Phacoemulsification in patients with corneal opacities using slit illumination of the surgical microscope

Effect of Anterior Chamber Air on Central Corneal Thickness in Human Donor Eyes

PURPOSE

The purpose of this study was to describe the effects of intracameral air on corneal edema.

METHODS

A laboratory investigation was performed on human donor corneas. Baseline pachymetry measurements through anterior segment optical coherence tomography and endothelial cell density were obtained for all corneas. Each pair of corneas was separated and randomly assigned to undergo air injection or Optisol-GS into a BIONIKO artificial anterior chamber for 5 minutes at physiologic intraocular pressure confirmed by digital palpation. Photographs were obtained immediately on connection of the cornea to the artificial anterior chamber and on completion of the 5 minutes of treatment, with anterior chamber air being exchanged for Optisol-GS. Pretreatment and posttreatment photographs were obtained. Immediately after treatment, pachymetry was again obtained on all corneas. Pachymetry data underwent statistical analysis.

RESULTS

Corneal pachymetry improved from 690.5 ± 126.6 to 576.1 ± 87.2 μm, yielding a 114.4 ± 50.4 μm improvement of pachymetry in the group with air injected into the anterior chamber. This was a significant improvement of pachymetry when compared with the group with Optisol-GS injected into the anterior chamber, which showed an improvement from 662.3 ± 126.5 to 613.5 ± 108.0 μm, yielding an improvement of 48.8 ± 34.3 μm.

CONCLUSIONS

Injection of air into the anterior chamber leads to a significant decrease in corneal pachymetry. We thereby propose that injecting air intracamerally is an effective intraoperative intervention when visualization is negatively affected by corneal edema.

Evaluation of visual and optical quality following phacoemulsification cataract surgery with diffractive multifocal intraocular lens implantation: An observational study

The assessment of patient satisfaction following cataract surgery is heavily reliant on the evaluation of visual quality, specifically after the placement of diffractive multifocal intraocular lenses (MIOLs) under varying pupil conditions. The objective of this study was to examine the visual and optical clarity following cataract phacoemulsification and the use of Tecnis ZMB00 MIOL for implantation. The study involved 116 individuals (135 eyes) who received cataract phacoemulsification and underwent Tecnis ZMB00 MIOL implantation. Assessments were conducted 1 week and 3 months after the surgery. These assessments involved measuring uncorrected and corrected visual acuity for distant, intermediate, and near vision. Additionally, scatter light values and wavefront aberrations were measured under different aperture settings of 3 and 5 mm. There was no noticeable disparity in visual acuity between 1 week and 3 months after the surgery. After 3 months of surgery, there was a considerable decrease in scatter light values and spherical aberrations compared to the values observed 1 week after surgery, under the setting of a 5 mm aperture. Moreover, the modulation transfer function values showed a significant rise after 3 months following the surgery, particularly under the 5 mm aperture condition. The most substantial increase was observed at the intermediate spatial frequency of 20 cycles per degree (cpd), in comparison to the values obtained 1 week after the operation. The combination of cataract phacoemulsification and Tecnis ZMB00 MIOL implantation yielded favorable visual acuity at various distances for patients. Furthermore, enhancements in the measurements of scattered light, higher-order aberrations, and modulation transfer function values were noted 3 months after the surgical procedure, specifically under the condition of a 5 mm pupil. These findings suggest an increase in visual clarity and night vision to a certain degree.

Evaluation of new approach to enhance visualization performance in cataract surgery: 3D visualization system with coaxial illumination

PURPOSE

To evaluate the visualization performance of different approaches, including the 3D visualization system with coaxial illumination and the 3D system or microscope with standard illumination.

SETTING

Fuzhou Eye Hospital, Fuzhou City, China.

DESIGN

Cross-sectional study.

METHODS

This 2-part performance assessment for visualization composed of an objective analysis using surgical video images and a subjective survey collecting feedback from surgeons. Data of each eye were obtained with 3 approaches: standard operating microscope with standard illumination (SOM-S), 3D visualization system with standard illumination (3D-S), and 3D visualization system with coaxial illumination (3D-C).

RESULTS

112 eyes (107 cases) and 6 cataract surgeons were involved. The red reflex value was markedly greater in the 3D-C approach compared with other 2 approaches ( P < .001). Compared with the SOM-S approach, the red reflex increased by 55%, 57%, and 53% in the 3D-C approach, corresponding to nuclear grades of II, III, and IV, respectively. In the questionnaire survey, red reflex scores were consistently significantly higher in the 3D-C approach than those in the others ( P < .001). Depth of field was enhanced in both 3D approaches compared with the SOM-S approach ( P < .05). The only minor advantage of the SOM system over the 3D-C approach was in the surrounding field clarity score, and the difference was not statistically significant ( P = 1.000).

CONCLUSIONS

The 3D-C approach significantly increased the red reflex in both objective and subjective assessments. Surgeon responses also showed a superior performance for the 3D-C approach.