after the Bhattacharjee ring implantation was ≥ 6 mm for 15 eyes (71.4%). The mean dilated pupil size before ring insertion was 4.5 ± 0.8 mm (range 2.5-5.8 mm), and the mean pupil size after ring insertion was 6.1 ± 0.3 mm (range 5.9-6.8 mm). Mean pupil size following removal of the ring was 4.2 ± 0.8 mm (range 2.5-5.4 mm). Two adverse events occurred during the surgeries: 1 Bhattacharjee ring broke prior to implantation, and 1 implanted Bhattacharjee ring was unstable and removed before the end of the surgery. No postoperative adverse event was recorded. CONCLUSIONS The Bhattacharjee ring is an effective pupil expansion device, which facilitates stable pupil expansion during cataract surgery. This study was registered as a clinical trial at clinicaltrials.gov under the number NCT02434588.
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Affiliation(s)
- Flore Salviat
- Department of Clinical Research, Rothschild Foundation, Paris, France
| | | | - Kevin Zuber
- Department of Clinical Research, Rothschild Foundation, Paris, France
| | - Amélie Yavchitz
- Department of Clinical Research, Rothschild Foundation, Paris, France
| | - Sarah Moran
- Department of Ophthalmology, South Infirmary Victoria University Hospital, Cork, Ireland.
| | - Damien Gatinel
- Department of Ophthalmology, Rothschild Foundation, Paris, France
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