Intraocular lens-shell technique: adjustment of the surgical procedure leads to greater safety when treating dense nuclear cataracts

Observations of the efficacy of the artificial lens cushion plate technique in hard-core cataract surgery

Objective

To evaluate the efficacy of intraocular lens (IOL) cushion plate technology in reducing corneal endothelial cell loss during hard-core cataract surgery compared with conventional ultrasonic emulsification.

Methods

Seventy-six patients with hard-core cataracts who underwent surgery at our institution from April 2019 to June 2022 were included. The patients were divided into an observation group (IOL cushion plate technology, 38 patients) and a control group (conventional ultrasonic emulsification, 38 patients). Surgical outcomes, including the corneal endothelial cell loss rate, best corrected visual acuity (BCVA), and central corneal thickness (CCTc), were compared between the two groups.

Results

Preoperative patient characteristics were similar between the groups. Postoperatively, both groups demonstrated similar BCVA and CCTc values on days 7 and 30. However, compared with the observation group, the control group presented a significantly greater rate of corneal endothelial cell loss on postoperative days 7 and 30 (p < 0.05). Intraoperative complications and postoperative complications were notably greater in the control group (p < 0.05). The observation group had reduced ultramilk time and total energy consumption (p < 0.05).

Conclusion

IOL cushion plate technology offers advantages in preserving corneal endothelial cells during hard-core cataract surgery, potentially improving surgical safety and efficacy.

Corneal Edema after Cataract Surgery

This systematic review investigates the prevalence and underlying causes of corneal edema following cataract surgery employing manual phacoemulsification. A comprehensive search encompassing databases such as PubMed, Embase, ProQuest, Cochrane Library, and Scopus was conducted, focusing on variables encompassing cataract surgery and corneal edema. Two independent reviewers systematically extracted pertinent data from 103 articles, consisting of 62 theoretical studies and 41 clinical trials. These studies delved into various aspects related to corneal edema after cataract surgery, including endothelial cell loss, pachymetry measurements, visual performance, surgical techniques, supplies, medications, and assessments of endothelial and epithelial barriers. This review, encompassing an extensive analysis of 3060 records, revealed significant correlations between corneal edema and endothelial cell loss during phacoemulsification surgery. Factors such as patient age, cataract grade, and mechanical stress were identified as contributors to endothelial cell loss. Furthermore, pachymetry and optical coherence tomography emerged as valuable diagnostic tools for assessing corneal edema. In conclusion, this systematic review underscores the link between corneal edema and endothelial cell loss in manual phacoemulsification cataract surgery. It highlights the relevance of factors like patient demographics and diagnostic modalities. However, further research is essential to unravel the complexities of refractive changes and the underlying mechanisms.

Femtosecond laser-assisted cataract surgery in a spherophakic lens: An unusual case report

RATIONALE

Spherophakia is a rare diagnosis which is often associated with a shallow anterior chamber, angle-closure glaucoma, lens subluxation, and lenticular myopia. When cataracts occur with subluxation of the lens, vision is often markedly affected. This often presents surgeons with a unique challenge of maintaining good visual outcomes while minimizing potential complications.

PATIENT CONCERNS

A 48-year-old female was referred for ophthalmological assessment due to decreased vision in the left eye. In the left eye, the best-corrected visual acuity at distance was 20/125 with manifest refraction of -6.5D + (-0.75) D × 118°. The slit lamp examination showed iridodonesis and a significant nuclear cataract (C3N3) with tremor in the left eye. After pupil dilation, a subluxated lens, weak zonules, and "fake golden ring" within the lens was noted.

DIAGNOSIS

Due to the patient's symptoms, examination results, she was diagnosed with cataract, subluxation of the lens and spherophakia in left eye.

INTERVENTIONS

The patient underwent an uneventful femtosecond laser-assisted cataract surgery (Alcon Fort Worth, TX). The laser was able to perform a circular free-floating anterior capsulotomy and easy lens fragmentation.

OUTCOMES

There were no postoperative complications. At 3 months postoperatively, the uncorrected visual acuity was 20/25, and the manifest refraction was -0.25 D - 0.75 D × 148° with the corrected distance visual acuity of 20/16.

LESSONS

Femtosecond laser-assisted cataract surgery is an effective approach for cataract surgery in patients with subluxated and spherophakic lenses, with the benefits of causing minimal further zonular damage and easy lens fragmentation.

"Crack, Reduce, and Implant": A Safe Phaco Technique in a Case with Hard Brown Cataract

This report describes two maneuvers in different steps of phaco surgery in a case with hard cataract, which provide debulking of the central dense nucleus and prevents posterior capsule rupture (PCR). In the current case, clear corneal incisions were created, and anterior chamber was filled with ophthalmic viscosurgical device (OVD). Anterior capsule was punctured, and capsulorhexis was completed. Nucleus was cracked into two halves following vertical groove formation. Core nucleus was hollowed sideward bilaterally in the capsular bag. Nuclear halves were removed from capsular bag, and each one was pushed to one side on the iris plane. Capsular bag was inflated with OVD, and intraocular lens (IOL) was implanted. Nuclear halves were removed in confidence. The presented maneuvers initially reduce dense nucleus load in the safe zone and allow surgeon to use IOL as a barrier to protect floppy posterior capsule from early steps of the surgery.

Influence of uncomplicated phacoemulsification on central macular thickness in diabetic patients: a meta-analysis

OBJECTIVE

To evaluate the effect of uncomplicated phacoemulsification on central macular thickness (CMT) and best corrected visual acuity (BCVA) in both diabetic patients without diabetic retinopathy (DR) and diabetic patients with mild to moderate non-proliferative diabetic retinopathy (NPDR).

METHODS

Potential prospective observational studies were searched through PubMed and EMBASE. Standardized mean difference (SMD) and 95% confidence interval (CI) for changes in CMT and BCVA were evaluated at postoperative 1, 3 and 6 months. The pooled effect estimates were calculated in the use of a random-effects model.

RESULTS

A total of 10 studies involving 190 eyes of diabetic patients without diabetic retinopathy and 143 eyes of diabetic patients with NPDR were identified. CMT values demonstrated a statistically significant increase after uncomplicated phacoemulsification at 1 month (SMD, -0.814; 95%CI, -1.230 to -0.399), 3 months (SMD, -0.565; 95%CI, -0.927 to -0.202) and 6 months (SMD, -0.458; 95%CI, -0.739 to -0.177) in diabetic patients with NPDR. There was no statistical difference in CMT values at postoperative 1 month (SMD, -1.206; 95%CI, -2.433 to 0.021)and no statistically significant increase in CMT values at postoperative3 months (SMD, -0.535; 95%CI, -1.252 to 0.182) and 6 months (SMD, -1.181; 95%CI, -2.625 to 0.263) in diabetic patients without DR.BCVA was significantly increased at postoperative 1 month (SMD, 1.149; 95%CI, 0.251 to 2.047; and SMD,1.349; 95%CI, 0.264 to 2.434, respectively) and 6 months (SMD, 1.295; 95%CI, 0.494 to 2.096; and SMD, 2.146; 95%CI, 0.172 to 4.120, respectively) in both diabetic patients without DR and diabetic patients with NPDR. Sensitivity analysis showed that the results were relatively stable and reliable.

CONCLUSION

Uncomplicated phacoemulsification in diabetic patients with mild to moderate NPDR seemed to influence significantly the subclinical thickening of the macular zones at postoperative 1, 3 and 6 months compared with diabetic patients without DR. BCVA was significantly improved in both diabetic patients without DR and diabetic patients with mild to moderate NPDR.