Continuous Curvilinear Capsulorrhexis Research Articles

Postoperative intraocular lens stability following cataract surgery with or without primary posterior continuous curvilinear capsulorrhexis: an intra-individual randomized controlled trial.

To evaluate the effect of primary posterior continuous curvilinear capsulorrhexis (PPCCC) on the positional stability of IOLs. This study is a prospective intra-individual comparative randomized controlled trial including 31 patients (62 eyes). Eyes of the same patient were randomly assigned to the PPCCC group (18 right eyes and 13 left eyes) or group without PPCCC (NPCCC group). Eyes in both groups were implanted with a one-piece foldable hydrophobic acrylic IOL via routine cataract surgery. Patients in the PPCCC group underwent additional manual PPCCC before IOL implantation. Examinations were performed 1day, 1week, 1month and 3months postoperatively. IOL tilt (x, y), decentration (x, y), anterior chamber depth (z) and refractive prediction error data were collected and analyzed with Pentacam. Postoperatively, the range of IOL position change over 3months in PPCCC group was comparable to NPCCC group, which indicated smaller value in every tilt and decentration index. PPCCC eyes showed comparable tilt and decentration with NPCCC eyes in this study endpoint: mean tilt (x, y), decentration (x, y) and anterior chamber depth (ACD) were 1.04 ± 0.56°, 0.90 ± 0.64°, 0.239 ± 0.140mm, 0.233 ± 0.133mm and 4.01 ± 0.32mm, respectively, in the PPCCC group vs. 1.09 ± 0.76°, 1.10 ± 0.82°, 0.252 ± 0.153mm, 0.244 ± 0.155mm and 4.01 ± 0.38mm, respectively, in the NPCCC group. Refractive prediction error in the PPCCC group demonstrated a mild hyperopic shift vs. the NPCCC group (0.13 ± 0.50 vs. 0.05 ± 0.39; p = 0.208), and corrected distance visual acuity (CDVA) did not differ between the two groups (0.027 ± 0.014 vs. 0.059 ± 0.185; p = 0.377). Comparable IOL tilt, decentration, ACD and refractive prediction error were observed in PPCCC eyes with that underwent routine cataract surgery. Little IOL position fluctuation and good visual acuity were shown in PPCCC group over time. The study was registered at the Chinese Clinical Trial Register Center on May 27th, 2020 (protocol code ChiCTR2000033304, 27/05/2020).

Analysis of postoperative visual and surgical outcome following surgery for absorbed cataract in pediatric age group and the intraoperative difficulties

Purpose:To analyze the postoperative visual and surgical outcomes following surgery for pediatric-absorbed cataracts and intraoperative difficulties.Methods:This prospective longitudinal study included 43 eyes (30 children) with absorbed cataracts aged between 6 months and 18 years (either sex). All children underwent best-corrected visual acuity (BCVA), anterior and posterior segment evaluation, rubella titer estimation, intraocular lens (IOL) power calculation, superior small incision cataract surgery with or without posterior capsulotomy/anterior vitrectomy/IOL implantation under general anesthesia, visual rehabilitation, and were followed up for 1 year.Results:The mean age was 7.89 ± 4.84 years. Preoperative BCVA distance: 39 eyes had either perception of light (PL) or counting finger close to face (CFCF); near BCVA: all eyes had either PL or N36. Postoperative (12 months) distant BCVA: a majority of the eyes (27) had 6/60–1/60, 11 eyes had 6/18–6/36; near: N18 in 19 eyes, N6 in 7 eyes. Anterior continuous curvilinear capsulorrhexis (ACCC) was possible in eight eyes. Cortical aspiration was difficult in 16 eyes (peripheral calcified ring). A majority (32 eyes) underwent in the sulcus implantation (in-the-bag: eight eyes); two eyes: no IOL, one eye: secondary IOL. Eleven eyes had early postoperative inflammation. At 12 months, one eye underwent membranectomy for visual axis opacification and 38 eyes had well-centered IOLs.Conclusion:Surgery in absorbed cataracts is challenging because of the anatomic disorganization of the absorbed lens. By adopting appropriate surgical methods and good visual rehabilitation, one can achieve satisfactory surgical and visual outcomes, highlighting the need for surgical intervention.

Three-dimensional assessment of posterior capsule–intraocular lens interaction with and without primary posterior capsulorrhexis: an intraindividual randomized trial

PurposeTo assess the morphologic and clinical features of posterior capsule-intraocular lens (IOL) interaction following cataract surgery with and without primary posterior continuous curvilinear capsulorrhexis (PPCCC) at a three-dimensional (3-D) level using Scheimpflug imaging.MethodsThis prospective intraindividual randomized comparative study comprised 56 patients (112 eyes) with age-related cataract who had bilateral cataract surgery and hydrophobic acrylic IOLs implantation. In randomized order, cataract surgery with PPCCC was performed in 1 eye (PPCCC group), and the posterior capsule was left intact in the fellow eye (NPCCC group). Scheimpflug imaging containing 25 images distributed in 360° was taken 1 day, 1 week, 1 month, and 3 months postoperatively.Results46 patients completed 3 months follow-up. Posterior capsule–IOL interaction can be morphologically classified into two types including complete adhesion and floppy shape in PPCCC group, and six types including full area wave, full area flat, concentric ring wave, concentric ring flat, sector, and complete adhesion in NPCCC group. The adhesion index (AI), defined as the proportion of complete adhesion of posterior capsule–IOL in 25 cross-section tomograms, was 0.45 ± 0.45, 0.79 ± 0.37, 0.92 ± 0.26 and 1.00 ± 0.00 in PPCCC group, while 0.05 ± 0.18, 0.41 ± 0.47, 0.87 ± 0.34, and 0.96 ± 0.21 in NPCCC group at 1 day, 1 week, 1 month and 3 months postoperatively, respectively (p = 0.001, 0.001, 0.338 and 0.151).Conclusions3-D Scheimpflug imaging was favorable in observing of posterior capsule–IOL interaction. Faster posterior capsule adhesion to the IOL was found in PPCCC group than in NPCCC group.

Parameters of Capsulorrhexis and Intraocular Lens Decentration After Femtosecond and Manual Capsulotomies in High Myopic Patients With Cataracts.

Purpose: To compare the parameters of capsulorrhexis and intraocular lens decentration after femtosecond laser capsulotomy and manual continuous curvilinear capsulorrhexis in high myopic patients with cataracts.Methods: This is a prospective consecutive non-randomized comparative cohort study. Selected patients with axial length > 26.0 mm were divided into femtosecond laser capsulotomy (FS) group and manual continuous curvilinear capsulorrhexis (CCC) group. Five experienced phacoemulsification surgeons conducted all surgeries. Intraoperative complications and post-operative anterior segment photography were recorded. Intraocular lens decentration, area of capsulorrhexis, circularity, and capsule overlap were measured at 1 week, 1 month, and 2 years after surgery. Between group differences of parameters were determined with independent-sample t-test or the Mann–Whitney U-test, analysis of variance test, Pearson chi-square test, and Spearman rank correlation test.Results: The study included 142 eyes (108 patients), 68 eyes in the FS group, and 74 eyes in the CCC group. At 1 week, 1 month, and 2 years after surgery, the area of capsulorrhexis in the CCC group was significantly larger than in the FS group (P < 0.05), while no significant difference was noted in circularity values. The complete overlap ratio in the FS group was significantly higher than that in the CCC group (P < 0.05) at each measured timepoint. Significant correlations were noted between the anterior chamber depth and the area of capsulorrhexis in the CCC group (R = 0.25, P = 0.04), but did not correlate in the FS group (P > 0.05). In patients with an anterior chamber depth >3 mm, the capsule-intraocular lens (IOL) overlap of the CCC group was less than that of the FS group at all measured timepoints after surgery (P < 0.05). Meanwhile, the IOL decentration in the CCC group was significantly greater than that of the FS group in those patients at 2 years after surgery (P < 0.05).Conclusion: In high myopic patients with cataracts, with anterior chamber depth more than 3 mm, femtosecond laser capsulotomy can achieve better capsulorrhexis sizing and centering. Due to more precise capsulotomy and a better capsule-IOL overlap in the FS group, femtosecond laser capsulotomy resulted in better long-term centration of the IOL.

Real-Time Surgical Problem Detection and Instrument Tracking in Cataract Surgery.

Surgical skill levels of young ophthalmologists tend to be instinctively judged by ophthalmologists in practice, and hence a stable evaluation is not always made for a single ophthalmologist. Although it has been said that standardizing skill levels presents difficulty as surgical methods vary greatly, approaches based on machine learning seem to be promising for this objective. In this study, we propose a method for displaying the information necessary to quantify the surgical techniques of cataract surgery in real-time. The proposed method consists of two steps. First, we use InceptionV3, an image classification network, to extract important surgical phases and to detect surgical problems. Next, one of the segmentation networks, scSE-FC-DenseNet, is used to detect the cornea and the tip of the surgical instrument and the incisional site in the continuous curvilinear capsulorrhexis, a particularly important phase in cataract surgery. The first and second steps are evaluated in terms of the area under curve (i.e., AUC) of the figure of the true positive rate versus (1—false positive rate) and the intersection over union (i.e., IoU) obtained by the ground truth and prediction associated with the region of interest. As a result, in the first step, the network was able to detect surgical problems with an AUC of 0.97. In the second step, the detection rate of the cornea was 99.7% when the IoU was 0.8 or more, and the detection rates of the tips of the forceps and the incisional site were 86.9% and 94.9% when the IoU was 0.1 or more, respectively. It was thus expected that the proposed method is one of the basic techniques to achieve the standardization of surgical skill levels.

Lens Epithelial Surface Disorders in Exfoliation Syndrome: A Scanning and Transmission Electron Microscopy Study

Background: Hydrodissection was recently reported to occur more easily in patients with exfoliation syndrome (XFS). Transmission electron microscopy (TEM) studies have already revealed alterations of the lens epithelial cells (LECs) and their apical membrane towards the lens fibers. Objective: The aim of this work was to examine the three-dimensional appearance of the lens epithelium in patients with XFS. Methods: Fourteen patients with senile cataract, 7 of whom had XFS, were included. Anterior lens capsules (aLCs) were obtained with continuous curvilinear capsulorrhexis (CCC) during phacoemulsification and were examined with scanning electron microscopy (SEM) and TEM. Results: Exfoliation samples exhibited an overall more irregular apical surface of the lens epithelium compared to control aLCs. The height of LECs varied extensively. On the apical surface of LECs, amorphous, crystalline-like, or microgranular extracellular material and membranous, oval-shaped structures were documented with SEM. All findings were connected to corresponding observations with TEM and were not correlated to the type of cataract. Conclusions: In XFS patients, the lens epithelial surface exhibited a highly irregular margin, with extracellular material covering the apical membrane of LECs. We suggest that XFS probably causes both epithelial and lens fiber degeneration which, during CCC and mechanical extraction of the aLC from the lens cortex, result in diverse alterations.

Comparison between the Characteristics of Femtosecond laser Anterior Capsulotomy Versus Manual Capsulorhexis and their Effects on Intra Ocular Lens Centration, Effectiveness and Safety in Cataract Surgery

Abstract Background Cataract is characterized with opacity of the crystalline lens that can markedly limit the routine activities of patients such as reading, writing, walking and in the long run reduce the quality of life. Cataract is the main cause of preventable blindness. Despite some modern advances in the field of cataract impending drug treatments, surgical treatment is still known to be the most actual treatment option(1). Objective To perform a meta-analysis on the characteristics of femtosecond laser anterior capsulotomy and manual capsulorhexis and their effects on intra ocular lens (IOL) centration, effectiveness and safety in cataract surgery. Methods This meta-analysis was conducted from 1/1/2015 to 31/7/2018. Literature search on PubMed was done to identify randomised controlled trials (RCT) and comparative studies MedCalc ver. 18.2 (MedCalc, Ostend, Belgium) was used for data analysis. Results Of the 17 articles included, there were 3 (18%) randomised controlled trials and 14 (82%) comparative study. The meta-analysis was based on a total of 18558 eyes. Of them, 9442 (50.88%) underwent femtosecond laser-assisted cataract surgery (FLACS) and 9116 (49.12%) underwent manual continuous curvilinear capsulorrhexis (CCC). Comparative study between the 2 groups revealed; highly significant increase in better IOL centration; in FLACS group compared to CCC group (p &amp;lt; 0.01), there is non-significant difference as regards capsulotomy diameter (p &amp;gt; 0.05) and non-significant difference as regards corrected distant visual acuity (CDVA) ,un corrected distant visual acuity (UDVA) and mean absolute error (MAE) (p &amp;gt; 0.05). As regards the complications; fixed-effect model showed highly significant increase in complications rate in FLACS group; but random-effects model showed non-significant difference between the 2 groups (p &amp;lt; 0.001, p &amp;gt; 0.05 respectively). Conclusion FLACS is better for IOL centration, but there is non-significant difference between FLACS and manual CCC as regards capsulotomy diameter, CDVA, UDVA, MAE and complication rate.

Phacoemulsification in posterior polar cataract: Experience from a tertiary eye care Centre in North India.

Purpose:To determine the rate of posterior capsular rupture (PCR) and assess the postoperative outcomes in patients of posterior polar cataract (PPC) undergoing phacoemulsification using a combination of “V” or “λ” nucleofractis and viscodissection.Methods:It was a retrospective study of 80 eyes of 64 patients undergoing surgery for PPC. All surgeries were performed by a single surgeon. After completion of the continuous curvilinear capsulorrhexis (CCC), controlled hydrodelineation was used to separate the endonucleus from the epinuclear shell with limited viscodissection. Phacoemulsification was then carried out by making a “V” or lambda-shaped nucleofractis with the phaco tip followed by multiple chopping of the nucleus, ensuring the integrity of the epinuclear part of the lens. The epinuclear plate was removed after viscodissection.Results:The overall rate of PCR was 7.5% (6 out of 80 eyes). Of the 6 eyes, 4 eyes had been documented to have a pre-existing posterior capsular defect on slit-lamp examination. The rate of “on table” PCR, that is, PCR occurring intraoperatively was only 2.6% (2 of 76 eyes). Nucleus drop was not encountered in any case. Overall 87.5% eyes achieved a final visual acuity of 20/40 or better with 68.75% being 20/20 or better. Of the eyes developing PCR, two-third achieved a visual acuity of 20/30 or better.Conclusion:Using a combination of surgical techniques of V groove or lambda technique for nucleofractis and removal of epinucleus by viscodissection can result in a low rate of PCR and extremely good postoperative outcomes in cases of PPC.

Real-Time Extraction of Important Surgical Phases in Cataract Surgery Videos

The present study aimed to conduct a real-time automatic analysis of two important surgical phases, which are continuous curvilinear capsulorrhexis (CCC), nuclear extraction, and three other surgical phases of cataract surgery using artificial intelligence technology. A total of 303 cases of cataract surgery registered in the clinical database of the Ophthalmology Department of Tsukazaki Hospital were used as a dataset. Surgical videos were downsampled to a resolution of 299 × 168 at 1 FPS to image each frame. Next, based on the start and end times of each surgical phase recorded by an ophthalmologist, the obtained images were labeled correctly. Using the data, a neural network model, known as InceptionV3, was developed to identify the given surgical phase for each image. Then, the obtained images were processed in chronological order using the neural network model, where the moving average of the output result of five consecutive images was derived. The class with the maximum output value was defined as the surgical phase. For each surgical phase, the time at which a phase was first identified was defined as the start time, and the time at which a phase was last identified was defined as the end time. The performance was evaluated by finding the mean absolute error between the start and end times of each important phase recorded by the ophthalmologist as well as the start and end times determined by the model. The correct response rate of the cataract surgical phase classification was 90.7% for CCC, 94.5% for nuclear extraction, and 97.9% for other phases, with a mean correct response rate of 96.5%. The errors between each phase’s start and end times recorded by the ophthalmologist and those determined by the neural network model were as follows: CCC’s start and end times, 3.34 seconds and 4.43 seconds, respectively and nuclear extraction’s start and end times, 7.21 seconds and 6.04 seconds, respectively, with a mean of 5.25 seconds. The neural network model used in this study was able to perform the classification of the surgical phase by only referring to the last 5 seconds of video images. Therefore, our method has performed like a real-time classification.

Observation on the efficacy of twice capsulorrhexis in phacoemulsification for white cataracts

Objective To observe the efficacy of the twice capsulorrhexis in phacoemulsification for the treatment of white cataract. Methods The clinical data of 76 eyes of 76 cases with white cataract in our hospital were analyzed retrospectively. All cases were randomly divided into two groups. Group A, 38 eyes of 38 cases, received twice continuous curvilinear capsulorrhexis. The first capsulorrhexis diameter was <3mm. The second capsulorrhexis diameter was 5.5 mm. Group B, 38 eyes of 38 cases, received the continuous curvilinear capsulorrhexis (CCC) with diameter 5.5 mm. All cases received the phacoemulsification combined with intraocular lens (IOL) implantation. The efficacy were compared and analyzed between the two groups. Results The success rate of CCC and the implantation rate of IOL in group A were higher than that in group B (P 0.05). Conclusion The twice capsulorhexis can improve the success rate of capsulorhexis and implantation rate of IOL in the capsule during phacoemulsification for white cataract. Key words: Capsulorrhexis, curvilinear, continuous, twice; Cataract, white; Phacoemulsification; Implantation, lens, intraocular

Comparison of Pediatric Cataract Surgical Techniques Between Pediatric Ophthalmology Consultants and Fellows in Training: A Video-Based Analysis

To compare intraoperative technique and quality of surgical steps in pediatric cataract surgery between pediatric ophthalmology consultants and fellows in training. In a video-based analysis by two fellowship-trained pediatric ophthalmologists, 42 surgical videos of pediatric ophthalmology consultants and 34 videos of fellows in training were graded based on the International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubrics (ICO-OSCAR). Six steps in surgery were analyzed: wound construction, anterior continuous curvilinear capsulorrhexis, irrigation and aspiration, intraocular lens implantation, primary posterior capsulorrhexis with anterior vitrectomy, and wound suturing. Cohen's Kappa was used to rate inter-observer agreement. Cohen's Kappa scores ranged from 0.6 to 0.8. The median scores for surgical steps for both analyzed groups were similar. The mean duration of surgery was shorter for consultants (24 minutes, range: 10 to 45 minutes) than for fellows (40 minutes, range: 15 to 70 minutes). The median age of patients operated on by consultants was younger (24 months, range: 2 to 180 months) than fellows (58 months, range: 10 to 150 months). The quality of the surgical steps performed by pediatric ophthalmology consultants and fellows in training was similar. [J Pediatr Ophthalmol Strabismus. 2019;56(2):83-87.].

Characterization and Management of Late Postoperative Capsular Block Syndrome Following Phacoemulsification or Phacovitrectomy

To compare the clinical characteristics of eyes affected by late postoperative capsular block syndrome (CBS) after routine phacoemulsification or phacovitrectomy, and to demonstrate the outcomes of neodymium-doped yttrium-aluminum-garnet (Nd:YAG) capsulotomy and posterior continuous curvilinear capsulorrhexis (PCCC) in the treatment of CBS. Retrospective interventional case series study. Twenty-eight patients with late postoperative CBS, comprising 13 eyes after phacoemulsification (Group A) and 15 eyes after phacovitrectomy (Group B), were analyzed. Seventeen patients with minimal (degree I), mild (II), and moderate (III) posterior capsular opacification (PCO) underwent Nd:YAG capsulotomy (Group A, 10 eyes and Group B, 7 eyes), while 11 patients with severe (degree IV) PCO underwent PCCC (Group A, 3 eyes and Group B, 8 eyes). A statistically significant postoperative improvement in best-corrected visual acuity (Group A, P= .0002 and Group B, P= .0070) and a significant postoperative decrease in aqueous flare value (Group A, P= .0077 and Group B, P= .0127) were observed. No significant differences were observed in intraocular pressure, aqueous depth, and diopters (P > .05). No surgical complications were experienced by either group. Late postoperative CBS had similar characteristics whether it developed after phacoemulsification or after phacovitrectomy. Nd:YAG capsulotomy and the PCCC technique are efficient approaches to mild and moderate PCO and severe PCO with CBS, respectively. PCCC may be a viable alternative for treating dense PCO with CBS in pseudophakic eyes.

Visual outcome and major surgical complications of extracapsular cataract extraction versus manual small-incision cataract surgery performed by resident doctors at tertiary care institute as part of learning curve

Background: Cataract surgery has its own learning curve to the resident doctors. Our resident doctors are trained in extracapsular cataract extraction (ECCE) and manual small-incision cataract surgery (MSICS). In ECCE and initial cases of MSICS, they are trained to do can-opener capsulotomy (COC) and then they are trained in continuous curvilinear capsulorrhexis (CCC). Aim: We designed a study to compare the visual outcome and major surgical complications of resident doctor performed ECCE versus MSICS at our institute. Setting and Design: This was a hospital-based study in ophthalmology department (retrospective study). Materials and Methods: A total of 239 patients with visually significant cataract presenting to our outpatient department were enrolled in the study. Data of consecutive cataract surgeries done by 10 junior residents (JRs) from March to August 2017 were analyzed. First-year residents were trained for ECCE (JR1 group) for 6 months. During the same time period, 2nd-year residents were trained for MSICS (with COC) for first 3 months (JR2 group). Then, as a part of learning curve, 2nd-year residents were then trained for MSICS (with CCC) for next 3 months (JR3 group). Data were analyzed using the Chi-square test, percentages. Results: Out of 239 cataract surgeries performed by residents over a 6-month period, ECCE were 52 (21.8%) and MSICS were 187 (78.2%) cases. Both the surgeries in MSICS (2nd-year residents) and ECCE (1st-year residents) had good visual outcome (94.6% vs. 84.6%). The overall major surgical complication rate for MSICS was 7.0% while that for ECCE was 11.5%. Conclusion: We conclude that both surgeries can be taught to beginner surgeons with good visual outcome. Both surgeries have safe learning curve with good visual results when done under supervision as evidenced by a low rate of major surgical complications.

Comparison of diathermic high-frequency capsulorhexis and continuous curvilinear capsulorrhexis in white cataract surgery.

To compare the corneal endothelial cell counts pre- and post-operation, ultrastructure of anterior lens capsule and surgical completion after diathermic high-frequency capsulorhexis (DHC) and continuous curvilinear capsulorrhexis (CCC) applied in phacoemulsification (PHACO) of white cataract surgery. Sixty-six eyes of 66 patients (33 males and 33 females) with cataract aged between 60 and 80y (mean 72.5±5.5) were recruited and undergone the surgery from June 2014 to November 2016. Anterior lens capsule, derived from two kinds of capsulorhexis, were randomly divided into two groups according to random number table. The ultrastructure of the capsule edge and its closer tissue were observed by transmission electron microscopy (TEM) and optical microscopy respectively. The surgical completion conditions and corneal endothelial cell counts were analyzed pre- and post-operation after two capsulorhexis. The capsule derived from CCC had smooth edge, well-organized cellular structure and the cells filling into the cutting edge under TEM and optical microscopy. The capsule derived from DHC had an approximate 60 banded area of cell degeneration and necrosis, with dentiform prominences at the edge of the capsule, and no cell structure was observed at this area. The corneal endothelial cell counts of both groups were slightly declined 1wk post-operation compared with that of pre-operation. There was no statistical difference between the two groups (t=1.63, P>0.05). DHC shows good clinical value in white mature and hypermature cataract surgery.

Transmission electron microscopy study of undescribed material at the anterior lens capsule in exfoliation syndrome.

In the present study, we aimed to examine the anterior lens capsule using transmission electron microscopy (TEM) and compare the findings in patients with and without exfoliation syndrome (XFS). Eighteen patients with senile cataract, including 10 with XFS, were included. Anterior capsule specimens were obtained from patients during phacoemulsification through continuous curvilinear capsulorrhexis, and were examined via TEM. In the XFS group, in addition to the typical fibrillar material above the basement membrane of the lens capsule, another unknown, microgranular, electron-dense, unbound material was observed beneath the lens epithelium. Larger formations appeared to detach from the surface of the epithelial cells, and oval or crescent-shaped structures of an electron-denser material were less commonly observed on the apical side of the epithelium. Membranous structures were occasionally attached to epithelial cells that often exhibited thicker or ruptured cell membranes on their apical-free side, along with deposits of electron-dense material. Degenerative lesions of various severities were observed at the epithelium in both groups. The anterior lens capsule epithelium in patients with XFS exhibits a highly irregular and rough margin on its free side, with unbound material over its membrane, which probably contributes to loose contact with the underlying lens and leads to different clinical behaviors in XFS eyes during cataract surgery.

Clinical results of the open ring PMMA guider assisted capsulorrhexis in cataract surgery

BackgroundTo compare the results of continuous curvilinear capsulorrhexis(CCC) after application of an open ring-shaped guider compared with a free-hand procedure in eyes with cataracts.MethodsThis study comprised patients undergoing cataract surgery in Seoul St.Mary’s Hospital, The Catholic University of Korea. Eyes were grouped depending on the capsulotomy method; CCC was performed by free-hand procedure on 94 eyes (free-hand group), and it was performed under the guidance after introduction of an open ring-shaped guider on consecutive 89 eyes (guided group). Horizontal and vertical diameter, area and circularity of capsulotomy were measured postoperatively at one day, two months and six months. Differences in parameters and the percentage of ideal capsulorrhexis were analyzed between the two groups.ResultsOn the first postoperative day, the vertical diameter in the guided group (5.24 ± 0.16 mm) was significantly longer than that of the free-hand group (5.01 ± 0.65 mm, P = 0.019). The area of capsulotomy was larger in the guided group (21.55 ± 0.87 mm2) than that of the free-hand group (20.34 ± 2.96 mm2, P < 0.001). Circularity in the guided group (0.84 ± 0.03), was significantly greater than that of the free-hand group (0.69 ± 0.17, P = 0.036). Ideal capsulorrhexis was obtained in 60 eyes (67%) in the free-hand group and 81 eyes (86%) in the guided group.ConclusionsAfter introduction of an open ring-shaped guider, CCC became larger and more circular with less anterior capsular contracture. The rate of acquiring ideal capsulorrhexis was higher in the guided group than it was in the free-hand group for six months after surgery.

Human lens epithelial cell apoptosis and epithelial to mesenchymal transition in femtosecond laser-assisted cataract surgery.

To evaluate human lens epithelium cell apoptosis and epithelial to mesenchymal transition (EMT) induced by femtosecond laser in femtosecond laser assisted cataract surgery (FLACS). Sixty cataract patients with N2 to N3 stage according to the LOCS III were enrolled in this study and divided into three groups randomly: FLACS1 group (cataract surgery by FLACS with LenSx), FLACS2 group (cataract surgery by FLACS with LensAR) and manual group (cataract surgery by phacoemulsification). Patients in two FLACS groups performed anterior capsulotomy by LenSx or LensAR laser system. Patients in the manual group were performed continuous curvilinear capsulorrhexis (CCC) manually. The anterior capsules were fixed right after moved out of eye. Hematoxylin-eosine staining, immunofluorescence staining and real-time PCR were performed in order to observe human lens epithelium cells changes after cataract surgery. The capsule cutting edge was shown irregularity and roughness in two FLACS groups and smooth edge in manual capsulotomy by pathologic staining. Irregularities of the cell configuration with partly swollen and destroyed nuclei were observed in two FLACS groups. Femtosecond laser could induce a significantly higher cell apoptosis in human lens epithelium cell than manually performed CCC (P<0.05). Lens epithelium cells apoptosis were correlated with femtosecond laser duration according to Pearson correlation analysis. Decreased N-cadherin expression, alpha-SMA and FSP-1 level in two FLACS groups showed the inhibition of cell EMT. Femtosecond laser may affect the apoptosis and EMT of lens epithelium cells which are under the peeled central lens capsule.

Corneal endothelial cell changes following Femtosecond laser - assisted cataract surgery versus phacoemulsification

The aim Is to compare the safety of femtosecond laser-assisted cataract surgery versus conventional phacoemulsification on the corneal endothelial cell changes. Method Prospective, randomized study of 30 eyes underwent femtosecond laser-assisted cataract surgery and 30 eyes underwent conventional phacoemulsification between January and September 2016 at a private ophthalmology clinic in Alexandria. Femtosecond laser-assisted cataractsurgery involved cornealincision, anteriorcapsulotomy, and lens fragmentation based on optical coherence tomography-guided treatment mapping. Conventional procedure involved manual continuous curvilinear capsulorrhexis. Both procedures were completed by means of standard phacoemulsification and insertion of an intraocular lens. Endothelial cell count was measured with a Tommy EM 3000 Specular microscope preoperatively and 1 and 3 month postoperatively. Results Central corneal thickness in femtosecond lasr assisted cataract surgery (FLACS) group was 545.87±29.045 μm, whereas in phaco group was 541.43±36.606 μm, with no statistically significant difference between the two groups preoperatively and 1 week postoperatively. Effective phacoemulsification time was reduced by 52% in the FLACS group (P Conclusions Femtosecond laser-assisted cataract surgery appears to be as safe as conventional cataract surgery regarding central corneal thickness and corneal endothelial cell count with lower effective phacoemulsification time and cumulative dissipated energy in femtosecond laser-assisted cataract surgery.

Comparing the outcome of intraocular lens implantation with or without posterior optic capture in pediatric cataract surgery

Purpose To evaluate the outcome of intraocular lens (IOL) implantation with posterior optic capture versus in-the-bag implantation in pediatric cataract surgery. Setting Ain Shams University Hospital and Research Institute of Ophthalmology. Design It is a prospective, comparative clinical study. Patients and methods Thirty eyes with developmental cataract underwent primary cataract extraction and IOL implantation of hydrophobic acrylic multipiece Sensar IOL AR40e. In all cases, anterior and posterior continuous curvilinear capsulorrhexis, lens aspiration, and anterior vitrectomy were performed. IOL was implanted in the ciliary sulcus, and the optic was captured in both anterior and posterior capsulorrhexis in group A (15 eyes) and implanted in the bag without capture in group B (15 eyes). Visual acuity, visual axis opacification, red reflex, intraocular pressure, centration, and complications were all assessed. Results The mean age of children was 5.3±2.93 years. At 6 months of follow-up, the mean postoperative corrected distant visual acuity was 0.69±0.19 and 0.65±0.23 in groups A and B, respectively. The mean clear central zone was 4.29±0.24 and 3.6±0.55 mm in groups A and B, respectively (P=0.001). The mean IOL decentration measured in mm was 1.61±1.17 and 0.86±0.28 SD in groups A and B, respectively (P=0.003). There were no postoperative complications in all cases. Conclusion Placement of IOL haptics in the ciliary sulcus while capturing the optic through the posterior continuous curvilinear capsulorrhexis provides more central clarity of the visual axis, however IOL decentration was more common.

Ultrastructural Integrity of Human Capsulotomies Created by a Thermal Device

To investigate the ultrastructural features of anterior capsulotomy performed with a thermal device, the precision pulse capsulotomy (PPC). Prospective, multicenter case series. Consecutive patients undergoing capsulotomy with the PPC device. Prospective study of patients undergoing capsulotomy with the PPC by 2 surgeons, followed up by routine phacoemulsification cataract surgery, was undertaken. All capsulotomy specimens were collected for scanning electron microscopy (SEM). Observations were made regarding uniformity of the capsular edge and the presence of irregularities that may compromise integrity. Comparisons were made with manual continuous curvilinear capsulorrhexis. Ultrastructural features of PPC and presence of irregularities. Frayed appearance of the anterior capsule edge was noted in postoperative visits under slit-lamp examination. Scanning electron microscopy sampling showed a generally uniform rolled capsular edge, but interspersed with areas of irregularity with frayed appearance at the capsule margin. The PPC device is capable of creating reproducible, central, and precise circular capsulotomy. The ultrastructural features in exvivo human capsulotomy specimens generally show eversion of the capsulotomy edge, but in some cases, this was accompanied by areas of irregular capsule margin with frayed edges, likely caused by dissipated thermal energy. The postoperative appearance and SEM features warrant further assessment of the PPC integrity and clinical correlation.