Slow-Motion Phacoemulsification Technique:

The use of ophthalmic viscosurgical devices during donor's corneal harvesting

PURPOSE OF THE STUDY

To evaluate the protective effect of Biolon (sodium-hyaluronate 1%) use on corneal endothelium, during donor's corneal harvesting.

MATERIALS AND METHODS

A prospective, randomized, double blind, comparative study was performed on 120 corneas donated from 60 donors. One cornea from each donor (n = 60) was harvested using intracameral injection of ophthalmic viscosurgical device (OVD), and the fellow cornea with no use of OVD (n = 60, control group). Endothelial cell density (ECD) values were obtained at the center of each corneal graft with a specular microscope one day after harvesting.

RESULTS

ECD in the OVD group were 2839 ± 412.5 cells/mm(2) and in the control group 2748 ± 429.7 cells/mm(2). (p = 0.03). Distribution curve of the difference in ECD between the OVD and no OVD eyes showed that 47% of the donors had > 100 cells/mm2 difference, and 32% of donors had >200 cells/mm(2) difference in favor of the OVD group.

CONCLUSIONS

Intracameral OVD injection during corneal graft harvesting may protect the endothelium from the mechanical damage induced during the procedure. Further investigation is needed before routine the use of intracameral OVD should be considered in this setting.

Multifocal iris sphincter ruptures: new sign of the lens-iris diaphragm retropulsion syndrome

We describe the case of a 78-year-old highly myopic woman who had bilateral phacoemulsification with posterior chamber intraocular lens implantation. During surgery, the anterior chamber was extremely deep and the pupil was excessively dilated, consistent with lens-iris diaphragm retropulsion syndrome (LIDRS). Subsequent biomicroscopy revealed multifocal iris sphincter ruptures, a new finding associated with LIDRS.

Microcoaxial phacoemulsification

PURPOSE

To determine whether microcoaxial phacoemulsification can be reliably and safely performed in a clinical setting and whether a full-sized single-piece acrylic intraocular lens (IOL) can be implanted through a 2.2 mm incision.

SETTING

Private practice, Cincinnati, Ohio, USA.

METHOD

One hundred consecutive patients had cataract surgery by microcoaxial phacoemulsification with the MicroSmooth Ultrasleeve (Alcon Surgical) through a 2.2 mm incision. Anterior chamber stability, incision competency, safety of IOL implantation, intraoperative complications, efficiency, and the learning curve were evaluated. Uncorrected visual acuity (UCVA) on the first postoperative day, corneal appearance, intraocular pressure, and postoperative complications were also analyzed.

RESULTS

Anterior chamber stability and incision competency were consistently excellent. The incision enlarged from 2.2 mm to 2.3 mm in 80% of the patients, to 2.4 mm in 12%, and to 2.5 mm in 8%. A high-power IOL and/or IOL insertion difficulty may account for 7 of the latter 8 cases. Efficiency and safety were equivalent to those in traditional phacoemulsification. The learning curve with the Ultrasleeve was minimal, although IOL implantation was initially more difficult. The UCVA on the first postoperative day was 20/40 or better in 91% of patients, a result consistent with mild corneal edema. There were no postoperative complications.

CONCLUSIONS

The clinical results in a prospective series of 100 patients confirmed the efficacy and safety of microcoaxial phacoemulsification. Fluidic advantages, competent incisions, and the new countertraction implantation technique provide another approach to achieving less-invasive, high-quality cataract surgery.

Fate of anterior capsule tears during cataract surgery

PURPOSE

To determine the incidence of anterior capsule tears, at what stage of surgery they occurred, and their intraoperative behavior.

SETTING

Ambulatory surgery center, Cincinnati Eye Institute, Cincinnati, Ohio, USA.

METHODS

This 5-year retrospective study was of patients having phacoemulsification with posterior chamber intraocular lens (IOL) implantation complicated by unplanned peripheral extension of the capsulorhexis tear or a radial anterior capsule tear. The operative notes and a videotape of the surgery were reviewed. The stage at which the tear was initially observed and when it extended were identified, as was whether the tear extended to the posterior capsule. Anterior vitrectomy and the design and location of the IOL implanted were also analyzed.

RESULTS

A discontinuous anterior capsulorhexis or a break in the anterior capsule rim was observed in 21 eyes of 2646 cases, for an overall incidence of 0.79%. Anterior capsule tears were identified during ophthalmic viscosurgical device injection in 1 eye, capsulorhexis in 13 eyes, hydrodissection in 2 eyes, phacoemulsification in 3 eyes, irrigation/aspiration (I/A) in 1 eye, and implantation of a prosthetic iris device in 1 eye. Seven of the 13 tears identified during the capsulorhexis were managed by redirecting the second edge of the "safety" capsulorhexis to incorporate the tear. In 14 eyes, the tear in the anterior capsule extended into the zonules; 4 of these tears were limited. Ten tears extended around the equator and through the posterior capsule, occurring during the hydrodissection in 1 eye, phacoemulsification in 2 eyes, I/A in 1 eye, and IOL implantation in 6 eyes. An anterior vitrectomy was required in 4 eyes that had posterior capsule involvement. Endocapsular fixation of a 1-piece acrylic IOL was achieved in 18 eyes. Three eyes required implantation of a 3-piece acrylic IOL in the ciliary sulcus.

CONCLUSIONS

Extension of an anterior capsule tear can complicate cataract surgery at any stage. Extension of the tear through the posterior capsule occurred in almost half the eyes with an anterior capsule tear, often requiring an anterior vitrectomy. Managing an anterior capsule tear can be challenging yet compatible with implantation of a posterior chamber IOL.