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Wang D, Shi J, Guan W, Zhu M, Lou X, Zhao Y, Chang P, Zhao Y. Fluid Supplementation Through Weakened Zonules via Side-Port Incision to Maintain Intraocular Pressure in High Myopic Eyes. Ophthalmol Ther 2023; 12:3323-3336. [PMID: 37812307 PMCID: PMC10640526 DOI: 10.1007/s40123-023-00814-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
INTRODUCTION During phacoemulsification, the infusion pressure can cause the liquefied vitreous fluid to escape through the ciliary fiber interspace in highly myopic eyes, leading to reduced vitreous cavity pressure similar to vitrectomized eyes. This study assessed the probability of low intraocular pressure (IOP) in high myopic eyes with different axial length (AL) group undergoing cataract surgery, as well as the impact of balanced salt solution (BSS) supplementation and the optimal IOP value for such supplementation. METHODS The control group consisted of cataract eyes with normal AL (group 1: 22 mm ≤ AL < 24.5 mm), while cataract eyes with high axial myopia were categorized into three groups (group 2: 26 mm ≤ AL < 28 mm, group 3: 28 mm ≤ AL < 30 mm, group 4: AL ≥ 30 mm). IOP was measured using the iCare pro tonometer intraoperatively. BSS supplementation was performed to raise IOP in cases of low IOP, before intraocular lens (IOL) implantation and before the end of surgery. The probability of low IOP was calculated, and the IOP before and after supplementation were compared. RESULTS Ninety-five eyes were included. The total probability of low IOP in groups 2, 3, and 4 was 56.52, 62.50, and 70.83%, respectively, significantly higher than that in group 1 (16.67%). Similarly, the probability of low IOP before IOL implantation was significantly higher in groups 2, 3, 4 (43.48, 41.67, and 62.50%) compared to group 1 (4.17%, P < 0.05). The IOP before and after the first BSS supplementation in three high myopia groups were statistically significant (P < 0.05), increasing from 12.10 mmHg (range, 6.0-24.9 mmHg) to 16.60 mmHg (range, 10.2-34.4 mmHg). After the second BSS supplementation before the end of surgery, the IOP of high myopia groups increased from 12.60 mmHg (range, 7.0-25.3 mmHg) to 14.60 mmHg (range, 9.8-25.3 mmHg). CONCLUSIONS The condition of highly myopic eyes seems more likely to develop low IOP during cataract surgery. There is an observed correlation: as AL increases, the total probability of low IOP rises. In patients with IOP < 9.5 mmHg intraoperatively, fluid supplementation via a side-port incision can effectively raise IOP to about 16 mmHg before IOL implantation and about 14 mmHg after incision sealing, facilitating smoother IOL implantation and reducing the risk of postoperative low IOP. TRIAL REGISTRATION NCT, NCT05201677. Registered 23 November 2021-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT05201677 .
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Affiliation(s)
- Dandan Wang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, 325000, Zhejiang, China
- Eye Hospital of Wenzhou Medical University, Hangzhou Branch, 618 Fengqi Road, Hangzhou, 310000, Zhejiang, China
| | - Jingyi Shi
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, 325000, Zhejiang, China
- Eye Hospital of Wenzhou Medical University, Hangzhou Branch, 618 Fengqi Road, Hangzhou, 310000, Zhejiang, China
| | - Weichen Guan
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, 325000, Zhejiang, China
- Eye Hospital of Wenzhou Medical University, Hangzhou Branch, 618 Fengqi Road, Hangzhou, 310000, Zhejiang, China
| | - Minying Zhu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, 325000, Zhejiang, China
- Eye Hospital of Wenzhou Medical University, Hangzhou Branch, 618 Fengqi Road, Hangzhou, 310000, Zhejiang, China
| | - Xicong Lou
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, 325000, Zhejiang, China
- Eye Hospital of Wenzhou Medical University, Hangzhou Branch, 618 Fengqi Road, Hangzhou, 310000, Zhejiang, China
| | - Yinying Zhao
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, 325000, Zhejiang, China
- Eye Hospital of Wenzhou Medical University, Hangzhou Branch, 618 Fengqi Road, Hangzhou, 310000, Zhejiang, China
| | - Pingjun Chang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, 325000, Zhejiang, China
- Eye Hospital of Wenzhou Medical University, Hangzhou Branch, 618 Fengqi Road, Hangzhou, 310000, Zhejiang, China
| | - Yune Zhao
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.
- National Clinical Research Center for Ocular Diseases, Wenzhou, 325000, Zhejiang, China.
- Eye Hospital of Wenzhou Medical University, Hangzhou Branch, 618 Fengqi Road, Hangzhou, 310000, Zhejiang, China.
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Zhao J, Li Z, Liu Y, Han X, Huang S. Application of prechop technique in phacoemulsification for cataract patients with highly liquefied vitreous: a retrospective study. BMC Ophthalmol 2022; 22:167. [PMID: 35421948 PMCID: PMC9009009 DOI: 10.1186/s12886-022-02392-0] [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] [Received: 06/07/2021] [Accepted: 04/07/2022] [Indexed: 11/24/2022] Open
Abstract
Background Phacoemulsification using phaco-chop technique has many challenging features in cataract patients with highly liquefied vitreous. This study aimed to compare the intraoperative parameters and safety between prechop technique and traditional phaco-chop in phacoemulsification for these patients. Methods A total of 54 eyes of 54 patients with high myopia-related or post-vitrectomy cataract that underwent phacoemulsification combined with intraocular lens implantation were included in this retrospective study. Of them, 25 eyes that received manual prechop were included in the prechop group, and 29 eyes with best match of age, axial length and nuclear opalescence (NO) that received standardized phaco-chop were included as the control group. The intraoperative complications and surgery parameters were compared between groups. Results No surgical complications were observed in the prechop group, while 2 eyes with posterior capsular rupture and 1 eye with a broken ciliary zonule (10.3%) were found in the control group. There was no significant difference in phaco time, average energy, and cumulative dissipated energy (CDE) between groups (all P > 0.05), but for hard nuclear cataracts with NO grading ≥ 5, prechop group required less phaco time (P = 0.008) and CDE (P = 0.029). There were significant correlations between phaco time vs. NO (r = 0.762 vs. 0.581, both P < 0.005) and CDE vs. NO (r = 0.717 vs. 0.668, both P < 0.001) in the prechop group and control group, respectively. Conclusions The prechop technique which seemed to have less intraoperative complications, reduced phaco time and CDE compared to standardized phaco-chop might be a good alternative for cataract patients with highly liquefied or vitrectomized vitreous, especially those with hard nuclear cataracts.
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