Effectiveness of intraoperative intraocular lens use on improving surgical safety for dense cataract phacoemulsification: a randomized controlled trial

Effect of capsule treatment on visual acuity and quality after phacoemulsification lens implantation in myopic patients with cataract

BACKGROUND

Cataracts pose a significant clinical burden due to their complex pathogenesis. In recent years, an increase in cataracts coexisting with myopia has heightened the incidence of retinopathy and posterior vitreous detachment. Additionally, symptoms of ocular axis elongation, lens nucleus hardening, and vitreous liquefaction have become more prevalent. While conventional extracapsular cataract extraction is commonly employed, it often yields suboptimal visual outcomes. Subsequent advancements in cataract phacoemulsification and lens implantation surgeries have gained widespread acceptance for their ability to improve refraction and significantly improve uncorrected visual acuity.

AIM

To investigate the effect of capsular treatment after phacoemulsification lens implantation in myopic patients with cataract.

METHODS

We selected 110 patients (with 134 eyes) with myopia and cataracts treated. These patients were categorized into two groups: an observation group (57 patients with 70 eyes) and a control group (53 patients with 64 eyes). The control group underwent cataract phacoemulsification and lens implantation, while the observation group received a refined capsular treatment based on the control group's procedure. We assessed the differences in visual acuity and quality between the two groups before and after surgery.

RESULTS

At six months post-operation, the observation group exhibited significantly improved far vision, intermediate vision, near vision, lower objective scattering index, higher Modulation transfer function cut-off frequency, and overall vision metrics at different contrast levels (100%, 20% and 9%) compared to the control group (P < 0.05). The total score of the National Eye Institute Visual Function Questionnaire in the observation group at 6 months after operation was significantly higher than that in the control group (P < 0.05). No significant difference in the incidence of adverse reactions was observed between the observation group and control group (P > 0.05).

CONCLUSION

Capsular treatment demonstrates efficacy in improving visual acuity and quality after phacoemulsification lens implantation in myopic patients with cataracts, warranting its clinical application.

Novel nucleus management technique in hypermature morgagnian cataracts with liquified cortex during phacoemulsification

PURPOSE

To describe a novel nucleus management technique of variable size mobile nucleus in Hypermature Morgagnian cataracts.

METHODS

In this technique, under topical anesthesia, temporal tunnel incision and capsulorhexis were performed, and the capsular bag was inflated with 2% w/v hydroxypropylmethylcellulose. A chopper and phacoemulsification probe were used to consciously nudge the nucleus towards the capsular periphery (fornix) to immobilize the floating nucleus against the capsular bag recess. Firm nuclear impaling was achieved using longitudinal power in linear mode (range 0-70%), 650 mmHg vacuum, and aspiration flow rate of 42 ml/min. The nucleus was chopped by direct chop technique, total separation achieved, and fragments emulsified. Primary outcome measures included ease of nuclear holding, iatrogenic zonular stress/damage, posterior capsule tear, and endothelial cell loss.

RESULTS

This technique was performed in 29 consecutive cases from June 2019 - December 2021, and no intraoperative or postoperative complications were noted. The average phacoemulsification time and cumulative dissipated energy (CDE) were nearly similar in all cases.

CONCLUSION

This technique would make phacoemulsification much safer in eyes with hypermature cataract and liquified cortex with lower complication rates and maintenance of better endothelial integrity.

Phacoemulsification: Proposals for Improvement in Its Application

A cataract is defined as opacity of the crystalline lens. It is currently one of the most prevalent ocular pathologies and is generally associated with aging. The most common treatment for cataracts is surgery. Cataract surgery is a quick and painless process, is very effective, and has few risks. The operation consists of removing the opacified lens and replacing it with an intraocular lens. The most common intraocular lens removal procedure that is currently used is phacoemulsification. The energy applied in this process is generated by ultrasonic waves, which are mechanical waves with a frequency higher than 20 kHz. A great deal of research on the different ways to perform the stages of this surgical procedure and the analysis of the possible side effects of the operation has been published, but there is little information on the technical characteristics, the intensities applied, and the use of ultrasound-emitting (U/S) equipment for cataract removal. More studies on the method and depth of absorption of ultrasonic waves in our visual system when performing the phacoemulsification procedure are needed. It would be advisable for health authorities and medical professionals to develop guidelines for the handling and use of ultrasonic wave-emitting equipment, such as those that exist for ultrasound and physiotherapy. This could help us to reduce undesirable effects after the operation.

The efficacy of ultrasonic emulsification with IOL implantation in patients with primary angle-closure glaucoma combined with cataract

PURPOSE

This study aimed to investigate the clinical efficacy of ultrasonic emulsification plus IOL implantation in patients with primary angle-closure glaucoma and cataract.

METHODS

The clinical data of 81 patients (91 eyes) with primary angle-closure glaucoma comorbid with cataract in our hospital were retrospectively analyzed and divided into two groups based on surgical modality. Group A (n=40, 45 eyes) underwent trabeculectomy and group B (n=41, 46 eyes) underwent ultrasonic emulsification and IOL implantation. The success rate, best corrected visual acuity, intraocular pressure, anterior chamber depth, anterior chamber angle, visual field, cornea's endothelial cell count, complications, and patient satisfaction were compared between the two groups.

RESULTS

The surgical success rate in group B was 97.83%, significantly higher than 86.67% in group A (P < 0.05); Compared with group A, group B had higher best-corrected visual acuity and lower intraocular pressure (P < 0.05) as well as higher central and peripheral anterior chamber depths at 3 months postoperatively (P < 0.05); After surgery, group A had significantly lower postoperative cornea's endothelial cell count (P < 0.05). Compared with group A, MS was higher and MD was lower in group B at 3 months postoperatively (P < 0.05); the complication rate in group B was 8.70%, lower than 28.89% in group A (P < 0.05).

CONCLUSION

The clinical efficacy of ultrasonic emulsification combined with IOL implantation is remarkable in patients with primary angle-closure glaucoma and cataract, which is conducive to improving postoperative visual acuity, lowering intraocular pressure, increasing the atrial angle, and improving visual field defects. It is also with high safety, but has little effect on cornea's endothelial cell count.