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Quesada G, Chang DH, Waltz KL, Kao AA, Quesada R, Wang Y, Ji L, Parizadeh D, Atiles L. Clinical Performance and Surgeon Acceptability of a New Dual Mode Phacoemulsification System. Clin Ophthalmol 2022; 16:2441-2451. [PMID: 35968054 PMCID: PMC9365053 DOI: 10.2147/opth.s363061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 07/25/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Gabriel Quesada
- Grupo Oftalmo & Plastico, San Salvador, El Salvador
- Correspondence: Gabriel Quesada, Grupo Oftalmo & Plastico, 9 C Pte, 4625, Col Escalon, San Salvador, El Salvador, Tel +1 (503) 22579003, Email
| | | | - Kevin L Waltz
- Central American Ophthalmic Research Consultants, Indianapolis, IN, USA
| | - Andrew A Kao
- Empire Eye and Laser Center, Bakersfield, CA, USA
| | | | - Ying Wang
- Johnson & Johnson Surgical Vision, Inc, Santa Ana, CA, USA
| | - Leilei Ji
- Johnson & Johnson Surgical Vision, Inc, Santa Ana, CA, USA
| | - Dari Parizadeh
- Johnson & Johnson Surgical Vision, Inc, Santa Ana, CA, USA
| | - Luis Atiles
- Johnson & Johnson Surgical Vision, Inc, Santa Ana, CA, USA
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Effects on phacoemulsification efficiency and chatter at variable longitudinal ultrasound settings when combined with constant torsional energy. J Cataract Refract Surg 2020; 46:774-777. [PMID: 32358274 DOI: 10.1097/j.jcrs.0000000000000150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate longitudinal power settings for optimally efficient lens fragment removal, using the Centurion machine. SETTING John A. Moran Eye Center, University of Utah, Salt Lake City, USA. DESIGN Experimental study. METHODS Porcine lens nuclei were cut into 2.0 mm cubes. Experiments were conducted at 100% torsional power; vacuum set at 500 mm Hg, aspiration 50 mL/min, and intraocular pressure 110 mm Hg. A 20-degree tip with a 30-degree bevel was used. Longitudinal power was tested between 20% and 100%. Efficiency (time for fragment removal) and chatter (the number of times the fragment bounced from the tip) were measured. RESULTS A linear increase in efficiency was observed from 20% to 100% longitudinal power (R = 0.9281, slope = -0.0271). An efficiency slope change occurred at 60% power, with the largest incremental change in efficiency between 20% and 60% (R = 0.9756, slope = -0.0394) and a lesser change between 60% and 100% (R = 0.9827, slope = -0.0121). Chatter analysis showed minimal events at 20% to 60%, but a significant increase at >80% (P = .005). This increase appeared to be incremental (R = 0.8929). CONCLUSIONS Increasing longitudinal power, with all other settings constant, increased efficiency. Greatest efficiency gains were observed between 20% and 60%. At 80% and 100%, chatter events increased significantly. With a goal of recommending optimally efficient settings while minimizing excess energy and chatter, adding 60% of longitudinal power to 100% torsional power was shown to be the best setting to increase efficiency and avoid repulsion in these vacuum and aspiration settings.
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Effectiveness of intraoperative intraocular lens use on improving surgical safety for dense cataract phacoemulsification: a randomized controlled trial. Sci Rep 2020; 10:1600. [PMID: 32005971 PMCID: PMC6994590 DOI: 10.1038/s41598-020-58597-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 01/17/2020] [Indexed: 11/22/2022] Open
Abstract
We designed this study to assess if surgical safety can be improved by intraoperative use of intraocular lens (IOL) for cataract phacoemulsification. We performed phacoemulsification cataract removal on 401 patients. We randomly assigned these patients into three groups: the standard setting (Group I, n = 134), with reduced vacuum and flow rate (Group II, n = 137), and with IOL insertion before the last quadrant was emulsified with standard setting (Group III, n = 130). The primary outcomes included the risk of posterior capsular rupture (PCR), ultrasound time, energy, and complications. The secondary outcomes included central corneal thickness (CCT), CCT changes, endothelial cells (ETC) counting, ETC loss, and the best corrected distance visual acuity (BCVA) measured on day 1, day 7 and day 30. If PCR occurred, we emulsified the residual lens materials after insertion of IOL and clean of the prolapsed vitreous. We found that the risk of PCR in Group III (0/130) was lower than Group I (9/134, corrected relative risk (RR) = 18.44, 95% CI: 1.08–313.56) and Group II (3/137, corrected RR = 6.64, 95% CI: 0.35–27.41). Group III showed better BCVA on day 1 and 7, less ECC loss on day 7 and 30, and less CCT increase on day 1 and 7. No cases converted to extracapsular cataract extraction. No residual lens materials misdirected into vitreous cavity. Intraoperative use of IOL can improve surgical safety for dense cataract phacoemulsification.
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Kabbara SW, Heczko J, Ta B, Bernhisel A, Barlow W, Zaugg B, Olson RJ, Pettey J. Impact of torsional micropulse on phacoemulsification efficiency and chatter. Can J Ophthalmol 2019; 54:560-564. [PMID: 31564345 DOI: 10.1016/j.jcjo.2019.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 01/31/2019] [Accepted: 02/05/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Evaluate the effect of increasing ultrasound (US) power on chatter events and efficiency under both continuous and micropulse torsional US to reduce total cataract extraction times. DESIGN In vitro laboratory study. METHODS Porcine lens nuclei were incubated in formalin for 2 hours and then cut into 2-mm cubes. Phacoemulsification was performed using the Centurion Vision System and Infiniti OZil handpiece with the balanced tip. Both US modalities were studied at 60%, 80%, and 100% power. Micropulse rate was 83 pulses per second with 50% on time. Each combination comprised 20 runs. Efficiency was considered as the total time for a cube to be emulsified; chatter was the number of times the lens fragment bounced off the tip. RESULTS There was significant decrease in efficiency when power was increased from 60% to 100% (1.33-1.97 s; p < 0.001) under micropulse US and significant increase in chatter when power was further increased to 100% from 60% (0.15-0.94 s; p < 0.001). There was no significant efficiency change with increased power under continuous US. Comparing the phacoemulsification efficiency between continuous and micropulse US, we found no significant difference at 60% and 80% power; at 100% power, continuous was significantly more efficient than micropulse (1.48 and 1.97 s, respectively; p = 0.001). CONCLUSIONS Increasing power above 60% decreased efficiency under torsional micropulse US. We believe that this was due to the chatter increase observed with increasing US power. Torsional continuous US was significantly more efficient than micropulse US at 100% power.
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Affiliation(s)
- Sami W Kabbara
- Banner-University of Arizona College of Medicine, Phoenix, AZ
| | - Joshua Heczko
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT
| | - Brian Ta
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT
| | - Ashlie Bernhisel
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT
| | - William Barlow
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT
| | - Brian Zaugg
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT
| | - Randall J Olson
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT
| | - Jeff Pettey
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT.
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Kabbara SW, Heczko J, Ta B, Bernhisel A, Barlow W, Zaugg B, Olson RJ, Pettey J. Determining optimal ultrasound percent on time with long-pulse torsional phacoemulsification. Can J Ophthalmol 2019; 54:395-398. [PMID: 31109482 DOI: 10.1016/j.jcjo.2018.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 07/06/2018] [Accepted: 07/13/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the optimum percent on time for the most efficient lens fragment removal using long-pulse torsional ultrasound (US). DESIGN In vitro laboratory study. METHODS Porcine lens nuclei were incubated in formalin for 2 hours and then cut into 2 mm cubes. Phacoemulsification was performed using the Centurion® Vision System and Infiniti OZil handpiece with the balanced tip. Vacuum was set at 500 mm Hg, aspiration rate at 50 mL/min, and intraocular pressure (IOP) at 50 mm Hg. Pulse rate was 26 pulses/second. Studied parameters were percent power: 60%, 80%, and 100%, and percent on times: 50%, 60%, 70%, and 80%. Efficiency was the total time for a cube to be emulsified. Chatter was the number of times the lens fragment bounced off the tip. RESULTS There was no significant difference in efficiency between 50%, 60%, and 70 % on-time settings (p = 0.17 and 0.08, respectively); however, there was significant increase in efficiency when the on time was increased from 70% to 80% (p = 0.03). Increasing power from 60% to 100% showed a statistically significant efficiency increase (p = 0.001). There was no significant change in chatter with increasing on time; however, there was a statistically significant increase in chatter with every power level increase. CONCLUSION Increasing on-time percent does not improve efficiency under torsional long-pulse US. There is no significant change in chatter with increasing on-time percent. Increasing power increases efficiency despite chatter increase. Long-pulse US does not appear to influence torsional action in a clinically meaningful way.
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Affiliation(s)
| | - Joshua Heczko
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT
| | - Brian Ta
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT
| | - Ashlie Bernhisel
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT
| | - William Barlow
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT
| | - Brian Zaugg
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT
| | - Randall J Olson
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT
| | - Jeff Pettey
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT..
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Kabbara S, Heczko JB, Bernhisel AA, Barlow WR, Zaugg B, Pettey JH, Olson RJ. Effect of high vacuum and aspiration on phacoemulsification efficiency and chatter using a transversal ultrasound machine. J Cataract Refract Surg 2018; 44:1378-1383. [PMID: 30201130 DOI: 10.1016/j.jcrs.2018.05.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 03/22/2018] [Accepted: 05/29/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE To examine the role of high vacuum and aspiration settings on efficiency using a transversal ultrasound (US) machine. SETTING John A. Moran Eye Center Laboratory, University of Utah, Salt Lake City, Utah, USA. DESIGN Experimental study. METHODS Porcine lens nuclei were incubated in formalin for 2 hours and then cut into 2.0 mm cubes. Phacoemulsification was performed using the Whitestar Signature machine. Settings were bottle height 50 cm, on-time 6 milliseconds, and off-time 6 milliseconds. One hundred percent power was used for all 240 runs. Tested parameters were aspiration of 50 mL/min and 60 mL/min and vacuum of 500, mm Hg, 600 mm Hg, and 650 mm Hg. RESULTS With continuous US, increasing aspiration from 50 mL/min to 60 mL/min significantly increased efficiency (23%). Increasing vacuum from 500 mm Hg to 650 mm Hg and from 600 mm Hg to 650 mm Hg significantly increased efficiency (20.2% and 13.6%, respectively). Higher vacuum and aspiration parameters did not influence the incidence of chatter events. In the micropulse US group, there was no significant efficiency increase with increasing vacuum or aspiration levels. There was a significant efficiency increase of continuous over micropulse US at an aspiration setting of 60 mL/min and vacuum settings of 600 mm Hg and 650 mm Hg. CONCLUSIONS As aspiration and vacuum increased, efficiency increased under continuous transverse US. No significant efficiency improvement occurred at high aspiration and vacuum settings under micropulse US. At 60 mL/min aspiration and more than 600 mm Hg vacuum, continuous power was significantly more efficient than micropulse transverse US.
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Affiliation(s)
- Sami Kabbara
- From the University of Arizona College of Medicine-Phoenix (Kabbara), Phoenix, Arizona, and the Department of Ophthalmology and Visual Sciences (Heczko, Bernhisel, Barlow, Zaugg, Pettey, Olson), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Joshua B Heczko
- From the University of Arizona College of Medicine-Phoenix (Kabbara), Phoenix, Arizona, and the Department of Ophthalmology and Visual Sciences (Heczko, Bernhisel, Barlow, Zaugg, Pettey, Olson), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Ashlie A Bernhisel
- From the University of Arizona College of Medicine-Phoenix (Kabbara), Phoenix, Arizona, and the Department of Ophthalmology and Visual Sciences (Heczko, Bernhisel, Barlow, Zaugg, Pettey, Olson), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - William R Barlow
- From the University of Arizona College of Medicine-Phoenix (Kabbara), Phoenix, Arizona, and the Department of Ophthalmology and Visual Sciences (Heczko, Bernhisel, Barlow, Zaugg, Pettey, Olson), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Brian Zaugg
- From the University of Arizona College of Medicine-Phoenix (Kabbara), Phoenix, Arizona, and the Department of Ophthalmology and Visual Sciences (Heczko, Bernhisel, Barlow, Zaugg, Pettey, Olson), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Jeff H Pettey
- From the University of Arizona College of Medicine-Phoenix (Kabbara), Phoenix, Arizona, and the Department of Ophthalmology and Visual Sciences (Heczko, Bernhisel, Barlow, Zaugg, Pettey, Olson), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Randall J Olson
- From the University of Arizona College of Medicine-Phoenix (Kabbara), Phoenix, Arizona, and the Department of Ophthalmology and Visual Sciences (Heczko, Bernhisel, Barlow, Zaugg, Pettey, Olson), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.
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Bohner AD, Wright AJ, Ta BT, Bernhisel AA, Zaugg B, Barlow WR, Pettey JH, Olson RJ. Optimum on-time duty cycle for a transversal ultrasound machine. J Cataract Refract Surg 2018; 44:1140-1143. [PMID: 30055953 DOI: 10.1016/j.jcrs.2018.03.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 03/22/2018] [Accepted: 03/29/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the optimum on-time setting for the most efficient removal of lens fragments using micropulse ultrasound (US) and Ellips FX transversal US in the Whitestar Signature Pro phacoemulsification machine. SETTING John A. Moran Eye Center Laboratories, University of Utah, Salt Lake City, Utah, USA. DESIGN Experimental study. METHODS Porcine lens nuclei were soaked in formalin for 2 hours and cut into 2.0 mm cubes. The US machine was used with a bent 0.9 mm phaco tip and a 30-degree bevel. The off time was set to 6 milliseconds (ms) and the on time varied from 4 to 10 ms in 1 ms increments. Efficiency (time for fragment removal) and chatter (number of times the fragment bounced from the tip) were measured. RESULTS A linear incremental increase in efficiency was observed between 4 ms and 6 ms. The most statistically significant efficiency was achieved with an on time of 6 ms. On times shorter than 6 ms were significantly less efficient (P = .05). Greater on times (7 to 10 ms) did not result in a significant difference in efficiency (P = .72), but did appear to have more chatter events when comparing on-time settings of 7 to 10 ms with 4 to 6 ms (P = .02). CONCLUSIONS With micropulse transversal US, 6 ms of on time was as efficient as longer on times. To maximize phacoemulsification efficiency and minimize chatter events, an on time of 6 ms is recommended.
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Affiliation(s)
- Austin D Bohner
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Alex J Wright
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Brian T Ta
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Ashlie A Bernhisel
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Brian Zaugg
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - William R Barlow
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Jeff H Pettey
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Randall J Olson
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.
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Gardiner GL, Garff K, Gupta I, Kramer GD, Farukhi MA, Stagg BC, Zaugg B, Olson RJ. Effect of pulsing ultrasound on phacoemulsification efficiency. J Cataract Refract Surg 2015; 41:2560-4. [PMID: 26703507 DOI: 10.1016/j.jcrs.2015.06.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 06/02/2015] [Accepted: 06/08/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate pulse type technology used to remove lens fragments during phacoemulsification. SETTING John A. Moran Eye Center Laboratories, University of Utah, Salt Lake City, Utah, USA. DESIGN Experimental study. METHODS Lens nuclei soaked in 10 mL of 10% neutral buffered formalin for 2 hours were placed in 10 mL of balanced salt solution. Lenses were cut into 2 mm × 2 mm cubes; no more than 36 hours later, cubes were randomly selected for testing. Two aspiration and 2 vacuum settings were assessed at moderate- and high-flow and vacuum (30 mL/min and 300 mm/Hg, low-flow vacuum; 50 mL/min and 500 mm/Hg, high-flow vacuum), with continuous 50 milliseconds on and off (long pulse) and 6 milliseconds on and off (micropulse) ultrasound. RESULTS There was a significant difference in efficiency favoring micropulse compared with combined long pulse and continuous pulse in high-flow vacuum at 80% power (P = .018) and between combined long pulse and continuous pulse versus micropulse in high-flow vacuum at 20% power (P = .019). Low-flow vacuum micropulse was more efficient than continuous (19.7%) (P < .0001) and long pulse (22.7%) (P < .0001). Continuous and long pulses were not significantly different from one other. There was a significant difference in chatter rates between high-flow vacuum and low-flow vacuum when all results were compared (P < .0001), with no additional significant differences found. CONCLUSION Micropulse technology was better than continuous and long pulse at moderate but not high-flow and vacuum settings. At the higher setting, chatter was observed less often, with all modalities more efficient than the lower setting.
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Affiliation(s)
- Gareth L Gardiner
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Kevin Garff
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Isha Gupta
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Gregory D Kramer
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - M Aabid Farukhi
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Brian C Stagg
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Brian Zaugg
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Randall J Olson
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.
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Lam D, Rao SK, Ratra V, Liu Y, Mitchell P, King J, Tassignon MJ, Jonas J, Pang CP, Chang DF. Cataract. Nat Rev Dis Primers 2015; 1:15014. [PMID: 27188414 DOI: 10.1038/nrdp.2015.14] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cataract is the leading cause of reversible blindness and visual impairment globally. Blindness from cataract is more common in populations with low socioeconomic status and in developing countries than in developed countries. The only treatment for cataract is surgery. Phacoemulsification is the gold standard for cataract surgery in the developed world, whereas manual small incision cataract surgery is used frequently in developing countries. In general, the outcomes of surgery are good and complications, such as endophthalmitis, often can be prevented or have good ouctomes if properly managed. Femtosecond laser-assisted cataract surgery, an advanced technology, can automate several steps; initial data show no superiority of this approach over current techniques, but the results of many large clinical trials are pending. The greatest challenge remains the growing 'backlog' of patients with cataract blindness in the developing world because of lack of access to affordable surgery. Efforts aimed at training additional cataract surgeons in these countries do not keep pace with the increasing demand associated with ageing population demographics. In the absence of strategie that can prevent or delay cataract formation, it is important to focus efforts and resources on developing models for efficient delivery of cataract surgical services in underserved regions. For an illustrated summary of this Primer, visit: http://go.nature.com/eQkKll.
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Affiliation(s)
- Dennis Lam
- State Key Laboratory of Ophthalmology, and Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou 510060, China.,C-MER (Shenzhen), Dennis Lam Eye Hospital, Shenzhen, China
| | | | - Vineet Ratra
- C-MER (Shenzhen), Dennis Lam Eye Hospital, Shenzhen, China
| | - Yizhi Liu
- State Key Laboratory of Ophthalmology, and Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou 510060, China
| | - Paul Mitchell
- Department of Ophthalmology, Centre for Vision Research, Westmead Hospital, University of Sydney, Sydney, Australia
| | - Jonathan King
- Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | | | - Jost Jonas
- Department of Ophthalmology, Ruprecht-Karls-University, Heidelberg, Germany
| | - Chi P Pang
- Department of Ophthalmology &Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - David F Chang
- Department of Ophthalmology, University of California, San Francisco, California, USA
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Jensen JD, Kirk KR, Gupta I, Ronquillo C, Farukhi MA, Stagg BC, Pettey JH, Olson RJ. Determining optimal ultrasound off time with micropulse longitudinal phacoemulsification. J Cataract Refract Surg 2015; 41:433-6. [PMID: 25661139 DOI: 10.1016/j.jcrs.2014.12.033] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 07/24/2014] [Accepted: 07/30/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate the optimum off time for the most efficient removal of lens fragments using micropulse ultrasound (US). SETTING John A. Moran Eye Center Laboratories, University of Utah, Salt Lake City, Utah, USA. DESIGN Experimental study. METHODS Porcine lens nuclei were soaked in formalin for 2 hours and then cut into 2.0 mm cubes using the Signature US machine with a bent 0.9 mm phaco tip with a 30-degree bevel. The on time was 7 milliseconds (ms), and the off time was varied from 2 to 20 ms in 2 ms steps. Phacoemulsification efficiency (time for fragment removal) and chatter (number of times the fragment bounced from the tip) were measured. RESULTS A nonsignificant linear increase in efficiency was observed with 2 to 6 ms of off time (R(2) = .87, P = .24). A significant linear decrease in efficiency was observed with 6 to 20 ms (R(2) = .74, P = .006). CONCLUSIONS With micropulse longitudinal US, 6 to 7 ms of off time was as efficient as shorter off times; longer off times (8 to 20 ms) showed decreased efficiency. Chatter was minimal and statistically similar throughout. To maximize phacoemulsification US efficiency, an off-time setting of 6 ms is recommended. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Jason D Jensen
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Kevin R Kirk
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Isha Gupta
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Cecinio Ronquillo
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - M Aabid Farukhi
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Brian C Stagg
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Jeff H Pettey
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Randall J Olson
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.
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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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Luo L, Lin H, Chen W, Qu B, Zhang X, Lin Z, Chen J, Liu Y. Intraocular lens-shell technique: adjustment of the surgical procedure leads to greater safety when treating dense nuclear cataracts. PLoS One 2014; 9:e112663. [PMID: 25401512 PMCID: PMC4234368 DOI: 10.1371/journal.pone.0112663] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 10/08/2014] [Indexed: 11/21/2022] Open
Abstract
Objective To compare the efficacy and safety of the intraocular lens (IOL)-shell procedure versus conventional phacoemulsification for the surgical treatment of dense cataracts. Methods Eighty eyes with dense nuclear cataracts were enrolled in a prospective, randomized controlled study. Patients were assigned to two groups. In Group I, the IOL was traditionally implanted after all nuclear fragments were completely removed, and in Group II, the IOL was innovatively implanted in the bag before the last residual nuclear fragment was removed. This novel adjusted surgical procedure, named the “IOL-shell technique”, features use of the IOL as a protective barrier rather than simply as a refractive alternative, and it is conceptually different from the traditional step-by-step procedure. Clinical examinations, including uncorrected visual acuity, central corneal thickness (CCT), temporal clear corneal incision thickness and corneal endothelial cell density, were carried out. Results The inter-group difference in temporal corneal thickness was found to be of no statistical significance at any of the visits. Compared to eyes in Group I, those in Group II were shown to have significantly less corneal endothelial cell loss on both the 7th and 30th day following surgery. At 7 days after surgery, the mean corneal endothelial cell loss in Group II was 10.29%, compared to 14.37% in Group I (P<0.05). The mean endothelial cell loss measured on postoperative day 30 was 16.88% in Group II compared to 23.32% in Group I (P<0.05). On the 1st day after surgery, the mean CCT of eyes in Group II was significantly smaller compared to Group I (Group I vs. Group II: 19.42% vs. 13.50%, P<0.05). Conclusions Compared to conventional phacoemulsification, the IOL-shell technique was shown to be a relatively safer procedure without compromised efficiency for dense cataracts, and it caused less corneal endothelial cell loss and milder postoperative corneal edema (Clinical Trials Identifier: NCT02138123). Trial Registration ClinicalTrials.gov NCT02138123
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Affiliation(s)
- Lixia Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Weirong Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Bo Qu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xinyu Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zhuoling Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jingjing Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yizhi Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- * E-mail:
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Kirk KR, Ronquillo C, Jensen JD, Zaugg B, Barlow WR, Stagg BC, Pettey JH, Olson RJ. Optimum on-time duty cycle for micropulse technology. J Cataract Refract Surg 2014; 40:1545-8. [PMID: 25135547 DOI: 10.1016/j.jcrs.2014.02.033] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 02/14/2014] [Accepted: 02/17/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the optimum on time for the most efficient removal of lens fragments using micropulsed ultrasound (US). SETTING John A. Moran Eye Center Laboratories, University of Utah, Salt Lake City, Utah, USA. DESIGN Experimental study. METHODS Twenty porcine lens nuclei were soaked in formalin for 2 hours and then divided into 2.0 mm cubes. Using an US machine with a 0.9 mm bent and a 30-degree bevel tip, the on time was varied every millisecond (ms) from 2 ms to 10 ms with the off time kept constant at 10 ms. Efficiency (time to lens removal) and chatter (number of lens fragment repulsions from the tip) were determined. RESULTS The most efficient phacoemulsification was achieved with an on time of 6 ms. On times shorter than 6 ms were significantly less efficient (R2=.82, P=.04). Greater on times did not result in a significant difference in efficiency (R2=.03, P=.78) but did appear to have more chatter events when comparing 9 to 10 ms with 2 to 8 ms (P<.0001). CONCLUSIONS With micropulsed longitudinal US, a 6 ms on time was equally as efficient as longer on times, while shorter on times (2 to 5 ms) had decreased efficiency. At 9 ms and 10 ms on time, significantly more chatter was noted. Therefore, to maximize phacoemulsification, an on-time setting of 6 ms is recommended. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Kevin R Kirk
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Cecinio Ronquillo
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Jason D Jensen
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Brian Zaugg
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - William R Barlow
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Brian C Stagg
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Jeff H Pettey
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Randall J Olson
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.
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Sharif-Kashani P, Fanney D, Injev V. Comparison of occlusion break responses and vacuum rise times of phacoemulsification systems. BMC Ophthalmol 2014; 14:96. [PMID: 25074069 PMCID: PMC4134114 DOI: 10.1186/1471-2415-14-96] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 07/16/2014] [Indexed: 11/10/2022] Open
Abstract
Background Occlusion break surge during phacoemulsification cataract surgery can lead to potential surgical complications. The purpose of this study was to quantify occlusion break surge and vacuum rise time of current phacoemulsification systems used in cataract surgery. Methods Occlusion break surge at vacuum pressures between 200 and 600 mmHg was assessed with the Infiniti® Vision System, the WhiteStar Signature® Phacoemulsification System, and the Centurion® Vision System using gravity-fed fluidics. Centurion Active FluidicsTM were also tested at multiple intraoperative pressure target settings. Vacuum rise time was evaluated for Infiniti, WhiteStar Signature, Centurion, and Stellaris® Vision Enhancement systems. Rise time to vacuum limits of 400 and 600 mmHg was assessed at flow rates of 30 and 60 cc/minute. Occlusion break surge was analyzed by 2-way analysis of variance. Results The Centurion system exhibited substantially less occlusion break surge than the other systems tested. Surge area with Centurion Active Fluidics was similar to gravity fluidics at an equivalent bottle height. At all Centurion Active Fluidics intraoperative pressure target settings tested, surge was smaller than with Infiniti and WhiteStar Signature. Infiniti had the fastest vacuum rise time and Stellaris had the slowest. No system tested reached the 600-mmHg vacuum limit. Conclusions In this laboratory study, Centurion had the least occlusion break surge and similar vacuum rise times compared with the other systems tested. Reducing occlusion break surge may increase safety of phacoemulsification cataract surgery.
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Affiliation(s)
| | - Douglas Fanney
- Alcon Research, Ltd,, 20511 Lake Forest Drive, Lake Forest, CA 92630, USA.
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15
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Farukhi AM, Stagg BC, Ronquillo C, Barlow WR, Pettey JH, Olson RJ, Gupta I, Jensen JD. Effect of phaco tip diameter on efficiency and chatter. J Cataract Refract Surg 2014; 40:811-7. [PMID: 24767913 DOI: 10.1016/j.jcrs.2013.09.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 08/30/2013] [Accepted: 09/19/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate 3 phacoemulsification tips of different sizes and determine which size is most efficient in lens fragment removal using 3 ultrasound (US) approaches. SETTING John A. Moran Eye Center Laboratories, University of Utah, Salt Lake City, Utah, USA. DESIGN Experimental study. METHODS Porcine lens nuclei were formalin-soaked for 2 hours then divided into 2.0 mm cubes; 1.1 mm, 0.9 mm, and 0.7 mm phaco tips were used with torsional and micropulsed US. The 1.1 mm tips were unavailable for torsional US, so 0.9 mm and 0.7 mm tips were used. Efficiency (amount of time for lens removal) and chatter (number of lens-fragment repulsions from the tip) were determined. RESULTS The mean phacoemulsification efficiency was highest with the 0.9 mm tip for all US variations. There were statistically significant differences between the 0.9 mm and 0.7 mm tips with micropulsed US (0.8 seconds ± 0.29 [SD] versus 1.4 ± 0.93 seconds; P=.0112) and transversal US (0.8 ± 0.17 seconds versus 1.4 ± 0.89 seconds; P=.0065). There was no significant difference between 0.9 mm and 0.7 mm tips with torsional US or between the 1.1 mm and 0.9 mm tips with micropulsed or transversal US; however, trends were identical, with 0.9 mm tips performing better than 0.7 mm and 1.1 mm tips. CONCLUSION With all 3 systems, the 0.9 mm tip was most efficient, with the fewest outliers and smallest standard deviation. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Aabid M Farukhi
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Brian C Stagg
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Cecinio Ronquillo
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - William R Barlow
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Jeff H Pettey
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Randall J Olson
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.
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16
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Fluid dynamics, cavitation, and tip-to-tissue interaction of longitudinal and torsional ultrasound modes during phacoemulsification. J Cataract Refract Surg 2013; 39:611-6. [DOI: 10.1016/j.jcrs.2012.10.050] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 10/16/2012] [Accepted: 10/21/2012] [Indexed: 11/20/2022]
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17
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Lee JY, Lee JH, Kim HK. Comparison of Balanced Salt Solution and Ophthalmic Viscosurgical Device to Maintain Optical Clarity During Phacoemulsification. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.10.1514] [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)
- Jin Young Lee
- Department of Ophthalmology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jun Hun Lee
- Department of Ophthalmology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hong Kyun Kim
- Department of Ophthalmology, Kyungpook National University School of Medicine, Daegu, Korea
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Aust SD, Terry S, Hebdon T, Gunderson B, Terry M, Dimalanta R. Determining the local origin of hydroxyl radical generation during phacoemulsification. J Cataract Refract Surg 2011; 37:1154-9. [PMID: 21596259 DOI: 10.1016/j.jcrs.2010.12.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 12/08/2010] [Accepted: 12/10/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE To determine the local origin of hydroxyl radicals during phacoemulsification using an ultrasonic phacoemulsification device that includes longitudinal and torsional modalities. SETTING Chemistry and Biochemistry Department, Utah State University, Logan, Utah, USA. DESIGN Experimental study. METHODS Experiments were conducted using the Infiniti Vision System and Ozil handpiece. Hydroxyl radical concentrations during longitudinal and torsional phacoemulsification were quantitated as malondialdehyde (MDA) determined spectrophotometrically using the deoxyribose assay. The difference between the total concentration found in the aspirated solution at steady-state concentrations and the pre-aspirate levels deductively determined the concentration of MDA formed along the interior of the sonicating tip. The time to reach 50% of steady state as a function of reaction vessel volume was determined. RESULTS The mean maximum for torsional ultrasound at 100% amplitude was 7.70 nM ± 0.38 (SD), 91.1% of which was generated outside the tip. During longitudinal ultrasound at 100% power, MDA concentration in the aspirated solution was 29.5 ± 0.3 nM, 71.6% of which was generated outside the tip. The time (seconds) to reach 50% of maximum for longitudinal ultrasound using 5 mL, 10 mL, and 20 mL reaction vessels was 12.6 ± 1.5, 21.0 ± 1.5, and 25.3 ± 3.4, respectively. CONCLUSION Although a significantly greater proportion of the hydroxyl radicals generated during ultrasound modality were formed outside the phaco tip (91.1% torsional; 71.6% longitudinal), torsional ultrasound generated only about one-fourth the amount of MDA as longitudinal ultrasound in total and about one-third that generated outside the tip (7.02 nM versus 21.1 nM). FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.
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Affiliation(s)
- Steven D Aust
- Department of Chemistry and Biochemistry, Utah State University, Logan, Utah, USA
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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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Greenberg PB, Liu J, Wu WC, Jiang L, Tseng VL, Scott IU, Friedmann PD. Predictors of Mortality within 90 Days of Cataract Surgery. Ophthalmology 2010; 117:1894-9, 1899.e1. [DOI: 10.1016/j.ophtha.2010.02.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Revised: 02/05/2010] [Accepted: 02/09/2010] [Indexed: 11/16/2022] Open
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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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Zeng M, Liu X, Zhang X, Xia Y, Liu Y, Yuan Z, Liu Y. A Comparative Study of Non-Chopping Rotation and Axial Rotation Versus Quick Chop Phacoemulsification Techniques. Ophthalmic Surg Lasers Imaging Retina 2009; 40:222-31. [PMID: 19485284 DOI: 10.3928/15428877-20090430-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Mingbing Zeng
- Zhongshan Ophthalmic Center, Sun-Yat-Sen University, Guangzhou, China
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23
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Zeng M, Liu X, Liu Y, Xia Y, Luo L, Yuan Z, Zeng Y, Liu Y. Torsional ultrasound modality for hard nucleus phacoemulsification cataract extraction. Br J Ophthalmol 2008; 92:1092-6. [PMID: 18567650 PMCID: PMC2569137 DOI: 10.1136/bjo.2007.128504] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2008] [Indexed: 12/02/2022]
Abstract
AIM To evaluate the efficacy and safety of phacoemulsification using torsional modality with different parameter settings for hard nucleus cataract extraction. DESIGN A prospective, randomised clinical study. METHODS A clinical practice study conducted at the Cataract Service, Zhongshan Ophthalmic Center, Sun-Yat-Sen University, and Guangzhou. One eye each from 198 consecutive patients with cataract density grade IV according to the Emery-Little system classification system, requiring phacoemulsification and intraocular lens implantation, was included. Eyes were randomly assigned to the Linear Torsional combined with Ultrasound power group (Linear Tor+US group, n = 66), 100% Fixed Torsional group (Fixed Tor group, n = 65) and conventional Ultrasound burst group (US group, n = 67). All surgeries were performed by a single experienced surgeon and outcomes evaluated by another surgeon masked to treatment. Intraoperative parameters were Ultrasound Time (UST), Cumulative Dissipated Energy (CDE) and surgical complications. Patients were examined on post-op days 1, 7 and 30. Postoperative outcomes were final best corrected visual acuity (BCVA), average central and incisional corneal thickness and central endothelial cell counts. RESULTS The mean UST was lower in the Fixed Tor group than in the US group and in the Lin US+Tor group (p 0.01), greater average central corneal and incisional thickness on days 1, 7 (p0.01), and higher average corneal endothelial cell losses on day 7 and 30 days (pCONCLUSIONS Torsional combined with ultrasound power or high fixed torsional amplitude can yield more effective hard nucleus phacoemulsification than conventional ultrasound modality.
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Affiliation(s)
- M Zeng
- Zhongshan Ophthalmic Center, Sun-Yat-Sen University Guangzhou, People’s Republic of China
- The Second Affiliated Hospital of Guangzhou Medical College, Guangzhou, People’s Republic of China
| | - X Liu
- Zhongshan Ophthalmic Center, Sun-Yat-Sen University Guangzhou, People’s Republic of China
| | - Y Liu
- Zhongshan Ophthalmic Center, Sun-Yat-Sen University Guangzhou, People’s Republic of China
| | - Y Xia
- Zhongshan Ophthalmic Center, Sun-Yat-Sen University Guangzhou, People’s Republic of China
| | - L Luo
- Zhongshan Ophthalmic Center, Sun-Yat-Sen University Guangzhou, People’s Republic of China
| | - Z Yuan
- Zhongshan Ophthalmic Center, Sun-Yat-Sen University Guangzhou, People’s Republic of China
| | - Y Zeng
- Zhongshan Ophthalmic Center, Sun-Yat-Sen University Guangzhou, People’s Republic of China
| | - Y Liu
- Zhongshan Ophthalmic Center, Sun-Yat-Sen University Guangzhou, People’s Republic of China
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Abstract
We describe a method of learning micro incision cataract surgery painlessly with the minimum of learning
curves. A large-bore or standard anterior chamber maintainer (ACM) facilitates learning without change of
machine or preferred surgical technique. Experience with the use of an ACM during phacoemulsification is
desirable.
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