Phacoemulsification Outcomes with Different Illumination Techniques

Surgical time and efficacy of illuminated chopper-assisted cataract surgery involving miosis after femtosecond laser pretreatment

PURPOSE

To evaluate the efficacy of the illuminated chopper-assisted cataract surgery in terms of shortening the surgical time in eyes with miosis after femtosecond laser pretreatment.

METHODS

As retrospective study, three hundred thirty-six eyes of 336 consecutive patients who underwent the femtosecond laser and illuminated chopper-assisted cataract surgery were included. Cases with pupil less than 6 mm after femtosecond laser pretreatment were included in the miosis group. Pupil diameter, surgical time, and improved efficacy (100/surgical time×pupil size) were compared between eyes with and without miosis.

RESULTS

Of 336 eyes, 20 were included in the miosis group (6.0%). Pupil diameter was smaller in eyes with miosis than in those without miosis (5.23 ± 0.38 mm vs 7.35 ± 0.64 mm, p < 0.001); however, surgical time was not different (6.86 ± 0.73 min vs 6.60 ± 1.27 min, p = 0.071) between the two groups. Mechanical pupil dilations were not needed in any cases. As a result, improved efficacy was calculated to be higher in patients with miosis (2.83 vs 2.14, p < 0.001).

CONCLUSION

In terms of surgical time and improved efficacy, using the illuminated chopper simplified cataract surgery involving miosis after femtosecond laser pretreatment. The use of an illuminated chopper is expected to be a good solution for femtosecond laser-assisted cataract surgeries.

3D visualization system and standard operating microscope for ease of visualization and surgeon comfort during phacoemulsification surgery

PURPOSE

To compare the ease of visualization and comfort of the surgeon during phacoemulsification surgery using NGENUITY® 3D (NG) visualization system and standard operating microscope (SOM).

METHODS

In this prospective, randomized, single-blind, single-center study, patients undergoing phacoemulsification surgery by one of the five surgeons were randomly assigned to two groups based on the visualization modality-NG and SOM. Ease of visualization and comfort of the surgeon was assessed using a 27-parameter in-house Surgeon Comfort Score questionnaire.

RESULTS

A total of 224 phacoemulsification with intraocular lens implantations were performed in senile immature cataract (SIMC, n = 174) and mature cataract patients (MC, n = 50). Surgeon's ease of visualization (4.92-5.00) and hand-eye coordination score (4.97-5.00) were comparable between the NG- and SOM-groups. Postoperative neck discomfort was lower in both the groups, with a relatively lower discomfort in the NG-group (score: 1.04 vs 1.56). The Spearman rank correlation coefficient (r) between illumination of the operation theatre room and the surgical field revealed a weak negative correlation for most of the patients in the NG-group, and a positive correlation for patients in the SOM-group. No correlation was obtained between brightness of the surgical field and comfort with the surgical field brightness.

CONCLUSIONS

Similar ease of visualization was experienced by the surgeons using NG- and SOM-system. Neck discomfort postsurgery was numerically lower in the NG-group, although not significant. Additionally, the NG-system permitted the safe performance of phacoemulsification using a lower surgical field illumination.

Intraoperative challenges and complications of cataract surgery between cataract surgery alone and phacovitrectomy in eyes with diabetic retinopathy: efficacy of illuminated chopper-assisted cataract surgery

BACKGROUND

To compare the intraoperative challenges, complications, and operation time of illuminated chopper-assisted cataract surgery between cataract surgery only and phacovitrectomy in eyes with diabetic retinopathy.

METHODS

One university hospital, retrospective case series. Two hundred ninety-five eyes of 295 consecutive patients with diabetic retinopathy who underwent cataract surgery only or phacovitrectomy were retrospectively reviewed. Intraoperative challenges and complications of cataract surgery were thoroughly analyzed by 3D viewing of digitally recorded videos. The pupil diameter, operation time, and improved efficacy (100/operation time × pupil diameter) were compared between the cataract surgery only and phacovitrectomy groups.

RESULTS

Of the 295 eyes, 211 underwent cataract surgery only, and 84 underwent phacovitrectomy. Intraoperative challenges such as small pupil, miosis, or poor red reflex occurred more frequently (46 [21.8%] vs. 28 [33.3%], p = 0.029); pupil diameter was smaller (7.34 ± 0.94 vs. 6.89 ± 0.88 mm, p < 0.001) in the phacovitrectomy group than in the cataract surgery only group; however, rates of posterior capsule rupture and operation time were not different between the two groups (0 [0%] vs. 1 [1.2%], p = 0.285; 16.54 ± 2.65 vs. 16.31 ± 4.30 min, p = 0.434). Improved efficacy was higher in the phacovitrectomy group (0.85 ± 0.18 vs. 0.97 ± 0.28, p = 0.002).

CONCLUSIONS

The use of an illuminated chopper is a potential solution for diabetic cataract surgery, particularly in phacovitrectomy, by decreasing the use of supplemental devices, operation time, and posterior capsule rupture.

TRIAL REGISTRATION

Retrospectively registered.

Learning Curve in Phaco Chop Cataract Surgery Using an Illuminated Chopper

Purpose: To confirm that the phaco chop method using an illuminated chopper (iChopper; Oculight, Seongnam, Korea) can reduce cataract surgery complications, and that even beginners can safely and effectively perform phaco chop.Methods: We retrospectively analyzed the medical records of the first 30 phaco chop cases using illuminated chopper of four cataract surgeons. Four ophthalmologists had a variety of empirical backgrounds, from those who have experienced more than 10,000 cataract surgery, to beginners who have experienced 20 cataract surgery.Results: Of the total 120 eyes, two eyes (1.67%) had posterior capsule rupture. The chopping method was changed from phaco chop to stop and chop in three eyes (2.5%) including one eye with brown cataract with pseudoexofoliation syndrome and two eyes with nuclear opacity grade ≥5.Conclusions: The rates of posterior capsule rupture of phaco chop using an illuminated chopper were very low in four surgeons with various experiences and who became proficient shortly in phaco chop.

Illuminated Chop Using an Illuminated Chopper in Cataract Surgery: on the Way to Minimal-energy Phacoemulsification

Purpose: To minimize ultrasound power use and surgical phaco time in illuminated chop cataract surgery.Methods: The charts of patients who underwent senile cataract surgery by a single surgeon were reviewed retrospectively. A conventional intracameral endoilluminator was used in a Stop & Chop group (n = 45), while an illuminated chopper was used in an illuminated chop (I-Chop) group (n = 71). EFX, a unitless value that roughly correlates with ultrasound energy during phacoemulsification, surgical phaco time, and changes in endothelial cell count were compared between the two groups and the ratio of zero phacoemulsification in the I-Chop group was evaluated.Results: EFX of the Stop & Chop and I-Chop groups was 18.08 ± 16.15 and 0.82 ± 3.53, respectively (p = 0.001), while the surgical phaco time was 185.08 ± 41.42 and 162.04 ± 49.65 seconds (p = 0.01). However, the endothelial loss did not differ in the two groups (7.03 ± 7.89 vs. 7.13 ± 9.47%, p = 0.76). In the I-Chop group, 56 (86%) eyes had zero phaco energy and patients with EFX >1 (n = 6) had more severe nuclear sclerosis grading (2.90 ± 0.71 vs. 4.5 ± 1.0; p = 0.001).Conclusions: The I-Chop group had lower EFX and shorter surgical phaco time than the Stop & Chop group. Illuminated chop using an illuminated chopper is one way to attain minimal phacoemulsification.

Contrast, visibility, and color balance between the microscope versus intracameral illumination in cataract surgery using a 3D visualization system

Purpose:

To compare image resolution and depth between the microscope versus intracameral illumination images during 3D heads-up cataract surgery.

Methods:

We collected 25 consecutive patients who had cataract surgery using the 3D viewing system. Based on bright, contrast, visibility, and color balance, the digital images (RGB color and three monochromes) extracted at the same point of the procedures were compared between the two illuminations.

Results:

Contrast values of green and blue channels except for red channel and visibility values of all three channels were higher in the intracameral illumination images than in the microscope images (P < 0.001, t-test). Color balance values of both green/red and blue/red were higher in the intracameral illumination images than in the microscope images (P < 0.001, t-test).

Conclusion:

The digital images in the digitally assisted cataract surgery were enhanced by using the intracameral illumination. Considering the contrast and color balance in the 3D cataract surgery, the intracameral illumination may be better than the microscope illumination.

Light exposure from microscope versus intracameral illumination during cataract surgery

Purpose:

To evaluate light exposure from microscope versus intracameral illuminations to patient's and surgeon's retina during cataract surgery.

Methods:

Thirty consecutive patients who had cataract surgery using microscope and intracameral illuminations. At the point of the ocular of an operating microscope, optical illuminance and irradiance from the microscope illumination (60, 40, 20% intensity) and the intracameral illumination (60% intensity) were measured using a light meter and a spectrometer at a pause after lens capsule polishing in cataract surgery.

Results:

Average illuminance (lux) was 1.46, 0.66, 0.27, and 0.1 from 60%, 40%, 20% intensity microscope illuminations and 60% intracameral illumination. Average total spectral irradiance (μW/cm2) was 1.25, 0.65, 0.26, and 0.03 from 60%, 40%, 20% intensity microscope illuminations and 60% intracameral illumination.

Conclusion:

Microscope ocular illuminance and irradiance during cataract surgery were higher in the microscope illumination than in the intracameral illumination. It suggests that light exposure reaching patient's and surgeon's retina during cataract surgery is lower in the intracameral illumination than in the microscope illumination.

Macular photostress and visual experience between microscope and intracameral illumination during cataract surgery

PURPOSE

To evaluate macular photostress and visual experience between coaxial microscope illumination versus oblique intracameral illumination during cataract surgery.

SETTING

Gachon University Gil Hospital, Incheon, South Korea.

DESIGN

Prospective case series.

METHODS

Consecutive patients who had cataract surgery using microscope illumination and intracameral illumination were included. The patients were asked to complete a questionnaire (seeing strong lights, feeling photophobia, feeling startled (fright) when seeing lights, seeing any colors, seeing any instruments or surgical procedures, and estimating intraoperative visual function) designed to describe their cataract surgery experience. The images projected on the retina of the model eye (rear view) with artificial opaque fragments in the anterior chamber during simulating cataract surgery were compared between the 2 illumination types.

RESULTS

Sixty patients completed the questionnaire. Scores for strong lights, photophobia, fright, and color perception were significantly higher with microscope illumination than with intracameral illumination (all P < .001). More patients preferred the intracameral illumination (45 [75.0%]) to the microscope illumination (13 [21.7%]). In the rear-view images created in a model eye, only the bright microscope light in the center was seen without any lens image in the microscope illumination. However, in the intracameral illumination, the less bright light from the light pipe in the periphery and the lens fragments were seen more clearly.

CONCLUSIONS

In a view of the patients' visual experience, oblique intracameral illumination caused less subjective photostress and was preferred over coaxial microscope illumination. Objective findings from the model-eye experiment correlated to the result of visual experience.

Intraoperative Complications of Cataract Surgery Using Intracameral Illumination in the Elderly over 75 Years

Purpose

To evaluate intraoperative complications and utilization of adjunctive devices between microscope and intracameral illuminations during cataract surgery in the elderly over 75 years.

Design

A retrospective, consecutive, interventional case series Participants. Two hundred eighty-six eyes of 184 patients older than 75 years who underwent cataract surgery using microscope and intracameral illuminations.

Methods

A chart review was performed on an advanced cataract surgery group of 141 consecutive cases in which the intracameral illumination was used and on a standard cataract surgery group of 145 consecutive cases in which the intracameral illumination was not used.

Main Outcome Measures

Intraoperative complications (posterior capsule rupture, radial tear of the anterior capsule, dropped nucleus, or sulcus-implanted/sclera-fixated IOL) and utilization of adjunctive devices (pupil expansion device or anterior capsule staining).

Results

The frequency of use of the pupil expansion device was lower in the advanced cataract surgery group than that in the standard cataract surgery group (0.7% vs 6.9%; p=0.007). Furthermore, the rates of a posterior capsule rupture and at least one intraoperative complication were lower in the advanced cataract surgery group than those in the standard cataract surgery group (0.7% vs 4.8%; p=0.067) (0.7% vs 7.6%; p=0.004).

Conclusions

In the current cohort of patients over 75 years, the rate of intraoperative complications was lower when using the intracameral illumination than that when using the conventional method. Cataract surgery using intracameral illumination would be good option for elderly people.