Capsular Staining Research Articles

Use of selective laser capsulotomy for mature white cataracts: Initial experience in Indian eyes.

To report the initial experience of performing capsulotomy in eyes with mature white cataracts using selective laser capsulotomy (SLC) in Indian eyes. This was a prospective, noncomparative, open-label study. All adults presenting to our institution with mature cataracts whose pupils dilated >6 mm and who were willing for phacoemulsification were invited to participate. During surgery, after staining the anterior capsule with a proprietary trypan blue, the CAPSULaser device (Excel-Lens Inc, Los Gatos, CA, USA) was used to create a capsulotomy of size ranging from 5 to 5.5 mm and phacoemulsification was carried out. The primary outcome was the size, centration, and continuity of the capsulotomy edge at the end of the surgery. Secondary outcomes were the surgical time for capsulotomy, capsulotomy centration on the intraocular lens (IOL) at 3 months, and adverse effects. Thirty eyes were studied of 30 patients who were recruited with a mean age of 66.4 ± 8.3 years, of which 17 (57%) were men. The intraoperative size of capsulotomy was the same as intended in all eyes and the edges were smooth. None of the eyes experienced any visible capsular tears or run out events; one had a capsular tag. The time for capsulotomy including capsular staining was 3 ± 0.23 min. All IOLs were well centered at 3 months with a capsulotomy size remaining the same. The endothelial cell count had dropped by 8% at 3 months post-op, and the vision improved significantly to 0.03 log of minimum angle of resolution. None of the eyes experienced any intraoperative complications or laser-induced adverse effects. SLC was a safe and effective technique providing precise, well-centered anterior capsulotomies in mature white cataracts.

Spontaneous filtering bleb: Diagnosis and treatment

Abstract: A 72-year-old patient presented with decreased visual acuity and ocular discomfort. The patient had not undergone previous ocular surgery or had a history of ocular trauma. Physical examination revealed decreased intraocular pressure (IOP) (9 mmHg), a subconjunctival filtering bleb, and hypotonic maculopathy. Ultrasound biomicroscopy revealed a fistula between the anterior chamber and the subconjunctival space at Schwalbe’s line. The patient presented no findings suggestive of systemic disease or dysmorphic facial features. Surgical closure of the fistula was attempted using multiple transconjunctival 10-0 nylon sutures and staining using trypan blue 0.06%. Although the fistula was not sealed, the bleb became flatter, IOP increased (18 mmHg), and hypotonic maculopathy resolved. Spontaneous formation of subconjunctival filtering blebs is exceedingly rare; most reported cases are associated with concomitant systemic or local disease. Our novel surgical approach successfully treated the hypotony and revealed that intraoperative use of trypan blue 0.06% in phakic patients causes temporary capsular staining.

Comparative study of the three-dimensional perception of videos recorded on a "Do it yourself" three-dimensional recording assembly versus the conventional recording system.

To develop an indigenous "Do it yourself" (DIY) three-dimensional (3D) ophthalmic surgery recording system and validate the perception of stereopsis using it. A cross-sectional survey of practicing ophthalmologists with post-postgraduation experience of at least 5 years for perception of stereopsis for three different surgeries was performed; cataract, retinal detachment, and intravitreal drug injection were recorded on DIY assembly, viewed on VRBOX and using laptop videos and pseudo 3 d videos as control. The laptop videos and 3D VR Box videos received higher ratings for stereopsis than the pseudo 3D videos. The parameters that received significantly higher ratings on the 3D VR Box viewing were instrument's position relative to the ocular surface in cataract surgery, anterior chamber depth during capsular staining, ophthalmic visco-surgical device injection, capsulorhexis, phaco tunnel depth, movement of nuclear fragments in the anterior chamber, and intra-ocular lens tilt in the capsular bag during cataract surgery ( P < 0.05). In scleral buckling surgery, the parameters that were significantly rated higher on VR Box were globe contour, separation of the scleral plane from muscle, and explant plane ( P < 0.05). Furthermore, the depth of the needle in the vitreous cavity while administering intravitreal drug injection was also rated significantly higher on VR Box ( P < 0.05). However, the ratings for the depth of corneal incision, depth of scleral incision, overall color, and overall quality were not different statistically when compared between laptop and VR Box viewing. DIY 3D recording assembly offers a superior means of appreciating depth at various stages of cataract surgery, scleral buckling, and intravitreal drug injection when compared to laptop viewing and can serve as an effective tool for skill transfer.

Different strokes for anterior capsulorhexis in pediatric cataract.

A successful outcome in pediatric cataract surgery is determined by an intact, curvilinear anterior capsulotomy which is dependent on the type and density of cataract, the morphology of the anterior capsule, and associated anterior segment pathologies. This video highlights 10 different techniques which can be used for capsulorhexis in pediatric cataract. The choice of technique for capsulorhexis in pediatric cataract is on case basis, namely the gold standard manual capsulotomy aided by rhexis forceps (1. Standard capsulorhexis/2. Vitrector, Vitrectorhexis), with an assistance from capsular staining (3. Blue-rhexis), or by coaxial illumination (4. Coaxial-rhexis) or by just the sheen of capsule (5. Sheen-rhexis). The anterior chamber can be maintained using ophthalmic visco-elastic device (Visco-rhexis) or by irrigation fluid (6. Hydro-rhexis). A speed-breaker in the routine capsulotomy is the presence of plaque which is managed by rhexis forceps (7. Plaque-rhexis) or by a vitrector (vitrectorhexis) or a pair of micro-scissors (8. Scissor rhexis). Above all, the technology of femto-second-laser-assisted (9. Femto-rhexis) and zepto-pulse-precision capsulotomy (10. Zepto-rhexis) is also illustrated. This video highlights the 10 different techniques of capsulorhexis in pediatric cataract surgery. https://youtu.be/TgDrk5RYdbI.

The impact of case complexity in resident-performed cataract surgery.

To evaluate the association of capsular dye and/or a pupil expansion device (PED) usage on the rate of major complication in resident-performed cataract extraction. Resident cataract surgeries between 2016 and 2019 were included. The primary outcomes were anterior or posterior vitrectomy (AVx and PPVx). Cases were grouped by the use of a PED and/or capsular staining along with additional preoperative risk factors. Of the 1,348 cases, 371 (27.5%) documented capsular staining ("Dye-only"), 91 (6.8%) required pupil expansion ("PED-only"), and 100 (7.4%) used both capsular stain and a PED ("Both"). The remainder of cases (n=786, 58.3%) were classified as "Routine." Compared to the "Routine" group, "PED-only" and "Both" had significantly higher odds of an AVx (OR=2.90, 95% CI 1.27-6.19, P=0.01) and/or a PPVx (OR=2.33, 95% CI 1.07-5.12, P=0.04). Among the PPVx cases, the "PED-only" group has significantly higher odds than "Routine" and "Dye-only" (OR=4.64, 95% CI 1.68-12.79, P=0.01; and OR=6.48, 95% CI 1.7-25.0, P=0.005, respectively). In case-control analysis, vision, intraocular pressure, anterior chamber depth, axial length, cataract type, or severity had no significant overall association with complication. When compared to nuclear sclerotic cataract, posterior subcapsular (OR=7.86, 95% CI 1.46-42.47, P=0.017) and white/mature cataracts (OR=3.05, 95% CI 1.1-8.43, P=0.032) had increased odds of complication. Resident-performed cataract surgery frequently required capsular staining and/or a PED, and intuitively, these cases had a higher overall complication rate compared to routine cases. However, the use of a PED independently was associated with significantly higher odds of a major complication requiring an unplanned vitrectomy independent of predisposing factors.

The Effect of Mesenchymal Stem Cells on Capsule Formation around Silicone Implant in Rats

ABSTRACT Objective: Capsular contracture is a common adverse effect of breast augmentation and reconstruction surgeries. In the present study we evaluate the effect of adipose tissue-derived mesenchymal stem cells on the capsular structure following breast implant surgery. Materials and Methods: Included in the study were 16 female Wistar-Albino rats, who were divided randomly into two groups. Silicone implants were placed subcutaneously in the pectoral region of the animals in the sham group, while 1 cc of approximately 40 million adipose tissue-derived stem cells were injected into the suture gap after the placement of silicone implants in the experimental group. All experimental animals were re-operated under the same conditions at postoperative week 12 and the implants were removed. All operations were performed by the same surgeon. The capsular structure that had formed around the implants was examined volumetrically and immunohistochemically. Results: Immunohistochemically, the presence of a thick fibrous capsule and prominent procollagen in the periphery was detected in the control group, while capsular staining was noted in the experimental group, wherein thin collagen fibers were organized with the appearance of loose connective tissue, while procollagen staining was lighter and scattered. A volumetric comparison revealed the mean capsule volume to be statistically significantly lower in the experimental group than in the control group. Conclusion: The administration of adipose tissue-derived stem cells resulted in the development of a soft capsule and the formation of new vessels around the implant, and so is likely to have effects that may reduce the development of capsular contracture following breast silicone implant surgery.

Age-Related Changes in the Testicular Morphophysiology of the Cane Rat (Thryonomys swinderianus).

This study evaluated age-related changes in the testicular morphophysiology of the cane rat (Thryonomys swinderianus) using histological, histochemical, and sex hormonal profile approaches. Twenty (20) pathogen-free male cane rats were used for the investigation. Cane rats were divided into four groups: prepubertal (≤4 months), pubertal (>4 ≤12 months), adult (>12 ≤30 months), and aged (>30 months) of 5 rats each. Blood was collected from the different cane rat groups and processed for sex serum hormonal levels. Testes were also excised and processed routinely for variations in histology, histochemistry (using Masson's trichrome [MT] and Periodic acid-Schiff [PAS]), and histomorphometric evaluations using GIMP2 software. Testosterone concentrations were significantly elevated (P < 0.05) in the prepubertal to adult, while there were no significant differences (P > 0.05) in this hormone between adult and aged. The concentrations of follicle-stimulating hormone (FSH) decreased significantly (P < 0.05) for prepubertal, pubertal, and adult, respectively. There were no significant differences (P > 0.05) between adult and aged for FSH and luteinizing hormone. Histologically, there were scanty interstitial cells, lack of patent lumen, and incomplete spermatogenetic cell series in prepubertal compared to other age groups. Testicular capsular (MT and PAS) staining intensity increased with age advancement, while in the parenchyma, remarkably high intensity was displayed by the pubertal compared to others. Seminiferous tubular and luminal diameters (LD) significantly (P < 0.05) increased with advancing age whereas epithelial height (EH) was markedly increased in pubertal relative to other groups. In conclusion, these sets of data have shown that reproductive activity is directly related to age and is at maximum in adult cane rat.

Inadvertent globe penetration due to self-attempted eyeball tattooing

Eyeball tattooing or scleral tattooing is a new form of body modification. A 27-year-old Indian male presented with defective vision in the left eye a day after self-attempted eyeball tattooing. The inadvertent penetration and ink injection led to the staining of the cornea, suspension of ink in the aqueous. The lens showed capsular staining and subsequent progression to the cataract. The posterior segment showed staining of vitreous with the red dye, retinal thickening at the macula. The optical coherence tomography showed inner retinal hyperreflectivity with retinal thickening. As these “Do it yourself” maneuvers are becoming trends influenced by social media, we report a case of self-attempted eyeball tattooing and its complications.

Outcome of cataract surgery in eyes with diabetic retinopathy: a Swedish national cataract register report.

To analyse if patients with diabetic retinopathy (DR) subjected to cataract surgery differ in outcome compared to patients without DR with regard to best-corrected visual acuity (BCVA), deviation from target refraction, intraoperative difficulties and risk of complications. A register-based study from the Swedish National Cataract Register (NCR) during the years 2015-2017 including 358 040 cataract procedures. Patients with other ocular pathology than cataract and DR were omitted from outcome analyses. Diabetic retinopathy was reported in 13 724 of all eyes (3.8%). Preoperative BCVA was significantly worse in DR patients than in patients without DR, 0.54 ± 0.33 compared to 0.40 ± 0.27 (logMAR, mean ± SD, p < 0.001). The same was evident for postoperative BCVA, 0.15 ± 0.25 for DR patients versus 0.06 ± 0.13 (p < 0.001). The improvement in BCVA was slightly better in DR than in non-DR, -0.40 ± 0.32 (logMAR; mean ± SD) versus -0.35 ± 0.27, p < 0.001. The absolute mean biometry prediction error was 0.42 ± 0.50 diopters (D) in DR and 0.43 ± 0.71 D in non-DR patients, p = 0.768. One or more intraoperative difficulties, including mechanical pupil dilation, capsular stain, hooks at capsulorhexis margin or capsular tension ring, had an adjusted odds ratio (OR) of 1.75 (95% confidence interval [CI] 1.61-1.90, p < 0.001) in DR versus non-DR cases and the rate of posterior capsular tears (PCR) had an adjusted OR of 1.76 (95% CI 1.40-2.20, p < 0.001). Eyes with DR have inferior pre- and postoperative BCVA compared to non-DR eyes. There is little difference in improvement of BCVA and no difference in absolute mean biometry prediction error. Importantly, intraoperative difficulties and PCRs are almost twice as common in DR patients, strongly indicating that these patients should be managed by experienced surgeons.

EVALUATION OF CITRIC ACID AND CLOVE OIL AS SAFE ANTI-VIRULENCE AND RESISTANCE-MODIFYING AGENTS AGAINST PROBLEMATIC KLEBSIELLA CLINICAL ISOLATES IN EGYPT

Klebsiella species are regarded as terrifying pathogens that threaten different healthcare systems. These pathogens possess a variety of virulence factors which markedly account for their pathogenicity. Three virulence factors (capsule formation, hypermucoviscosity and biofilm formation) were screened, phenotypically and genotypically, among selected Egyptian Klebsiella clinical isolates. Two safe edible agents, clove oil and citric acid, were tested for their effect on bacterial capsules using the Anthony capsular staining method and the transmission electron microscopy. The antibiotic-resistance modifying activity of both agents was studied against selected troublesome isolates showing resistance to amikacin, meropenem and cefotaxime. Molecular docking of citric acid and eugenol with NDM-1, as well as the docking of citric acid with AAC(6′)-Ib and CTX-M-15 were carried out to explain the resistance modifying activity of the tested agents. Capsule formation was the most prominent virulence factor that was detected in all isolates. Both citric acid and clove oil could effectively reduce the size of the formed bacterial capsules. Citric acid showed promising synergistic effects when combined with the studied antibiotics against all the tested isolates. However, clove oil showed a synergistic effect only against 50% of the tested isolates when combined with meropenem. Relying on their binding efficiency mode obtained from molecular docking studies, the tested agents were recognized as promising inhibitors of the studied enzymes. In conclusion, both citric acid and clove oil are auspicious anti-virulence and resistance-modifying agents that can be combined with conventional antibiotics to combat virulent and multidrug resistant Klebsiella isolates.

Acinetobacter baumannii Strains Deficient in the Clp Chaperone-Protease Genes Have Reduced Virulence in a Murine Model of Pneumonia

Acinetobacter baumannii has emerged as a significant opportunistic Gram-negative pathogen and causative agent of nosocomial pneumonia especially in immunocompromised individuals in intensive care units. Recent advances to understand the contribution and function of A. baumannii virulence factors in its pathogenesis have begun to elucidate how this bacterium interacts with immune cells and its interesting mechanisms for multi-antibiotic resistance. Taking advantage of the availability of the A. baumannii AB5075 transposon mutant library, we investigated the impact of the A. baumannii Clp genes, which encode for a chaperone-protease responsible for the degradation of misfolded proteins, on bacterial virulence in a model of pneumonia using C57BL/6 mice and survival within J774.16 macrophage-like cells. Clp-protease A. baumannii mutants exhibit decreased virulence in rodents, high phagocytic cell-mediated killing and reduced biofilm formation. Capsular staining showed evidence of encapsulation in A. baumannii AB5075 and Clp-mutant strains. Surprisingly, clpA and clpS mutants displayed irregular cell morphology, which may be important in the biofilm structural deficiencies observed in these strains. Interestingly, clpA showed apical-like growth, proliferation normally observed in filamentous fungi. These findings provide new information regarding A. baumannii pathogenesis and may be important for the development of therapies intended at reducing morbidity and mortality associated with this remarkable pathogen.

Incidence of corneal transplantation after challenging cataract surgery in patients with and without corneal guttata.

To study the risk for corneal transplantation after phacoemulsification with dense cataract or posterior capsule rupture (PCR) and the impact of corneal guttata. Forty-nine Swedish cataract surgical units and 8 Swedish cornea transplantation units. Registry-based cohort study. Patient data from the Swedish National Cataract Registry (2010 to 2012) were linked with data from the Swedish Cornea Transplant Registry (2010 to 2017). The outcome measures were risk for future corneal transplantation, visual acuity, and self-assessed visual function after phacoemulsification. Logistic and Poisson regression analyses with adjustment for confounder effects were used to investigate the association of the outcome measures with dense cataract, indicated by trypan blue capsular staining (TB) and PCR, separately and together. Altogether, data from 276 362 cataract patients were linked with data from 2091 patients with endothelial failure who underwent corneal transplantation.The risk for future corneal transplantation increased more than 3-fold with the presence of dense cataract or PCR, and a trend toward an ever-higher risk with the combination of TB and PCR together, but without any significant synergy of corneal guttata. Dense cataract, but not PCR, was significantly associated with an increased probability of inferior visual acuity after phacoemulsification. The impact on satisfaction was not statistically significant for any of the factors. Challenging cataract surgery increases the risk for future corneal transplantation equally in patients both with and without corneal guttata, despite a more vulnerable endothelium in the guttata group. This supports a strategy where PCR is limited and handled optimally and that cataract surgery is performed before the cataract turns critically dense.

“White-puncture”: A simple technique to prevent tearing of the anterior capsule during capsulorhexis in intumescent white cataracts

In order to avoid radial tearing of the anterior capsule while performing continuous circular capsulorhexis (CCC) in a white intumescent cataract, called the “Argentinian flag sign” when CCC is associated with a previous capsular stain with trypan blue , an initial puncture of the anterior capsule is performed with a 30G needle as the first step of the surgical procedure, that means, prior to any previous aperture of the anterior chamber . This act seems to allow the pressure of the intracrystalline space and the pressure of the anterior chamber to be equalized, as the liquefied content of the intumescent white cataract is released into a presumably hermetic anterior chamber, avoiding the dreaded anterior capsular radial tear. This technique, called “white-puncture”, has been used in 174 cases without any associated complications. Para evitar el desgarro radial de la cápsula anterior al realizar la capsulorrexis circular continua (CCC) que puede ocurrir durante la cirugía en las cataratas blancas intumescentes, el conocido como signo de la bandera argentina cuando se asocia la CCC a una tinción capsular previa con azul de tripano, se hace una punción inicial de la cápsula anterior con una aguja 30 G, como primer paso del procedimiento quirúrgico, es decir, previo a cualquier apertura de la cámara anterior. Este acto parece permitir que la presión del compartimento intracristaliniano y la presión de la cámara anterior se igualen, al liberarse el contenido licuado de la catarata blanca intumescente en una cámara anterior presumiblemente hermética, evitando el temido desgarro radial capsular anterior. Esta técnica, denominada blancopunción, ha sido utilizada en 174 casos sin ninguna complicación asociada.

Blancopunción: una técnica simple para prevenir el desgarro de la cápsula anterior durante la capsulorrexis en cataratas blancas intumescentes

In order to avoid radial tearing of the anterior capsule while performing continuous circular capsulorhexis (CCC) in a white intumescent cataract, called the “Argentinian flag sign” when CCC is associated with a previous capsular stain with trypan blue, an initial puncture of the anterior capsule is performed with a 30G needle as the first step of the surgical procedure, that means, prior to any previous aperture of the anterior chamber. This act seems to allow the pressure of the intracrystalline space and the pressure of the anterior chamber to be equalized, as the liquefied content of the intumescent white cataract is released into a presumably hermetic anterior chamber, avoiding the dreaded anterior capsular radial tear. This technique, called “white-puncture”, has been used in 174 cases without any associated complications.

Safety and efficacy of brilliant blue g250 (BBG) for lens capsular staining: a phase III physician-initiated multicenter clinical trial.

To evaluate the safety and efficacy of BBG (Brilliant Blue G250) for lens capsular staining during cataract surgery with continuous curvilinear capsulorhexis. Prospective clinical study. This clinical trial enrolled 30 eyes of 30 patients who underwent cataract surgery with BBG (0.25mg/mL Brilliant Blue G250) for capsular staining. Visualization of the lens capsule and the ease of capsulorhexis with BBG staining were evaluated in five grades (grade 0 to 4) by the Independent Data Monitoring Committee and the surgeons. The safety of BBG was also evaluated in terms of ocular and systemic tolerance for 7days after surgery. The use of BBG improved visualization of the lens capsule and complete capsulorhexis was performed in all patients. The major endpoint (Independent Data Monitoring Committee evaluation) showed that use of BBG improved visualization of the lens capsule and the ease of capsulorhexis (grades 2 to 4); the committee's grading results were similar to those of the surgeons. Frequent complications observed in more than two eyes were conjunctival injection, corneal edema and intraocular pressure elevation. No severe complications were observed in ocular and systemic evaluations. BBG staining contributed to improved visualization of the lens capsule and aided in the completion of capsulorhexis during cataract surgery. The use of BBG for capsular staining also exhibited favorable safety results.

Closed-Chamber Anterior Capsulorhexis Under Air Tamponade In White Cataract.

PurposeTo evaluate the efficacy and safety of a closed-chamber air bubble capsulotomy technique to prevent the Argentinean flag sign (AFS) in patients with white and intumescent cataracts.SettingSohag University, Faculty of Medicine, Ophthalmology Department, Sohag, Egypt.DesignProspective interventional noncomparative case series.MethodsEighty-two eyes of 80 patients with white and intumescent cataracts were included. Eyes with any ocular pathology other than cataract or eyes subjected to previous intraocular surgery were excluded. Needle capsulorhexis was performed under a large air bubble tamponade without capsular staining. Efficacy of the technique was assessed intraoperatively by successful completion of capsulorhexis. Safety of the technique was assessed by the occurrence of intraoperative or postoperative complications.ResultsComplete capsulorhexis by the closed-chamber air bubble technique was successful in 75 eyes (91.5%), while capsulorhexis extension occurred in seven eyes. In four eyes with extension, the procedure was shifted to the standard technique of CCC (circular curvilinear capsulorhexis), using a viscoelastic device. A shift to extracapsular cataract extraction (ECCE) surgery occurred in the remaining three eyes, as the extension was so far-gone. No intraoperative or postoperative complications were observed.ConclusionThe closed anterior chamber air bubble technique for capsulorhexis is a novel, safe, and effective technique to prevent AFS in white and intumescent cataracts. It is also time-saving and cost-effective, with less likelihood of capsulorhexis extension. The technique is considered a valuable addition to previously described techniques.

A multipronged approach to prevent Argentinian flag sign in intumescent cataracts.

In this communication, we describe a technique for creation of a single stage, adequately sized capsulorrhexis in intumescent cataracts by depressurizing the anterior and posterior intralenticular compartments in a nonleaky anterior chamber (AC) to prevent capsulorrhexis extension and Argentina flag sign. Initially, an incomplete main-port incision is made by the partial entry of a 2.2-mm keratome. A cohesive dispersive ophthalmic viscosurgical device (OVD) is injected into AC. Standard side-port incisions are made, followed by anterior capsular staining. The fluid cortex in anterior intralenticular compartment is aspirated by puncturing anterior capsule in the center using a 30-gauge needle entered through a separate limbal stab incision. The nucleus edge is gently tipped posteriorly with the needle tip to release the fluid from posterior intralenticular compartment also and as much fluid aspirated as possible. OVD is again injected and capsulorrhexis is performed in a single stage using micro-capsulorrhexis forceps.

Virulence peptide 1 (VP1; green) binds to the surface of pneumococcal cells in early biofilms visualized by capsular staining (red). For details, see the article by Cuevas et al. on pp. 554–571 of this issue.

Molecular MicrobiologyVolume 105, Issue 4 p. i-i Front CoverFree Access Virulence peptide 1 (VP1; green) binds to the surface of pneumococcal cells in early biofilms visualized by capsular staining (red). For details, see the article by Cuevas et al. on pp. 554–571 of this issue. First published: 08 August 2017 https://doi.org/10.1111/mmi.13515AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume105, Issue4August 2017Pages i-i RelatedInformation

Risk Factors for Return to the Operating Room after Resident-Performed Cataract Surgery

ABSTRACTObjective: Investigate risk factors for unplanned return to the operating room after resident-performed cataract surgery. Design: Retrospective case-control study. Setting: Institutional. Methods: Study population: All patients with reoperation within 90 days of resident-performed phacoemulsification were matched to four control eyes which had surgery within 30 days of the reoperation at the same institution. Observation Procedure: Billing codes were used to identify all patients who underwent resident-performed intended phacoemulsification with intraocular lens placement from January 2005 to December 2010. Main Outcome Measures: Investigated risk factors for reoperation included cataract characteristics and preexisting ocular co-morbidities, including diabetic retinopathy, retinal detachment history, glaucoma, corneal pathology, and uveitis. Additional preoperative risk factors studied included resident training year, history of tamsulosin use, phacodonesis, pupillary dilation, presence of pseudoexfoliation, myopia, history of trauma, visual acuity, and monocular status. Intraoperative variables were the use of iris expansion devices, use of capsular stain, attending type, incision type, use of sutures, vitreous loss, anesthesia type, and phacoemulsification technique. Results: There were 67 returns to the operating room (i.e., cases) over five years that were assigned to 268 control eyes. In preoperative multivariate analysis, phacoemulsification done by a first- or second-year resident (OR 3.2, 95% CI: 1.7–6.0, p < 0.001) was associated with an increased risk of reoperation. In postoperative multivariate analysis, only the use of the divide-and-conquer technique (OR 4.0, 95% CI:1.7–9.2, p = 0.001) was associated with an increased risk of reoperation. Conclusions: Phacoemulsification done by a junior resident or using the divide-and-conquer technique had the highest risk of reoperation.

Impact of Indocyanine Green Concentration, Exposure Time, and Degree of Dissolution in Creating Toxic Anterior Segment Syndrome: Evaluation in a Rabbit Model.

Purpose. To investigate the role of indocyanine green (ICG) dye as a causative material of toxic anterior segment syndrome (TASS) in an experimental rabbit model. Method. Eight eyes of four rabbits were allocated to this study. Capsular staining was performed using ICG dye, after which the anterior chamber was irrigated with a balanced salt solution. The effects of different concentrations (control, 0.25, 0.5, and 1.0%), exposure times (10 and 60 seconds), and the degree of dissolution (differently vortexed) were investigated. The analysis involved anterior segment photography, ultrasound pachymetry, prostaglandin assay (PGE2 Parameter Assay, R&D systems, Inc.), and scanning electron microscopy of each iris. Result. There was no reaction in the control eye. A higher aqueous level of PGE2 and more severe inflammatory reaction were observed in cases of eyes with higher concentration, longer exposure time, and poorly dissolved dye. Additionally, scanning electron microscopy revealed larger and coarser ICG particles. Conclusion. TASS occurrence may be associated with the concentration, exposure time, and degree of dissolution of ICG dye during cataract surgery.