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Cardenas IA, Ungricht EL, Zaugg B, Olson RJ, Pettey JH. Efficiency of a polymer-coated phacoemulsification tip in cataract surgery. J Cataract Refract Surg 2023; 49:1056-1060. [PMID: 37057705 DOI: 10.1097/j.jcrs.0000000000001198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/10/2023] [Indexed: 04/15/2023]
Abstract
PURPOSE To determine whether there is a difference in efficiency during phacoemulsification when using the hybrid polymer tip compared with the metal balanced tip, as measured by cumulative dissipated energy (CDE) and total procedure time. SETTING John A. Moran Eye Center, University of Utah, Salt Lake City, Utah. DESIGN Experimental study. METHODS Phacoemulsification was performed with the Centurion Vision System and Infiniti OZil handpiece, with a 30-degree bevel metal balanced tip and hybrid polymer tip. The vacuum was set at 500 mm Hg and the aspiration flow rate at 50 mL/min. Power was changed for torsional and longitudinal ultrasound (US) at 20%, 40%, 60%, 80%, and 100%. Hardened porcine lenses were cut into 200 two mm cubes, 10 for each specified tip/power setting. They were placed into an artificial anterior chamber filled with a balanced salt solution, and phacoemulsification was performed. A second observer randomly assigned the US type and power. The same observer timed trials with a stopwatch, and CDE was recorded. RESULTS There were no significant differences in time or CDE for any power levels or US modes when comparing the 2 tips. CONCLUSIONS No significant difference in efficiency was observed when comparing the metal balanced tip with the hybrid polymer tip. Given the known improved safety profile and the overall equivalent efficiency of the hybrid tip, it could improve the performance of beginning and advanced surgeons in the future. Future study is needed to evaluate other setting combinations and to evaluate the hybrid tip in clinical settings.
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Affiliation(s)
- Ivan A Cardenas
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah (Cardenas, Ungricht, Zaugg, Olson, Pettey); University of Utah School of Medicine, Salt Lake City, Utah (Cardenas, Ungricht)
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Jensen NR, Ungricht EL, Harris JT, Zaugg B, Barlow WR, Murri MS, Olson RJ, Pettey JH. Temperature Change of Ophthalmic Viscosurgical Devices in a Bi-Chamber Set-Up at a Flow of 0 and 20mL/min. Clin Ophthalmol 2023; 17:555-560. [PMID: 36798796 PMCID: PMC9926926 DOI: 10.2147/opth.s389136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/10/2023] [Indexed: 02/11/2023] Open
Abstract
Purpose To understand the role of ophthalmic viscosurgical devices (OVDs) in corneal incision contracture (CIC). Specifically, the aim was to evaluate with the tip of the phacoemulsification needle free of OVD, how various OVDs near the tip and sleeve may transmit thermal energy to the incision site. Methods A small chamber was filled with balanced saline solution (BSS), and a thin membrane was placed on the surface. OVD was placed atop the membrane. A temperature probe was placed in the OVD, while the handpiece pierced the membrane. The experiment was run both with and without flow and vacuum. Temperature measurements were gathered for each of the OVDs at four separate time points at 0 and 20mL/min flow. Results As expected, there was a more pronounced temperature increase in all test groups with no fluid flow. While the temperature increase was not significantly different from BSS for any of the OVDs tested at either 0 or 20mL/min, Viscoat showed the most variable results at both flow settings. Conclusion As long as the phaco tip is not in OVD, residual OVD near the incision is not exothermic and so not an additional risk for CIC.
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Grants
- T35 EY026511 NEI NIH HHS
- UL1 TR002529 NCATS NIH HHS
- Research to Prevent Blindness, Inc., New York, New York, USA, to the Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah, USA. Dr. Harris and Dr. Ungricht were awarded the NIH Ruth L. Kirschstein National Research Service Award (NRS) institutional training grant
- the Indiana Clinical and Translational Sciences Institute
- the National Institutes of Health, National Center for Advancing Translational Sciences, Clinical and Translational Sciences Award
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Affiliation(s)
- Nathan R Jensen
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
- University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
| | - Emilie L Ungricht
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
- University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
| | - Jacob T Harris
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
- University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
| | - Brian Zaugg
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
| | - William R Barlow
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
| | - Michael S Murri
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
| | - Randall J Olson
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
| | - Jeff H Pettey
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
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Wilkinson SW, Ungricht EL, West WB, Harris JT, Zaugg B, Olson RJ, Pettey JH. Comparison of Phacoemulsification Grooving Efficiency in Longitudinal vs Transversal Handpieces. Clin Ophthalmol 2023; 17:191-195. [PMID: 36660311 PMCID: PMC9844818 DOI: 10.2147/opth.s391928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 11/29/2022] [Indexed: 01/12/2023] Open
Abstract
Purpose To determine the difference, if any, in grooving efficiency at various settings on the Whitestar Signature Pro phacoemulsification (phaco) system. Methods Cataractous lenses were simulated by exposing porcine lenses to formalin for 2 hours. A total of 120 lenses were analyzed at various power settings on both longitudinal and transversal handpieces. Twenty trials each were performed with power set to 25%, 50%, and 75% on both handpieces. A Whitestar Phaco Handpiece System was used to provide longitudinal power, and a Whitestar Signature Ellipsis Handpiece provided transversal power. Lenses were placed within a plastic chamber and grooved by an investigator blinded to settings. A second investigator recorded times and adjusted settings. The Whitestar Signature Pro phaco system was used for grooving. Results There was no significant difference in grooving times between the longitudinal and transverse handpieces at any power setting (P > 0.05). There was a significant decrease in grooving times when comparing the 25% power setting with the 75% power setting for the transversal handpiece (P=0.021). Conclusion Both longitudinal and transversal handpieces on the Whitestar Signature Pro phaco system produce similar results to one another at each power setting. There is a general trend toward shorter grooving times, reflecting greater efficiency, at higher power settings. Grooving efficiency on the transversal handpiece may be more affected by changes in the power settings as compared with the longitudinal settings.
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Affiliation(s)
- Samuel W Wilkinson
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Emilie L Ungricht
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA,University of Utah School of Medicine, Salt Lake City, UT, USA
| | - William B West
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA,University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jacob T Harris
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA,University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Brian Zaugg
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Randall J Olson
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Jeff H Pettey
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA,Correspondence: Jeff H Pettey, John A. Moran Eye Center, University of Utah, 65 Mario Capecchi Drive, Salt Lake City, UT, 84132, USA, Tel +1 801-581-2352, Fax +1 801-581-3357, Email
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Peterson JS, Cooper C, Ungricht EL, Mamalis C, Barlow W, Zaugg B, Bernhisel AA, Olson RJ, Pettey JH. Measurement of Phacoemulsification Vacuum Pressure in the Oertli CataRhex3. Clin Ophthalmol 2022; 16:1731-1737. [PMID: 35673346 PMCID: PMC9167595 DOI: 10.2147/opth.s356657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 04/20/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose To determine the actual vacuum pressure generated by the Oertli CataRhex 3® (Oertli), using an external measuring system. Methods The effective vacuum pressure created by the Oertli was measured with a pressure device that was continuous with the vacuum tubing system while closed to the external environment. Measurements were taken with the machine set to 300 and 500 mmHg at flow rates of 20, 35, and 50 mL/min and at bottle heights of 60, 80, and 100 cm. Pressures were recorded after the foot pedal was depressed to vacuum setting (second position), and the pressure was allowed to stabilize. Subsequently, it was compared to the pressure value displayed by the machine. Results Externally measured vacuum pressure was on average 13.02% greater (39.05 mmHg) than displayed vacuum pressure at 300 mmHg (P < 0.005) and 8.60% greater (42.98 mmHg) than displayed vacuum at 500 mmHg (P < 0.005). The average difference between displayed and measured pressure increased with increasing bottle heights. Conclusion On average, the vacuum pressure generated in the Oertli was found to be significantly higher than the machine’s reading when the machine was set at 300 mmHg and 500 mmHg. Adjusting vacuum had variable effects on the measured versus displayed pressure readings.
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Affiliation(s)
- John S Peterson
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
- University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
| | - Caitlynn Cooper
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
- University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
| | - Emilie L Ungricht
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
- University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
| | - Christina Mamalis
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
| | - William Barlow
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
| | - Brian Zaugg
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
| | - Ashlie A Bernhisel
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
| | - Randall J Olson
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
| | - Jeff H Pettey
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
- Correspondence: Jeff H Pettey, Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, 65 Mario Capecchi Drive, Salt Lake City, UT, 84132, USA, Tel +1 801 581 2352, Fax +1 801 581 3357, Email
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Peterson JS, Christensen MR, Cooper C, Mamalis C, Bernhisel AA, Zaugg B, Barlow WR, Ungricht E, Olson RJ, Pettey JH. Optimization of Phacoemulsification Tip Gauge on the Oertli CataRhex3 in an in vitro Setting. Clin Ophthalmol 2022; 16:1091-1097. [PMID: 35422610 PMCID: PMC9005135 DOI: 10.2147/opth.s355094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/17/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the effect of each of the tip sizes available for the Oertli CataRhex3® phacoemulsification machine on efficiency. Methods Porcine lenses were fixed in formalin for 2 hours, then cut into 3.0 mm cubes. We studied three Oertli tips, all of which had a 30-degree bevel: easyTip 2.2 mm (20G), easyTip 2.8 mm (19G), and CO-MICS (21G). For the 19G and 20G tips, vacuum was set at 600 mmHg, irrigation rate at 50 mL/min, continuous power 70%, and bottle height 85 cm. For the 21G tip, vacuum was set at 450 mmHg; irrigation and power settings were identical to those used for the easyTip tips. We measured time to removal and chatter events to determine efficiency. Results Results from 20 trials for each tip showed that the larger the gauge size, the more quickly lens fragments were removed. Chatter events demonstrated an increasing trend with smaller tip gauge. The 19G tip used an average time to fragment removal of 2.8 seconds; the 20G, 3.2 seconds; and the 21G, 4.6 seconds. Increasing tip diameter from 21G to 20G decreased emulsification time by 33% (P = 0.02). Increasing the diameter from 21G to 19G further decreased time to emulsification by 42% (P = 0.003). The 21G tip had a mean 1.4 events/cube; 20G, 0.35 events; and 19G, 0.1 events. Differences in mean chatter events for each tip were each statistically significant. Conclusion These data suggest that when evaluated by chatter events and emulsification time, the 2.8 mm (19G) easyTip proves to have greatest efficiency.
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Affiliation(s)
- John S Peterson
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
- University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
| | - Michael R Christensen
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
- Medical College of Virginia/Virginia Commonwealth University School of Medicine, Richmond, VA, 23298, USA
| | - Caitlynn Cooper
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
- University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
| | - Christina Mamalis
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
| | - Ashlie A Bernhisel
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
| | - Brian Zaugg
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
| | - William R Barlow
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
| | - Emilie Ungricht
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
- University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
| | - Randall J Olson
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
| | - Jeff H Pettey
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
- Correspondence: Jeff H Pettey, Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, 65 Mario Capecchi Drive, Salt Lake City, UT, 84132, USA, Tel +1 801 581 2352, Fax +1 801 581 3357, Email
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Ramshekar A, Heczko J, Bernhisel A, Barlow W, Zaugg B, Olson R, Pettey J. Optimizing Tip Diameter in Phacoemulsification of Varying Lens Sizes: An in vitro Study. Clin Ophthalmol 2021; 15:4475-4484. [PMID: 34819719 PMCID: PMC8607188 DOI: 10.2147/opth.s333903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/11/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose We assessed the effect of two lens cube sizes, three tip sizes, and two ultrasound (US) approaches on phacoemulsification efficiency and chatter. Methods After porcine lens nuclei were soaked in formalin, we divided them into cubes measuring 2.0 mm or 3.0 mm. We collected efficiency and chatter data for 30-degree bent 19 G, 20 G, and 21 G tips with a continuous torsional US system; and for straight 19 G, 20 G, and 21 G tips with a micropulse longitudinal US system. Results The average time needed for removal was always higher for the 3.0 mm lens cube than for the 2.0 mm lens cube. Statistically significant differences were observed between the 19 G and 21 G tips with micropulse longitudinal US using a 2.0 mm cube and a 3.0 mm cube, and with continuous transversal US using a 2.0 mm lens cube and a 3.0 mm cube. We did not observe significant differences between 19 G and 20 G tips with either cube size in either US system. However, we noted identical trends for both cube sizes with both US approaches; 19 G tips performed better than 20 G and 21 G tips. Conclusion Regardless of the lens size, 19 G needles were the most efficient, and had both the fewest outliers and the smallest standard deviations.
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Affiliation(s)
- Aniket Ramshekar
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA.,University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
| | - Joshua Heczko
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
| | - Ashlie Bernhisel
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
| | - William Barlow
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
| | - Brian Zaugg
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
| | - Randall Olson
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
| | - Jeff Pettey
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, 84132, USA
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Bernhisel AA, Cahoon JM, Sella R, Zaugg B, Barlow WR, Stagg BC, Afshari NA, Olson RJ, Pettey JH. Optimum on-time and off-time combinations for micropulse phacoemulsification in venturi vacuum mode. J Cataract Refract Surg 2019; 45:1797-1800. [PMID: 31856992 DOI: 10.1016/j.jcrs.2019.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 06/28/2019] [Accepted: 07/01/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE To measure the time to fragment removal and number of chatter events using various combinations of micropulse on times and off times (measured in milliseconds) of longitudinal ultrasound (US) using a venturi-based phacoemulsification system. SETTING John A. Moran Eye Center, University of Utah, Salt Lake City, USA. DESIGN Experimental study. METHODS Pig lenses were hardened with formalin and cut into 2.0 mm cubes. The time to fragment removal (efficiency) and frequency of fragments bouncing off the tip (chatter) were measured with the venturi-based system. Micropulse longitudinal US was tested. Parameters were combinations of 5, 6, and 7 milliseconds on, with 5, 6, and 7 milliseconds off. Twenty runs each of 9 combinations were completed. RESULTS There was a statistically significant difference between on/off duty cycle combinations. The 6 on/7 off group had higher efficiency than the 5 on/6 off and 7 on/7 off groups. Six on/5 off was more efficient than 5 on/6 off. When data were pooled and on times alone were used, 6 milliseconds on time was more efficient than 5 or 7 milliseconds. No efficiency differences in off times were found. No significant chatter differences were observed. CONCLUSIONS Using micropulse longitudinal US in venturi vacuum mode, 6 milliseconds on was the most efficient on time. Five, 6, and 7 milliseconds off times had similar efficiency. These data suggest that the most efficient setting with lowest US energy use is 6 milliseconds on and 7 milliseconds off.
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Affiliation(s)
- Ashlie A Bernhisel
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, USA; Department of Ophthalmology, Shiley Eye Institute at University of California San Diego Health, San Diego, USA
| | - Judd M Cahoon
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, USA; Stein Eye Institute, University of California Los Angeles, USA
| | - Ruti Sella
- Department of Ophthalmology, Shiley Eye Institute at University of California San Diego Health, San Diego, USA
| | - Brian Zaugg
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, USA
| | - William R Barlow
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, USA
| | - Brian C Stagg
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, USA; Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina, USA
| | - Natalie A Afshari
- Department of Ophthalmology, Shiley Eye Institute at University of California San Diego Health, San Diego, USA
| | - Randall J Olson
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, USA
| | - Jeff H Pettey
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, USA.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Stutz LA, Heczko JB, Bird BA, Thomson RS, Bernhisel AA, Barlow WR, Zaugg B, Olson RJ, Pettey JH. Optimization of the Oertli CataRhex 3 ® phacoemulsification machine. Clin Ophthalmol 2019; 13:633-639. [PMID: 31354230 PMCID: PMC6585395 DOI: 10.2147/opth.s196281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of this study was to determine optimal bottle height, vacuum, aspiration rate, and power settings of the Oertli CataRhex 3® phacoemulsification machine. Methods Porcine lens nuclei were hardened with formalin and cut into 2.0 mm cubes. Lens cubes were emulsified using the easyTip® 2.2 mm at 30°. Fragment removal time (efficiency) and fragment bounces off the tip (chatter) were measured. Settings tested included bottle height of 60, 80, 100 and 120 cm; aspiration rate of 40, 45, and 50 mL/min; vacuum of 400, 500, and 600 mmHg; and power of 50, 60, 70, 80, 90, and 100%. Results Efficiency and chatter increased in a linear fashion with increasing vacuum to 600 mmHg (P=0.017, P=0.046, respectively). The most efficient aspiration rate was 50 mL/min, although this finding lacked statistical significance (P=0.66). Increasing power increased efficiency up to 80% without increasing chatter (P=0.042, P=0.71, respectively). Compared to all other power settings, chatter was increased at 100% (P=0.014). Conclusion The most efficient machine settings were vacuum at 600 mmHg, aspiration rate at 50 mL/min, and power at 80%.
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Affiliation(s)
- Lance A Stutz
- University of Texas Southwestern Medical School, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Joshua B Heczko
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT 84132, USA,
| | - Brian A Bird
- University of Nevada Reno, School of Medicine, Reno, NV 89557, USA
| | - Rhett S Thomson
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT 84132, USA, .,University of Utah, School of Medicine, Salt Lake City, UT 84132, USA
| | - Ashlie A Bernhisel
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT 84132, USA,
| | - William R Barlow
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT 84132, USA,
| | - Brian Zaugg
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT 84132, USA,
| | - Randall J Olson
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT 84132, USA,
| | - Jeff H Pettey
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT 84132, USA,
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Boulter T, Bernhisel A, Mamalis C, Zaugg B, Barlow WR, Olson RJ, Pettey JH. Phacoemulsification in review: Optimization of cataract removal in an in vitro setting. Surv Ophthalmol 2019; 64:868-875. [PMID: 31276738 DOI: 10.1016/j.survophthal.2019.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/17/2019] [Accepted: 06/17/2019] [Indexed: 10/26/2022]
Abstract
Phacoemulsification, initially used in the late 1960s, continues to be the standard of care for cataract removal. An animal model was developed so that, in a controlled research setting, all the various machines, handpieces, tips, and settings could be investigated. As a general rule, the higher power, vacuum, and aspiration settings lead to optimally efficient phacoemulsification. In addition, both new phacoemulsification platforms and newly developed devices have been shown to improve efficiency. As a result, we recommend that the integration of these recent developments should be considered in future investigations.
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Affiliation(s)
- Tyler Boulter
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, USA
| | - Ashlie Bernhisel
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA; Department of Ophthalmology, Shiley Eye Institute at University of California San Diego Health, San Diego, California, USA
| | - Christina Mamalis
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Brian Zaugg
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - William R Barlow
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Randall J Olson
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Jeff H Pettey
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Thomson RS, Bird BA, Stutz LA, Heczko JB, Bernhisel AA, Barlow WR, Zaugg B, Olson RJ, Pettey JH. The effect of increasing power when grooving using phacoemulsification. Clin Ophthalmol 2019; 13:611-615. [PMID: 31043766 PMCID: PMC6469737 DOI: 10.2147/opth.s194731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To determine optimal power settings on the Centurion Vision System during the grooving step in cataract surgery. METHODS Intact porcine lenses hardened by formalin and placed in a chamber designed to simulate the anterior chamber of the eye were used to test longitudinal power at 40%, 70%, and 100% and torsional power at 0%. Flow rate was set at 40 mL/min. Vacuum was set at 400 mmHg, intraocular pressure was set at 50 mmHg, and a balanced phacoemulsification tip with a 20 degree tip and a 30 degree bevel was used. Efficiency (time to groove the lens in half) was determined. RESULTS Increasing longitudinal power from 40% to 70% increased efficiency by 28% (P<0.05), and by 32% (P<0.05) when increasing longitudinal power from 40% to 100%. There was no statistically significant increase in efficiency from 70% to 100%. CONCLUSION For the tested variables, a longitudinal power of 70% was determined to be most efficient during the grooving step of cataract surgery for equivalent 3-4+ nuclei. Further increases in power demonstrated no statistically significant improvement in efficiency.
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Affiliation(s)
- Rhett S Thomson
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT 84132, USA,
- University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Brian A Bird
- University of Nevada Reno School of Medicine, Reno, NV 89557, USA
| | - Lance A Stutz
- University of Texas Southwestern Medical School, Dallas, TX 75390, USA
| | - Joshua B Heczko
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT 84132, USA,
| | - Ashlie A Bernhisel
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT 84132, USA,
| | - William R Barlow
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT 84132, USA,
| | - Brian Zaugg
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT 84132, USA,
| | - Randall J Olson
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT 84132, USA,
| | - Jeff H Pettey
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT 84132, USA,
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Ha L, Wright A, Wright DD, Bernhisel A, Barlow WR, Pettey JH, Zaugg B, Olson RJ. High vacuum and aspiration on phacoemulsification efficiency and chatter for Centurion. Can J Ophthalmol 2019; 54:136-138. [PMID: 30851768 DOI: 10.1016/j.jcjo.2018.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 02/28/2018] [Accepted: 03/05/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare relative efficiency and chatter of high aspiration and vacuum settings. DESIGN In vitro laboratory study. METHODS The John A. Moran Eye Center Laboratories, University of Utah, Salt Lake City, Utah, was the study setting. Porcine nuclei were fixed in formalin and cut into 2.0 mm cubes. Lens cubes were phacoemulsified with Balanced tips at 50 and 60 mL/min aspiration with 500, 600, and 700 mm Hg vacuum with monitored forced infusion. Experiments were conducted at constant torsional power, longitudinal power, and intraocular pressure. RESULTS No significant change was observed in average chatter across each tested setting. Increasing aspiration rate did not increase efficiency. Increasing vacuum up to 600 mm Hg from 500 mm Hg did not change efficiency. However, increasing vacuum to 700 mm Hg decreased efficiency (p = 0.008 for 500 mm Hg vs 700 mm Hg and p = 0.05 for 600 mm Hg vs 700 mm Hg). Increasing aspiration and increasing vacuum did not significantly improve chatter. CONCLUSIONS Increasing aspiration above 50 mL/min did not improve phacoemulsification efficiency. Increasing vacuum settings to 700 mm Hg decreases efficiency. Chatter did not significantly change with increasing aspiration and vacuum settings.
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Affiliation(s)
- Larry Ha
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Alex Wright
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Dannen D Wright
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Ashlie Bernhisel
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - William R Barlow
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Jeff H Pettey
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Brian Zaugg
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Randall J Olson
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah..
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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15
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Bird BA, Thomson RS, Stutz LA, Heczko JB, Bernhisel AA, Barlow WR, Zaugg B, Pettey JH, Olson RJ. Effect of increasing flow when grooving during phacoemulsification. J Cataract Refract Surg 2018; 44:623-626. [PMID: 29773457 DOI: 10.1016/j.jcrs.2018.01.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 12/22/2017] [Accepted: 01/09/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE To determine optimum flow settings on the Centurion Vision System during the grooving step in cataract surgery. SETTING John A. Moran Eye Center Laboratory, University of Utah, Salt Lake City, Utah, USA. DESIGN Experimental study. METHODS Intact porcine lenses hardened by formalin and placed in a chamber designed to simulate the anterior chamber of the eye were used to test flow rate settings at 20 mL/min, 40 mL/min, and 60 mL/min. Vacuum was set at 400 mm Hg, longitudinal power at 80%, torsional power at 80%, and intraocular pressure at 50 mm Hg. A balanced phaco tip with a 20-degree tip and a 30-degree bevel was used. Efficiency (time to groove the lens in half) was determined. RESULTS Increasing flow from 20 to 40 mL/min during grooving increased efficiency by 17% (P = .05), with no significant improvement shown at 60 mL/min. CONCLUSIONS A flow rate of 40 mL/min was determined to be most efficient during the grooving step of cataract surgery. Further increases in flow rate showed no statistically significant improvement in efficiency, and with only 17% improvement flow rates less than 40 mL/min might be almost as efficient and might be safer.
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Affiliation(s)
- Brian A Bird
- From the University of Nevada Reno School of Medicine (Bird), Reno, Nevada, Department of Ophthalmology and Visual Sciences (Thomson, Heczko, Bernhisel, Barlow, Zaugg, Pettey, Olson), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, and the University of Texas Southwestern Medical Center (Stutz), Dallas, Texas, USA
| | - Rhett S Thomson
- From the University of Nevada Reno School of Medicine (Bird), Reno, Nevada, Department of Ophthalmology and Visual Sciences (Thomson, Heczko, Bernhisel, Barlow, Zaugg, Pettey, Olson), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, and the University of Texas Southwestern Medical Center (Stutz), Dallas, Texas, USA
| | - Lance A Stutz
- From the University of Nevada Reno School of Medicine (Bird), Reno, Nevada, Department of Ophthalmology and Visual Sciences (Thomson, Heczko, Bernhisel, Barlow, Zaugg, Pettey, Olson), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, and the University of Texas Southwestern Medical Center (Stutz), Dallas, Texas, USA
| | - Joshua B Heczko
- From the University of Nevada Reno School of Medicine (Bird), Reno, Nevada, Department of Ophthalmology and Visual Sciences (Thomson, Heczko, Bernhisel, Barlow, Zaugg, Pettey, Olson), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, and the University of Texas Southwestern Medical Center (Stutz), Dallas, Texas, USA
| | - Ashlie A Bernhisel
- From the University of Nevada Reno School of Medicine (Bird), Reno, Nevada, Department of Ophthalmology and Visual Sciences (Thomson, Heczko, Bernhisel, Barlow, Zaugg, Pettey, Olson), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, and the University of Texas Southwestern Medical Center (Stutz), Dallas, Texas, USA
| | - William R Barlow
- From the University of Nevada Reno School of Medicine (Bird), Reno, Nevada, Department of Ophthalmology and Visual Sciences (Thomson, Heczko, Bernhisel, Barlow, Zaugg, Pettey, Olson), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, and the University of Texas Southwestern Medical Center (Stutz), Dallas, Texas, USA
| | - Brian Zaugg
- From the University of Nevada Reno School of Medicine (Bird), Reno, Nevada, Department of Ophthalmology and Visual Sciences (Thomson, Heczko, Bernhisel, Barlow, Zaugg, Pettey, Olson), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, and the University of Texas Southwestern Medical Center (Stutz), Dallas, Texas, USA
| | - Jeff H Pettey
- From the University of Nevada Reno School of Medicine (Bird), Reno, Nevada, Department of Ophthalmology and Visual Sciences (Thomson, Heczko, Bernhisel, Barlow, Zaugg, Pettey, Olson), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, and the University of Texas Southwestern Medical Center (Stutz), Dallas, Texas, USA
| | - Randall J Olson
- From the University of Nevada Reno School of Medicine (Bird), Reno, Nevada, Department of Ophthalmology and Visual Sciences (Thomson, Heczko, Bernhisel, Barlow, Zaugg, Pettey, Olson), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, and the University of Texas Southwestern Medical Center (Stutz), Dallas, Texas, USA.
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Wright AJ, Thomson RS, Bernhisel AA, Zaugg B, Barlow WR, Pettey JH, Olson RJ. Effect of chamber stabilization software on efficiency and chatter in a porcine lens model. J Cataract Refract Surg 2017; 43:1464-1467. [PMID: 29223237 DOI: 10.1016/j.jcrs.2017.08.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/30/2017] [Accepted: 08/04/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the effects of the use of programmable chamber stabilization software (Chamber Stabilization Environment) settings on efficiency and chatter in a porcine lens model. SETTING John A. Moran Eye Center Laboratory, University of Utah, Salt Lake City, Utah, USA. DESIGN Experimental study. METHODS Porcine eyes were dissected and the lenses extracted. The lenses were then hardened and processed for the experiment. Phacoemulsification of the lens fragments was performed with the Whitestar Signature Pro with the Whitestar handpiece and a 0.9 mm straight Dewey tip with a 30-degree bevel. All arms of the study were run in peristaltic mode with 50 mL/minute aspiration, 100 cm bottle height, and on 100% power. The chamber stabilization software setting was used for each of the 4 study arms with a maximum vacuum of 500 mm Hg. Arm 1 included 20 runs with the up time set to 2000 milliseconds. Arm 2 was performed with similar settings but with an up time of 0 millisecond. Arms 3 and 4 were run with up times of 1000 milliseconds and 500 milliseconds, respectively. RESULTS The mean efficiency time of each run was as follows: 0 millisecond = 1.4 seconds, 500 milliseconds = 0.95 seconds, 1000 milliseconds = 0.88 seconds, 2000 milliseconds = 0.93 seconds. When compared with 0 millisecond, each of the other arms were significantly faster. Chatter events were comparable between the study arms. CONCLUSION The chamber stabilization software does not decrease efficiency when compared with full vacuum on if at least 500 milliseconds of up time is maintained.
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Affiliation(s)
- Alex J Wright
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Rhett S Thomson
- 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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Wright AJ, Bohner AD, Bernhisel AA, Zaugg B, Barlow WR, Pettey JH, Olson RJ. The Effect of Pulsing on Transverse Ultrasound Efficiency and Chatter. Am J Ophthalmol 2017; 183:107-110. [PMID: 28860045 DOI: 10.1016/j.ajo.2017.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/04/2017] [Accepted: 08/18/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the effects of micropulse, long pulse, and continuous ultrasound on transverse ultrasound using Abbott Medical Optics' (AMO) WhiteStar Signature Pro with the Ellips FX handpiece. DESIGN In vitro laboratory study. METHODS This study was conducted at the John A. Moran Eye Center Laboratory, University of Utah, Salt Lake City, Utah, USA. Porcine lenses were hardened in formalin for 2 hours and equilibrated in basic salt solution (BSS) over a 24-hour period. The lenses were then cubed in 2.0 × 2.0-mm pieces. These pieces were stored in BSS until the time of experimentation. The AMO WhiteStar Signature Pro machine (Abbott Medical Optics) with the Ellips FX handpiece and a 0.9-mm bent Dewey tip with a 30-degree bevel (Microsurgical Technology Inc) were used for phacoemulsification. Three runs of 20 lenses each were performed, measuring efficiency and chatter. Transverse ultrasound varied in the 3 runs and included continuous, 6 ms on/off micropulse, and 50 ms on/off long pulse. RESULTS Micropulse was more efficient than long pulse by 43% (P = .00003) and continuous by 42% (P = .000387). There were also less chatter events with micropulse than with long-pulse and continuous ultrasound. However, this difference did not reach significance. CONCLUSION The 6 ms on and 6 ms off micropulse transverse 3-dimensional ultrasound is more efficient and produces fewer chatter events than both long-pulse and continuous ultrasound.
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Wright DD, Wright AJ, Boulter TD, Bernhisel AA, Stagg BC, Zaugg B, Pettey JH, Ha L, Ta BT, Olson RJ. Optimization of transversal phacoemulsification settings in peristaltic mode using a new transversal ultrasound machine. J Cataract Refract Surg 2017; 43:1202-1206. [PMID: 28991618 DOI: 10.1016/j.jcrs.2017.06.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 06/27/2017] [Indexed: 11/15/2022]
Abstract
PURPOSE To determine the optimum bottle height, vacuum, aspiration rate, and power settings in the peristaltic mode of the Whitestar Signature Pro machine with Ellips FX tip action (transversal). SETTING John A. Moran Eye Center Laboratories, University of Utah, Salt Lake City, Utah, USA. DESIGN Experimental study. METHODS Porcine lens nuclei were hardened with formalin and cut into 2.0 mm cubes. Lens cubes were emulsified using transversal and fragment removal time (efficiency), and fragment bounces off the tip (chatter) were measured to determine optimum aspiration rate, bottle height, vacuum, and power settings in the peristaltic mode. RESULTS Efficiency increased in a linear fashion with increasing bottle height and vacuum. The most efficient aspiration rate was 50 mL/min, with 60 mL/min statistically similar. Increasing power increased efficiency up to 90% with increased chatter at 100%. CONCLUSION The most efficient values for the settings tested were bottle height at 100 cm, vacuum at 600 mm Hg, aspiration rate of 50 or 60 mL/min, and power at 90%.
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Affiliation(s)
- Dannen D Wright
- From the Department of Ophthalmology and Visual Sciences (D.D. Wright, A.J. Wright, Bernhisel, Stagg, Zaugg, Pettey, Olson, Ha, Ta), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, and the Texas A&M Health Science Center College of Medicine (Boulter), Bryan, Texas, USA
| | - Alex J Wright
- From the Department of Ophthalmology and Visual Sciences (D.D. Wright, A.J. Wright, Bernhisel, Stagg, Zaugg, Pettey, Olson, Ha, Ta), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, and the Texas A&M Health Science Center College of Medicine (Boulter), Bryan, Texas, USA
| | - Tyler D Boulter
- From the Department of Ophthalmology and Visual Sciences (D.D. Wright, A.J. Wright, Bernhisel, Stagg, Zaugg, Pettey, Olson, Ha, Ta), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, and the Texas A&M Health Science Center College of Medicine (Boulter), Bryan, Texas, USA
| | - Ashlie A Bernhisel
- From the Department of Ophthalmology and Visual Sciences (D.D. Wright, A.J. Wright, Bernhisel, Stagg, Zaugg, Pettey, Olson, Ha, Ta), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, and the Texas A&M Health Science Center College of Medicine (Boulter), Bryan, Texas, USA
| | - Brian C Stagg
- From the Department of Ophthalmology and Visual Sciences (D.D. Wright, A.J. Wright, Bernhisel, Stagg, Zaugg, Pettey, Olson, Ha, Ta), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, and the Texas A&M Health Science Center College of Medicine (Boulter), Bryan, Texas, USA
| | - Brian Zaugg
- From the Department of Ophthalmology and Visual Sciences (D.D. Wright, A.J. Wright, Bernhisel, Stagg, Zaugg, Pettey, Olson, Ha, Ta), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, and the Texas A&M Health Science Center College of Medicine (Boulter), Bryan, Texas, USA
| | - Jeff H Pettey
- From the Department of Ophthalmology and Visual Sciences (D.D. Wright, A.J. Wright, Bernhisel, Stagg, Zaugg, Pettey, Olson, Ha, Ta), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, and the Texas A&M Health Science Center College of Medicine (Boulter), Bryan, Texas, USA
| | - Larry Ha
- From the Department of Ophthalmology and Visual Sciences (D.D. Wright, A.J. Wright, Bernhisel, Stagg, Zaugg, Pettey, Olson, Ha, Ta), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, and the Texas A&M Health Science Center College of Medicine (Boulter), Bryan, Texas, USA
| | - Brian T Ta
- From the Department of Ophthalmology and Visual Sciences (D.D. Wright, A.J. Wright, Bernhisel, Stagg, Zaugg, Pettey, Olson, Ha, Ta), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, and the Texas A&M Health Science Center College of Medicine (Boulter), Bryan, Texas, USA
| | - Randall J Olson
- From the Department of Ophthalmology and Visual Sciences (D.D. Wright, A.J. Wright, Bernhisel, Stagg, Zaugg, Pettey, Olson, Ha, Ta), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, and the Texas A&M Health Science Center College of Medicine (Boulter), Bryan, Texas, USA.
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Abstract
Purpose To study the accuracy and reliability of optical pachymetry using the Alcon WaveLight EX500 during laser-assisted in situ keratomileusis (LASIK). Materials and methods This was a retrospective chart review of 90 eyes from 45 patients who had undergone LASIK (mean age 35.2±8.2 years; 19 males, 26 females). The WaveLight FS200 femtosecond laser was programmed to cut LASIK flaps at a desired depth of 120 μm. Optical low-coherence reflectometry (WaveLight EX500) was used to measure central corneal thickness prior to lifting the flap, and the residual stromal bed immediately after excimer ablation. Flap thickness (FT) was calculated using simple subtraction. Optical coherence tomography (OCT) was used to measure central corneal thickness, flap thickness, and residual stromal bed in the postoperative period and the results compared to intraoperative measurements. Results Mean programmed FS200 FT was 119 μm. Mean FT using EX500 optical pachymetry was 109 μm. The difference between FS200- programmed and EX500-measured FT was 9 μm (P<0.001). There was also a significant difference between the EX500 and OCT FT (109 μm vs 119 μm, respectively; P<0.001). Conclusion FT values calculated using intraoperative EX500 optical pachymetry were significantly lower than programmed FS200 values or OCT measurements.
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Affiliation(s)
- Mark D Mifflin
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT
| | - Xavier M Mortensen
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT
| | - Brent S Betts
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT
| | - Cole Gross
- University of Nevada School of Medicine, Reno, NV, USA
| | - Brian Zaugg
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT
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Mifflin MD, Betts BS, Frederick PA, Feuerman JM, Fenzl CR, Moshirfar M, Zaugg B. Efficacy and safety of a 3-month loteprednol etabonate 0.5% gel taper for routine prophylaxis after photorefractive keratectomy compared to a 3-month prednisolone acetate 1% and fluorometholone 0.1% taper. Clin Ophthalmol 2017; 11:1113-1118. [PMID: 28652697 PMCID: PMC5476723 DOI: 10.2147/opth.s138272] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare the outcome of photorefractive keratectomy (PRK) and complications in patients treated with either loteprednol etabonate 0.5% gel or prednisolone acetate 1% suspension and fluorometholone (fml) 0.1% suspension. Setting John A Moran Eye Center, University of Utah, Salt Lake City, UT, USA. Design Prospective, randomized, partially masked trial. Methods PRK was performed on 261 eyes of 132 participants. Patients were randomized to a postoperative corticosteroid regimen of either loteprednol etabonate 0.5% gel (loteprednol) or prednisolone 1% acetate suspension followed by fluorometholone 0.1% suspension (prednisolone/fml). Primary outcome measures included incidence and grade of postoperative corneal haze and incidence of increased intraocular pressure of 10 mmHg above baseline, or any intraocular pressure over 21 mmHg. Secondary outcome measures included uncorrected distance visual acuity, best corrected distance visual acuity, and manifest refraction spherical equivalent. Results The incidence of haze in the first 3 months was 2.6% (3/114 eyes) in the loteprednol group and 4.8% (7/147 eyes) in the prednisolone/fml group and was not statistically significant between groups (P=0.37). The incidence of elevated intraocular pressure was 1.8% (2/114 eyes) in the loteprednol group and 4.1% (6/147 eyes) in the prednisolone/fml group, and was not statistically significant between the groups (P=0.12). The mean 3-month postoperative logMAR uncorrected visual acuity was −0.078±0.10 and −0.075±0.09 in the loteprednol and prednisolone/fml groups, respectively (P=0.83). Conclusion Postoperative corneal haze and elevated intraocular pressure were uncommon in both treatment arms. There was no statistically significant difference between each postoperative regimen. Refractive results were similar and excellent in both treatment arms. A tapered prophylactic regimen of loteprednol 0.5% gel is equally effective to prednisolone 1%/fml 0.1% after PRK.
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Affiliation(s)
- Mark D Mifflin
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT
| | - Brent S Betts
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT
| | | | | | | | - Majid Moshirfar
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT.,Hoopes Vision, Draper, UT, USA
| | - Brian Zaugg
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT
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Shi DS, Jensen JD, Kramer GD, Zaugg B, Stagg BC, Pettey JH, Barlow WR, Olson RJ. Comparison of Vacuum and Aspiration on Phacoemulsification Efficiency and Chatter Using a Monitored Forced Infusion System. Am J Ophthalmol 2016; 169:162-167. [PMID: 27349412 DOI: 10.1016/j.ajo.2016.06.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 06/15/2016] [Accepted: 06/16/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the effect of vacuum and aspiration rates on phacoemulsification efficiency and chatter using a monitored forced infusion system. DESIGN In vitro animal study. METHODS SETTING John A. Moran Eye Center, University of Utah, Salt Lake City, Utah. PROCEDURES Formalin-soaked porcine lenses were divided into 2 mm cubes (tip diameter, 0.9 mm). Vacuum levels were tested at 200, 300, 400, and 500 mm Hg; aspiration rates at 20, 35, and 50 mL/min. Torsional power was set at 60% and intraocular pressure at 50 mm Hg. RESULTS Increasing vacuum increased efficiency regardless of aspiration rates (R(2) = 0.92; P = .0004). Increasing aspiration further increased efficiency when vacuum was at 400 and 500 mm Hg (P = .004 for 20 vs 35 mL/min, P = .0008 for 35 vs 50 mL/min). At 200 and 300 mm Hg, efficiency only improved when increasing aspiration to 35 mL/min (P < .0001 with 20 vs 35 + 50 mL/min). Chatter improved with increasing vacuum, up to 400 mm Hg (P = .003 for 200 vs 300 mm Hg and P = .045 for 300 vs 500 mm Hg). A similar trend of improved chatter was seen with increasing levels of aspiration. CONCLUSIONS Vacuum improved efficiency up to 500 mm Hg independent of flow. Flow has an additive effect on efficiency through 50 mL/min, when vacuum is at 400 mm Hg or higher, and only up to 35 mL/min at vacuums less than 400 mm Hg. Chatter correlated with both vacuum and flow such that increasing either parameter decreases chatter, up to 400 mm Hg with vacuum.
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Affiliation(s)
- Dallas S Shi
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Jason D Jensen
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Gregory D Kramer
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Brian Zaugg
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Brian C Stagg
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Jeff H Pettey
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - William R Barlow
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Randall J Olson
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah.
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Jensen JD, Boulter T, Lambert NG, Zaugg B, Stagg BC, Pettey JH, Olson RJ. Intraocular pressure study using monitored forced-infusion system phacoemulsification technology. J Cataract Refract Surg 2016; 42:768-71. [DOI: 10.1016/j.jcrs.2016.01.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 01/14/2016] [Accepted: 01/26/2016] [Indexed: 10/21/2022]
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Boulter T, Jensen JD, Christensen MD, Lambert NG, Zaugg B, Stagg BC, Pettey JH, Olson RJ. Comparison of a torsional and a standard tip with a monitored forced infusion phacoemulsification system. J Cataract Refract Surg 2016; 42:613-7. [PMID: 27113886 DOI: 10.1016/j.jcrs.2015.11.048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 11/03/2015] [Accepted: 11/03/2015] [Indexed: 10/21/2022]
Abstract
PURPOSE To compare the relative efficiency and chatter of the 30-degree 0.9 mm Kelman tip (standard tip) and Ozil Intrepid Balanced tip (torsional tip) with identical optimum settings. SETTING John A. Moran Eye Center Laboratories, University of Utah, Salt Lake City, Utah, USA. DESIGN Experimental study. METHODS Porcine nuclei were fixed in formalin and cut into 2.0 mm cubes. Lens cubes were phacoemulsified with standard and torsional tips at 60% and 100% torsional amplitude with 0%, 25%, 50%, 75%, and 100% longitudinal power with monitored forced infusion. Experiments were performed at a constant vacuum, aspiration rate, and intraocular pressure. RESULTS Linear regression showed increased efficiency with up to 75% longitudinal power at 60% torsional amplitude for both tips (P = .046 standard; P = .0093 torsional). Longitudinal did not significantly increase efficiency at 100% torsional power for either tip. Torsional tips were on average 29% more efficient than standard tips throughout the range tested (P < .0001), and 100% torsional power was on average 45% more efficient than 60% torsional power (P = .0028). Chatter was minimal except at 100% longitudinal power, which was greater than at 75% longitudinal power (P < .0001). At 100% longitudinal power, torsional tips had more chatter than standard tips (at 60% torsional, P < .0001; at 100% torsional, P = .0022). CONCLUSIONS Increasing up to 75% longitudinal power increased the efficiency at 60% torsional for standard and torsional tips. Torsional tips were more efficient than standard tips. Chatter was generally minimal. Torsional tips showed more chatter than standard tips at 100% longitudinal power. FINANCIAL DISCLOSURE None of the authors has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Tyler Boulter
- From the Department of Ophthalmology (Boulter), Texas A & M University, College Station, Texas, and the Department of Ophthalmology and Visual Sciences (Jensen, Christensen, Lambert, Zaugg, Stagg, Pettey, Olson), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Jason D Jensen
- From the Department of Ophthalmology (Boulter), Texas A & M University, College Station, Texas, and the Department of Ophthalmology and Visual Sciences (Jensen, Christensen, Lambert, Zaugg, Stagg, Pettey, Olson), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Michael D Christensen
- From the Department of Ophthalmology (Boulter), Texas A & M University, College Station, Texas, and the Department of Ophthalmology and Visual Sciences (Jensen, Christensen, Lambert, Zaugg, Stagg, Pettey, Olson), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Nathan G Lambert
- From the Department of Ophthalmology (Boulter), Texas A & M University, College Station, Texas, and the Department of Ophthalmology and Visual Sciences (Jensen, Christensen, Lambert, Zaugg, Stagg, Pettey, Olson), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Brian Zaugg
- From the Department of Ophthalmology (Boulter), Texas A & M University, College Station, Texas, and the Department of Ophthalmology and Visual Sciences (Jensen, Christensen, Lambert, Zaugg, Stagg, Pettey, Olson), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Brian C Stagg
- From the Department of Ophthalmology (Boulter), Texas A & M University, College Station, Texas, and the Department of Ophthalmology and Visual Sciences (Jensen, Christensen, Lambert, Zaugg, Stagg, Pettey, Olson), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Jeff H Pettey
- From the Department of Ophthalmology (Boulter), Texas A & M University, College Station, Texas, and the Department of Ophthalmology and Visual Sciences (Jensen, Christensen, Lambert, Zaugg, Stagg, Pettey, Olson), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Randall J Olson
- From the Department of Ophthalmology (Boulter), Texas A & M University, College Station, Texas, and the Department of Ophthalmology and Visual Sciences (Jensen, Christensen, Lambert, Zaugg, Stagg, Pettey, Olson), John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.
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Jensen JD, Shi DS, Robinson MS, Kramer GD, Zaugg B, Stagg BC, Pettey JH, Barlow WR, Olson RJ. Torsional power study using CENTURION phacoemulsification technology. Clin Exp Ophthalmol 2016; 44:710-713. [PMID: 26999336 DOI: 10.1111/ceo.12748] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 02/24/2016] [Accepted: 03/14/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND To evaluate the effect of varying levels of power on phacoemulsification efficiency using the CENTURION Vision System. METHODS Formalin-soaked porcine lenses were divided into 2-mm cubes; 0.9-mm, balanced tips were used. Torsional power levels were tested from 10% to 100% at 10% intervals. Vacuum was set to 550 mmHg, aspiration to 50 ml/min, and intraocular pressure at 50 mmHg. Efficiency (time to lens removal) and chatter (number of lens fragment repulsions from the tip) were determined. RESULTS Increasing torsional power up to 60% increased efficiency. This effect was linear from 30 to 60% power (R2 = .90; P < 0.05). There were no significant differences in efficiency past 60%. Chatter was highest at 10% power and decreased linearly (R2 = .87; P = 0.007) as power was increased up to 60% power, and chatter did not improve above this power level. CONCLUSIONS Power improved efficiency only up to a 60% power level, and then was negligible. Chatter correlated well with power up to the 60% level, so that as power was increased, chatter decreased. Because there are no additional benefits in efficiency past 60% power, and because chatter is minimal at 60% power, we recommend torsional ultrasound at 60% as the optimal power setting for using the CENTURION System for phacoemulsification.l.
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Affiliation(s)
- Jason D Jensen
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Dallas S Shi
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Mark S Robinson
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Gregory D Kramer
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Brian Zaugg
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Brian C Stagg
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Jeff H Pettey
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - William R Barlow
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Randall J Olson
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
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Henriksen BS, Gardiner G, Garff K, Gupta I, Stagg BC, Zaugg B, Pettey JH, Barlow WR, Olson RJ. Thermal evaluation of two phacoemulsification systems. Can J Ophthalmol 2016; 51:14-8. [PMID: 26874153 DOI: 10.1016/j.jcjo.2015.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/09/2015] [Accepted: 10/28/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To compare thermal profiles of new transversal ultrasound power modulation to torsional ultrasound in an artificial chamber and cadaver eye. DESIGN Laboratory investigation. METHODS John A. Moran Eye Center Laboratories, University of Utah, Salt Lake City, Utah, was the study setting. Temperature increase after 30 seconds was measured at the needle midshaft in an artificial chamber and at maximal friction point in a cadaver eye. Ellips FX (transverse) was tested at 100% power, as was Signature with micropulse settings (6 milliseconds on and off). OZil (torsional only) was tested at 100% power in the artificial chamber and cadaver eye. Runs were completed with aspiration blocked. Temperature was continuously measured on the phacoemulsification sleeve using a microthermistor probe connected to the BAT-10 multipurpose thermometer, with an accuracy of ±0.1°C. RESULTS Transversal FX had a greater temperature increase than micropulse (p < 0.001) and torsional (p < 0.001). Micropulse had a greater temperature increase than torsional (p < 0.001). The cadaver eye had a greater temperature increase than the artificial chamber for torsional (p < 0.001). CONCLUSIONS Higher heat accumulation and potential for incisional burn occurred with the cadaver model than with the artificial chamber, suggesting the need for caution when using 100% torsional ultrasound with aspiration blocked. Transversal FX generated more heat than was reported originally. Further study is needed to determine the incidence of incisional burn with varied power settings for this new model. Micropulse generated more heat than previous reports, but the increased efficiency is likely to negate potentially increased incisional burn risk.
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Affiliation(s)
- Bradley S Henriksen
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Gareth Gardiner
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Kevin Garff
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Isha Gupta
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Brian C Stagg
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Brian Zaugg
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Jeff H Pettey
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - William R Barlow
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Randall J Olson
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Stagg BC, Gupta I, Cahoon J, Ronquillo C, Shi D, Zaugg B, Gardiner G, Barlow WR, Pettey JH, Aabid Farukhi M, Jensen J, Olson RJ. Bent versus straight tips in micropulsed longitudinal phacoemulsification. Can J Ophthalmol 2015; 50:354-9. [PMID: 26455970 DOI: 10.1016/j.jcjo.2015.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 04/02/2015] [Accepted: 06/12/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate bent and straight phacoemulsification tips to determine which tip is more efficient in removal of lens fragments, using micropulsed longitudinal ultrasound in phacoemulsification. DESIGN In vitro laboratory study. METHODS The John A. Moran Eye Center Laboratories, University of Utah, Salt Lake City, Utah, was the study setting. Pig lenses hardened in a manner comparable with dense human cataracts were cut into 2-mm cubes and removed with micropulsed longitudinal ultrasound using settings previously shown to be optimally efficient (6 milliseconds on and 6 milliseconds off for a bent tip). To verify this time as most efficient for a straight tip, we also tested times of 5, 6, and 7 milliseconds time on and off. The tips were either straight or with a 20-degree bend. Twenty cubes were used for each comparative run. RESULTS For the straight tip, 6 milliseconds on (1.56 ± 0.815 seconds) was significantly more efficient than 7 milliseconds on (2.45 ± 1.56 seconds, p = 0.001) and not significantly more efficient than 5 milliseconds on (1.69 ± 0.86 seconds, p = 0.43). Five milliseconds off time (1.45 ± 0.76s) was more efficient than 6 milliseconds (2.06 ± 1.37 seconds, p = 0.004) and 7 milliseconds off (2.18 ± 1.24s, p = 0.001). The straight tip was more efficient than the bent tip (1.38 ± 0.83 versus 2.93 ± 2.14 seconds, p = 0.006). CONCLUSIONS Results are contrary to accepted common belief. Micropulsed longitudinal phacoemulsification is more efficient with a straight rather than a bent tip.
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Affiliation(s)
- Brian C Stagg
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Isha Gupta
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Judd Cahoon
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Cecinio Ronquillo
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Dallas Shi
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Brian Zaugg
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Gareth Gardiner
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - William R Barlow
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Jeff H Pettey
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - M Aabid Farukhi
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Jason Jensen
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Randall J Olson
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah.
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Cahoon JM, Gupta I, Gardiner G, Shi D, Zaugg B, Pettey JH, Barlow WR, Olson RJ. Comparison of venturi and peristaltic vacuum in phacoemulsification. J Cataract Refract Surg 2015; 41:428-32. [PMID: 25661138 DOI: 10.1016/j.jcrs.2014.12.043] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 07/08/2014] [Accepted: 07/28/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the efficiency of peristaltic-based and venturi-based vacuums. SETTING John A. Moran Eye Center Laboratories, University of Utah, Salt Lake City, Utah, USA. DESIGN Experimental study. METHODS Porcine lenses were hardened with formalin and cut into 2.0 mm cubes. Time to fragment removal (efficiency) and fragment bounces off the tip (chatter) were measured using a Signature machine with the ability to switch between peristaltic-based and venturi-based vacuum. Micropulse longitudinal and transversal ultrasound motions were tested. RESULTS Venturi-based vacuum had increased efficiency and decreased chatter compared with peristaltic-based vacuum at lower vacuum levels. CONCLUSION Use of a venturi-based vacuum, when available, may result in reduced clearance time of lens material and mitigate chatter even under noisy conditions. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Judd M Cahoon
- 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
| | - Gareth Gardiner
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Dallas Shi
- 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
| | - Jeff H Pettey
- 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
| | - 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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Gilbert M, Zaugg B, Stagg B, Olson RJ. Safety Profile of Venturi Versus Peristaltic Phacoemulsification Pumps in Cataract Surgery Using a Capsular Surrogate for the Human Lens. Am J Ophthalmol 2015; 160:179-4.e1. [PMID: 25892125 DOI: 10.1016/j.ajo.2015.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 04/09/2015] [Accepted: 04/10/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the risk of capsular rupture of the human lens during cataract surgery from contact by phacoemulsification needles using different vacuum pumps, ultrasound modalities, and contact angles. DESIGN Experimental laboratory investigation. METHODS The John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, was the setting for this study. A Signature (Abbott Medical Optics, Inc) phacoemulsification machine was used in peristaltic and Venturi vacuum modes with transversal and micropulsed ultrasound. Contact was made with a capsular surrogate to achieve tip occlusion or tip contact only. Breakage rates were calculated by analyzing the capsular surrogate under a surgical microscope. RESULTS Venturi and peristaltic pump modes had similar risk of capsular rupture, regardless of whether the data were analyzed with tip occlusion data included (44.2% peristaltic vs 40.2% Venturi, P = .047) or excluded from the analysis (66.3% peristaltic vs 60.3% Venturi, P = .013). Transversal ultrasound was significantly more likely to cause capsular rupture than micropulsed ultrasound (69.8% vs 56.8%, P < .0001). Tip contact was significantly more likely than tip occlusion to cause capsular rupture (63.3% vs 0%, P < .0001). CONCLUSIONS There is no significant difference in risk of capsular rupture using Venturi rather than peristaltic vacuum pumps, while transversal seemed to increase the risk when compared to micropulsed ultrasound. Tip occlusion is not a risk factor for capsular rupture, as all breaks in the capsular surrogate occurred with tip contact.
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Affiliation(s)
- Michael Gilbert
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Brian Zaugg
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Brian Stagg
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Randall J Olson
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah.
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Ronquillo CC, Zaugg B, Stagg B, Kirk KR, Gupta I, Barlow WR, Pettey JH, Olson RJ. Determining optimal torsional ultrasound power for cataract surgery with automatic longitudinal pulses at maximum vacuum ex vivo. Am J Ophthalmol 2014; 158:1262-1266.e2. [PMID: 25174892 DOI: 10.1016/j.ajo.2014.08.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 08/25/2014] [Accepted: 08/26/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the optimal longitudinal power settings for Infiniti OZil Intelligent Phaco (IP) at varying torsional amplitude settings; and to test the hypothesis that increasing longitudinal power is more important at lower torsional amplitudes to achieve efficient phacoemulsification. DESIGN Laboratory investigation. METHODS setting: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah. procedure: Individual porcine nuclei were fixed in formalin, then cut into 2.0 mm cubes. Lens cube phacoemulsification was done using OZil IP at 60%, 80%, and 100% torsional amplitude with 0%, 10%, 20%, 30%, 50%, 75%, or 100% longitudinal power. All experiments were done using a 20 gauge 0.9 mm bent reverse bevel phaco tip at constant vacuum (550 mm Hg), aspiration rate (40 mL/min), and bottle height (50 cm). main outcome measure: Complete lens particle phacoemulsification (efficiency). RESULTS Linear regression analysis showed a significant increase in efficiency with increasing longitudinal power at 60% torsional amplitude (R(2) = 0.7269, P = .01) and 80% torsional amplitude (R(2) = 0.6995, P = .02) but not at 100% amplitude (R(2) = 0.3053, P = .2). Baseline comparison of 60% or 80% vs 100% torsional amplitude without longitudinal power showed increased efficiency at 100% (P = .0004). Increasing longitudinal power to 20% abolished the efficiency difference between 80% vs 100% amplitudes. In contrast, 75% longitudinal power abolished the efficiency difference between 60% vs 100% torsional amplitudes. CONCLUSIONS Results suggest that longitudinal power becomes more critical at increasing phacoemulsification efficiencies at torsional amplitudes less than 100%. Increasing longitudinal power does not further increase efficiency at maximal torsional amplitudes.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Kleinmann G, Zaugg B, Apple DJ, Bleik J. Pediatric cataract surgery with hydrophilic acrylic intraocular lens. J AAPOS 2013; 17:367-70. [PMID: 23928003 DOI: 10.1016/j.jaapos.2013.04.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Revised: 03/23/2013] [Accepted: 04/02/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To assess the outcomes after hydrophilic acrylic intraocular lens (IOL) implantation during pediatric cataract surgery. METHODS This was a retrospective chart review of children who underwent cataract surgery or secondary IOL implantation at Beirut Eye Specialist Centre, Rizk Hospital, between March 2002 and August 2007. RESULTS A total of 57 eyes of 40 patients (20 boys) were included in this study. The average age at surgery was 48 ± 40 months (range, 5-172 months). Of these, 54 eyes had congenital or developmental cataracts and 3 eyes had traumatic cataracts. Primary cataract removal and IOL implantation accounted for 45 surgeries, and secondary IOL implantation accounted for 12 surgeries. Hydrophilic acrylic IOLs were implanted in all surgeries. Average follow-up time was 47 ± 21 months (range, 9-97 months). No intraoperative complications were recorded. Of the 57 eyes, 12 (21%) had postoperative complications, but only 7 (12%) required secondary intervention. Average best-corrected visual acuity improved from 2.0 ± 1.0 logMAR preoperatively to 0.8 ± 1.0 logMAR at last follow-up. Improved visual acuity was observed in 47 eyes (82.5%); 31 eyes (54.4%) had a visual acuity of ≥ 20/40 at the last follow-up. CONCLUSIONS Hydrophilic acrylic IOLs appear to be suitable for use in pediatric cataract surgery. Results from this study suggest that, compared with hydrophobic IOLs, these IOLs produce similar complication rates, secondary intervention rates, and visual acuity results.
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Affiliation(s)
- Guy Kleinmann
- John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah.
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Apple DJ, Escobar-Gomez M, Zaugg B, Kleinmann G, Borkenstein AF. Modern cataract surgery: unfinished business and unanswered questions. Surv Ophthalmol 2012; 56:S3-53. [PMID: 22117905 DOI: 10.1016/j.survophthal.2011.10.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Accepted: 10/06/2011] [Indexed: 11/18/2022]
Abstract
We summarize information, based on clinicopathologic studies over the past decade, on various cataract intraocular lens (IOL) procedures and modern "specialized" IOLs, that will help surgeons continuously improve long-term results for cataract patients. Although most operations do initially provide excellent refractive correction and visual rehabilitation, late complications occur. These sometimes are missed because they are outside of the routine period of follow-up care. We have tried to determine if the various techniques and IOLs truly deliver the long-term results that we desire. Most safety and efficacy information is derived from the manufacturer and is passed through the U.S. Food and Drug Administration (FDA). This is often based on limited, relatively short-term observations made by the manufacturer. After a lens receives FDA approval, there are few means to assess the outcome of each procedure and lens years later. We rarely hear of a 10- or 20-year follow-up study. We have found that one of the best means to assess long-term results is pathologic analyses. We discuss recently studied aspects of pathologic reactions, such as posterior capsule opacification, intracapsular fibrosis, glistenings, intralenticular opacification, and other issues with the various IOL platforms; we then present a clinicopathological overview of tissues and IOLs from our database. These include hydrophobic and hydrophilic acrylic designs, plate lenses, and a dual optic lens.
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Affiliation(s)
- David J Apple
- Laboratory for Ophthalmic Devices Research, Sullivan's Island, South Carolina, USA
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Werner L, Zaugg B, Neuhann T, Burrow M, Tetz M. In-the-Bag Capsular Tension Ring and Intraocular Lens Subluxation or Dislocation. Ophthalmology 2012; 119:266-71. [DOI: 10.1016/j.ophtha.2011.08.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 08/04/2011] [Accepted: 08/05/2011] [Indexed: 11/26/2022] Open
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Maddula S, Werner L, Ness PJ, Davis D, Zaugg B, Stringham J, Burrow M, Yeh O. Pathology of 157 human cadaver eyes with round-edged or modern square-edged silicone intraocular lenses: analyses of capsule bag opacification. J Cataract Refract Surg 2011; 37:740-8. [PMID: 21420600 DOI: 10.1016/j.jcrs.2010.10.058] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 10/12/2010] [Accepted: 10/14/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE To assess the degree of capsular bag opacification in human cadaver eyes with silicone intraocular lenses (IOLs), specifically comparing the differences between round-edged IOLs and modern square-edged IOLs. SETTING John A. Moran Eye Center, University of Utah, USA. DESIGN Experimental study. METHODS The eyes were immersed in 10% formalin on enucleation. They had anterior segment scanning with a very-high-frequency ultrasound (Artemis). After the eyes were sectioned at the equator, gross examination of the anterior segment was performed from the posterior aspect to assess the degree of capsular bag opacification, coverage of the IOL edge by the anterior capsule, and IOL fixation. Selected eyes also had histopathologic examination. RESULTS Eighty-seven eyes with a 3-piece round-edged IOL, 43 with a 3-piece square-edged IOL, 26 with a 1-piece plate IOL, and 1 with an accommodating IOL design were included in the analyses of capsular bag opacification. Comparison between 3-piece round-edged IOLs and square-edged IOLs showed statistically significant differences in central posterior capsule opacification (PCO) (P=.0001687) and peripheral PCO (P<.0001). In eyes with square-edged IOLs, PCO had a tendency to start in areas without capsulorhexis coverage of the optic. Twenty-one of 26 eyes with a silicone plate IOL had a neodymium:YAG posterior capsulotomy for dense PCO. CONCLUSIONS This first study using pseudophakic human cadaver eyes that includes a significant number of modern 3-piece silicone IOLs with square optic edges confirmed the role of this design in the prevention of PCO. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Surekha Maddula
- John A. Moran Eye Center, University of Utah, Salt Lake City, Utah 84132, USA
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Hudis C, Tauer KW, Hermann RC, Makari-Judson G, Isaacs C, Beck JT, Kaklamani VG, Stepanski EJ, Rugo HS, Wang W, Bell-McGuinn KM, Chera H, Zaugg B, Ro SK, Li S, Schwartzberg LS. Sorafenib (SOR) plus chemotherapy (CRx) for patients (pts) with advanced (adv) breast cancer (BC) previously treated with bevacizumab (BEV). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.1009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Zaugg B, Werner L, Neuhann T, Burrow M, Davis D, Mamalis N, Tetz M. Clinicopathologic correlation of capsulorhexis phimosis with anterior flexing of single-piece hydrophilic acrylic intraocular lens haptics. J Cataract Refract Surg 2010; 36:1605-9. [PMID: 20692577 DOI: 10.1016/j.jcrs.2010.06.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 04/29/2010] [Accepted: 04/30/2010] [Indexed: 11/16/2022]
Abstract
UNLABELLED We describe 2 cases in which patients with 4-looped single-piece hydrophilic acrylic intraocular lenses (IOLs) exhibited postoperative complications including capsulorhexis phimosis, decentration, tilt, hyperopic shift, and luxation leading to explantation of the IOL-capsular bag complex. The excessive capsule fibrosis led to anterior flexing of the IOL haptics in both cases, even in the presence of a capsular tension ring (CTR). Histopathological analyses revealed a thick fibrocellular tissue attached to the inner surface of the anterior capsules, corresponding to the anterior capsule opacification and folds. An amorphous substance was observed on the outer surface of the anterior capsule in the case with a CTR, suggesting pseudoexfoliation material. These and similar cases raise concerns about the postoperative behavior of highly flexible IOLs in the presence of excessive capsular bag fibrosis. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Brian Zaugg
- John A Moran Eye Center, University of Utah, Salt Lake City, Utah 84132, USA
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Apple DJ, Borkenstein AFM, Kleinmann G, Zaugg B, Auffarth GU. The role of the Soemmerring's Ring in the pathogenesis of post-capsule opacification and other post-surgical opacifications. Klin Monbl Augenheilkd 2009. [DOI: 10.1055/s-0029-1213627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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40
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Borkenstein AFM, Apple DJ, Kleinmann G, Zaugg B, Auffarth GU. New concepts on “no space – no cells“. New information derived from almost 57 years of observation of implanted Ridley lens. Klin Monbl Augenheilkd 2009. [DOI: 10.1055/s-0029-1213626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rowe PC, McLean RH, Ruley EJ, Salcedo JR, Baumgardner RA, Zaugg B, Mellits ED, DeAngelis C. Intravenous immunoglobulin in minimal change nephrotic syndrome: a crossover trial. Pediatr Nephrol 1990; 4:32-5. [PMID: 2206878 DOI: 10.1007/bf00858434] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
To determine whether intravenous immunoglobulin (IVGG) would be an efficacious adjunct in the treatment of childhood minimal change nephrotic syndrome (MCNS), we enrolled ten patients with frequently relapsing or steroid-dependent MCNS in a double-blind crossover clinical trial. At the time of relapse of the nephrotic syndrome, patients were assigned to treatment with a single outpatient infusion of IVGG (800 mg/kg) or intravenous albumin as a control. The relapse was treated concurrently with standard doses of oral prednisone. At the time of the next relapse, patients who had first received IVGG were treated with albumin, and vice versa. There were no significant differences in the length of remission between the IVGG and albumin treatments. The study had a power of 0.72 to detect a true difference of 45 days between the two therapies. We conclude that in the dose of drug used in this trial, administered at the time of relapse in conjunction with prednisone therapy to children with frequently relapsing or steroid-dependent MCNS, IVGG does not lead to a clinically important extension of the period of remission.
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Affiliation(s)
- P C Rowe
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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