Effective Phacoemulsification Time Research Articles

Effect of femtosecond laser-assisted phacoemulsification on corneal endothelium and prognosis of diabetic patients with cataract with different nuclear hardness

Objective: To assess the impact of femtosecond laser-assisted phacoemulsification on corneal endothelial characteristics and prognosis among patients with type 2 diabetes and age-related cataracts, considering varying nuclear hardness. Methods: This non-randomized controlled trial involved 161 patients (161 eyes) with type 2 diabetes undergoing cataract extraction at Weifang Eye Hospital between March 2020 and December 2022. The cohort comprised 73 males and 88 females, with an average age of (65.9±5.23) years. Based on patient preference, 101 individuals underwent conventional phacoemulsification (group A), while 60 chose femtosecond laser-assisted phacoemulsification (group B). Patients were further stratified based on Emery-Little grade of lens nuclei into A1/B1 (grade Ⅰ and Ⅱ), A2/B2 (grade Ⅲ), and A3/B3 (grade Ⅳ) subgroups. The study compared effective phacoemulsification time (EPT), cumulative energy release of phacoemulsification (CDE), central corneal thickness (CCT), endothelial cell density (ECD), coefficient of variation (CV), and hexagon cell ratio (HEX) before and after surgery at 1 day, 1 week, 1 month, and 3 months. Results: The intraoperative EPT of patients in groups A and B were (6.52±4.93) and (5.63±4.31)s, respectively, and the CDE were 11.57%±5.21% and 10.68%±6.02%, respectively. The differences between them were not statistically significant (all P>0.05).There were no significant differences in EPT and CDE between groups A1 and B1 (all P>0.05), and there were statistically significant differences between groups A2 and B2, A3 and B3 (all P<0.05).The postoperative CCT was increased in both groups.There were no statistically significant differences in CCT between A1 and B1 groups at different time after surgery (all P>0.05), and there were statistically significant differences in CCT between A2 and B2, A3 and B3 groups at 1 day and 1 week after surgery (all P<0.05), and group B was significantly lower than group A.There was no significant difference between 1 month and 3 months after surgery (P>0.05).ECD was reduced in both groups.There was no statistically significant difference in ECD at different time of operation between A1 and B1 groups (all P>0.05), while there was statistically significant difference in ECD at 1 day, 1 week, 1 month and 3 months after operation in A2 and B2, A3 and B3 groups (all P<0.05). Group B was significantly better than group A. There was no significant difference in coefficient of variation and HEX between the two groups at different time after surgery (P>0.05). Conclusion: Femtosecond laser-assisted phacoemulsification demonstrates benefits in preserving corneal endothelial cells, reducing early postoperative corneal edema, and minimizing corneal injury in type 2 diabetes patients with cataracts of high nuclear hardness.

Comparative study of FLACS vs conventional phacoemulsification for cataract patients with high myopia.

To compare the short-term changes in cornea, retina, and choroid of femtosecond laser-assisted cataract surgery (FLACS) with conventional phacoemulsification (CPS) in high myopia patients with cataract. Affiliated Hospital of Nantong University, Jiangsu Province, China. Prospective single-center study. Demographics, ocular clinical features, ultrasound power, absolute phacoemulsification time, and effective phacoemulsification time were recorded for each patient. Endothelial cell density (ECD), central corneal thickness (CCT), corrected distance visual acuity (CDVA), intraocular pressure (IOP), center foveal thickness (CFT), subfoveal choroidal thickness (SFCT), and choroidal vascularity index (CVI) were evaluated preoperatively and at 1 week, 1 month, and 3 months postoperatively. Intraoperative parameters and intraoperative/postoperative complications were recorded. 97 eyes (46 eyes and 51 eyes in the FLACS and CPS groups, respectively) were included and analyzed. Effective phacoemulsification time was lower in the FLACS group compared with the CPS group ( P < .05). The increase in CCT was significantly lower in the FLACS group compared with the CPS group at 1 week and 1 month ( P < .05). CDVA and IOP were similar in both groups at the final visit ( P > .05). The ECD decreased was lower among CPS patients compared with FLACS patients. CFT, SFCT, and CVI increase in both groups but were increased more in the CPS group with high myopia patients. No serious complications occurred in either group. FLACS is a more safety and effective in cataract patients with high myopia. It has advantages in effectively reducing EPT and promoting faster recovery of the cornea, macular, and choroidal thickness.

Systematic and objective wet-lab testing of instruments for phacoemulsification: new Formalin Quadrant Model.

To validate an improved wet-lab model for systematic and objective efficiency testing of instruments for phacoemulsification. Institute of Medical Engineering, Lucerne University of Applied Sciences and Arts, Lucerne, Switzerland. Experimental study. Porcine lenses were incubated for different time spans in formalin to simulate different cataract densities. Lenses were cut in quadrants and emulsified in a silicone test chamber. The use of ultrasound was restricted to full occlusion and the minimal power needed to promote emulsification. Equivalence to the surgical situation and cataract consistency were judged by an experienced surgeon. Efficiency was rated by effective phacoemulsification time, liquid consumption, and total surgery time. Formalin incubation times of 2 hours, 1.25 hours, and 0.5 hours were validated for hard, middle-hard, and soft cataracts, respectively. Systematic testing of different fluidics settings revealed the unique opportunities of the improved model: Experiments could be performed by laboratory staff without any surgical experience after a short training, and the model provided results in a fast and reproducible manner. Reduced effective phacoemulsification time, shorter total surgery time, and less liquid consumption were observed with higher fluidics settings, confirming and complementing earlier clinical findings. The Formalin Quadrant Model can be used to test new designs of instrumentation on different cataract densities or various instrument settings for efficiency. Using a validated cataract substitute, it closely represents the clinical situation and thus renders valid results in a short time. Instruments can be tested and improved profoundly before costly and elaborate clinical trials have to be applied.

Changes in endothelial cell density after conventional phacoemulsification and FLACS in eyes with dense cataracts.

To compare the safety, effectiveness, and changes in endothelial cell density (ECD) after standard phacoemulsification and femtosecond laser-assisted cataract surgery (FLACS) in dense cataracts (Lens Opacities Classification System III grade 3.0 NO and above). Nethradhama Superspeciality Eye Hospital, Bangalore, India. Prospective, randomized, comparative study. 100 eyes of 100 patients were randomly assigned to either conventional phacoemulsification surgery (CPS) or FLACS (LENSAR Laser System) using predefined patterns of nuclear fragmentations. Measured outcomes included intraoperative phacoemulsification time, irrigation fluid volume, surgical time, and complication rates. ECD was evaluated at baseline, 2 weeks, and 6 months postoperatively. The CPS group had significantly higher mean total phacoemulsification time (11.17 ± 6.5 seconds vs 8.03 ± 3.77 seconds), effective phacoemulsification time (6.14 ± 3.62 seconds vs 4.42 ± 2.07 seconds), and total surgical time (8.18 ± 2.36 minutes vs 7.11 ± 1.55 minutes) than the FLACS group ( P < .001). Volume of irrigation fluid was comparable between the 2 groups (CPS, 36.7 ± 12.18 mL; FLACS, 38.64 ± 13.73 mL ( P = .45). Mean corneal edema score and central corneal thickness values on postoperative day 1 were significantly higher for the CPS group. At 6 months, % ECD loss was significantly higher in the CPS group (16.08%) vs the FLACS group (12.8%) ( P < .001). 3 eyes in the CPS group had wound burns of varying severity. FLACS with customized nuclear fragmentation patterns resulted in significantly less intraoperative phacoemulsification time, surgical time, and endothelial cell loss compared with conventional phacoemulsification when treating dense cataracts. CTRI/2021/12/038887.

Femtofakoemulsyfikacja zaćmy – 10 lat doświadczeń

Femtosecond laser-assisted cataract surgery is a procedure known for more than a decade. The review compares this surgical technique with conventional cataract phacoemulsification – the most frequently performed operation of this type. The review took into account metanalysis, clinical trials and reports from the last 10 years to evaluate several aspects, including intraoperative parameters, surgical complications and advantages for patients. Femtosecond laser-assisted cataract surgery is the method with less effective phacoemulsification time, cumulative dissipate energy and better intraocular lens centration. Reduction of aberrations in presbyopia correcting intraocular lens is also noticeable. Best uncorrected and corrected visual acuity and postoperative predicted refraction are similar in both groups of patients. Surgical complications are comparable as well. Noteworthy is the fact that patients with hard nuclear cataracts have smaller endothelial cell loss. The results for low and medium severity of cataracts are mostly the same in laser-assisted surgery versus phacoemulsification. Femtosecond laser-assisted cataract surgery is a new solution for patients with low endothelial density or endothelial dystrophy, especially in advanced cataracts. The procedure is also recommended for surgery with presbyopia-correcting lens implantation due to better centration and smaller ocular aberrations. This whole new surgical technique requires greater financial outlay but provides some improvements in cataract surgery

The Effects of Uneventful Phacoemulsification on Subfoveal Choroidal Thickness.

To evaluate the impacts of phacoemulsification preoperative and intraoperative factors on postoperative subfoveal choroidal thickness (SFCT). This prospective interventional study was conducted on patients undergoing uneventful phacoemulsification with posterior chamber intraocular lens (IOL) implantation at the private clinic Ophthalmica Eye Institute, in Thessaloniki, Greece. Forty-six eyes of 46 patients were included in the study. Operative time (OT), phacoemulsification time (PT), effective phacoemulsification time (EPT) and phacoemulsification power (PP) were recorded for each patient. All patients received dexamethasone and nepafenac drops for 4weeks postoperatively. Choroidal thickness (CT) at five anatomical locations was measured preoperatively and at 1week, 1month and 3months postoperatively. Subfoveal choroidal thickness significantly increased over baseline thickness at 1week postoperatively, returned to preoperative levels at 1month and increased again at 3months. Changes at 1week and 3months postoperatively correlated to baseline choroidal thickness (p = 0.023 and p = 0.011, respectively). Spherical equivalent (SE) inversely correlated to SFCT throughout the entire follow-up period (baseline p = 0.044, 1-week p = 0.011, 1-month p = 0.013, 3-month p = 0.018). EPT was the most significant determinant of increased SFCT at all time points (1-week p = 0.011, 1-month p = 0.01, 3-month p = 0.015). PT and PP significantly correlated to the SFCT increase at 3months postoperatively (p = 0.033 and p = 0.043, respectively). OT was not associated with a change in SFCT at any time point (p > 0.05). Phacoemulsification can alter choroidal thickness until at least 3months after surgery. Preoperative and intraoperative factors, notably SE, baseline SFCT, PT, PP and especially EPT, can influence postoperative CT increase.

Evaluation of structural and vascular changes in the choroid after uneventful phacoemulsification surgery.

Objective: The aim of this study was to evaluate structural and vascular changes in the choroid after phacoemulsification surgery. Methods: This research comprised 50 eyes of 50 individuals who received uneventful surgical treatment for cataracts. Intraocular pressure, axial length, subfoveal choroidal thickness, and choroidal thickness in the nasal and temporal areas at 1,500-micron distance from the fovea were measured before surgery and at one and three months after surgery. At the same evaluation times, the choroidal luminal area and choroidal stromal area were calculated with the binarization method using image J software, and the choroidal vascular index (CVI) was calculated by dividing the luminal area by the total area. In addition, total surgery time and effective phacoemulsification time were recorded. Results: The patients had a mean age of 64.7 ± 8.5 years. The mean total operative time was 13.9 ± 3.8 minutes, and the mean effective phacoemulsification time was 3.8 ± 2.1 minutes. The mean intraocular pressure value was 14.4 ± 3.4 mmHg before surgery, and 13.2 ± 2.9 mmHg at the first month and 13.0 ± 2.1 mmHg at the third month postoperatively. Although there was a decrease in the intraocular pressure after surgery, no significant difference was found (p>0.05 for all). The axial length measured during the first and third months postoperatively did not significantly differ from the evaluation undertaken preoperatively (p>0.05 for all). A significant increase was detected in the subfoveal, nasal, and temporal choroidal thicknesses at the first postoperative month compared to the preoperative values (p<0.05), but no significant difference was found at the third month postoperatively (p>0.05). The mean CVI was 61.6 ± 3.5% preoperatively, 65.2 ± 4.2% at the first postoperative month, and 65.9 ± 3.9% at the third postoperative month. The increase at the first and third postoperative months was significant when compared to the evaluation made preoperatively (p=0.004 and p<0.001, respectively). Conclusion: Structural and vascular choroidal changes in the after-cataract surgery are important. In this study, it was observed that after uneventful phacoemulsification, the choroidal thickness increased at the first postoperative month and reached the preoperative values at the third month. It was also determined that CVI increased at the first and third postoperative months. CVI can offer an idea about whether cataract surgery is a predisposing factor in diseases involving the choroid. Abbreviations: CVI = choroidal vascular index.

Effect of Nondominant Left-Handed Phacoemulsification Surgery on Corneal Endothelium.

To evaluate the effect of phacoemulsification surgery performed with the nondominant left hand on the corneal endothelium. The study included 160 patients who were followed up for at least six months after uneventful cataract surgery. Seventy-seven patients who underwent nondominant left-handed phacoemulsification were evaluated as Group 1 and 83patients who underwent dominant right-handed phacoemulsification were evaluated as Group 2. In all the patients, preoperative axial length (AL), aqueous depth (AD), anterior chamber depth (ACD), and lens thickness (LT) were evaluated. All phacoemulsification procedures were undertaken with the same device by two surgeons using the same technique, and the intraoperative cumulative dissipated energy (CDE) value, effective phacoemulsification time, and total operative time were recorded. Corneal endothelial cell density (ECD), coefficient of variation (CV) percentage, hexagonal cell percentage (HCP), and central corneal thickness (CCT) measurements were evaluated by specular microscopy preoperatively and at the postoperative first and sixth months. The two groups had a similar age and gender distribution and did not significantly differ in terms of the preoperative AL, AD, ACD, LT, intraoperative CDE, effective phacoemulsification time, and total operative time with similar age and gender distribution (p > 0.05 for all). The preoperative and postoperative first- and sixth-month specular microscopy measurements of ECD, CV, HCP, and CCT ​​were also similar in the groups (p > 0.05 for all). In this study, it was observed that nondominant left-handed phacoemulsification resulted in similar changes in endothelial cell count and morphology to those obtained from dominant-handed phacoemulsification.

Efficacy of a new fragmentation pattern in femtosecond laser-assisted cataract surgery with the Ziemer FEMTO LDV Z8.

To determine the efficacy of different fragmentation patterns in femtosecond laser-assisted cataract surgery (FLACS) using Ziemer FEMTO LDV Z8. We compared three different types of surgery: conventional cataract surgery (CCS), FLACS with conventional radial slices (named No-Spiderweb), and FLACS with a novel fragmentation pattern (radial slices combined with one or two rings) called "Spiderweb." Visual acuity (VA), nuclear opacity (NO) according to the Lens Opacities Classification System (LOCS lll), effective phacoemulsification time (EPT) and vacuum time were obtained for 845 eyes. Using FLACS (Spiderweb + No-Spiderweb), EPT was significantly reduced by 26% compared to CCS (FLACS: 2.46 ± 2.60s; CCS: 3.34 ± 2.89s; ΔM = - 0.88s, p < .001). Furthermore, EPT as a function of progression of lens opacity was found to be not only lower in Spiderweb compared to CCS, but also in comparison with No-Spiderweb. At NO3, a significant reduction of 65% in EPT was observed by using Spiderweb compared to CCS (Spiderweb:0.68 ± 1.23 s; CCS: 1.96 ± 1.53 s; ΔM = - 1.28 s, p <.001). Interestingly, EPT at NO3 was also significantly reduced by 57% in Spiderweb compared to No-Spiderweb (Spiderweb:0.68 ± 1.23 s; No-Spiderweb: 1.57 ± 1 .59 s; ΔM = - 0.90 s, p <.001). The use of Spiderweb only marginally extends the vacuum time compared to No-Spiderweb by 11s (Spiderweb:209.13 ± 35.83s; No-Spiderweb: 198.35 ± 36.84s; p = .003) and the postoperative improved VA showed no significant difference among the different types of surgery (all ps ≥ .05). FLACS significantly reduces EPT compared to CCS. Furthermore, the novel Spiderweb pattern significantly reduces EPT in patients with a cataract of NO3 compared to CCS, but also to FLACS with the existing radial pattern (No-Spiderweb).

Real-time corneal thickness changes during phacoemulsification cataract surgery.

To observe the changes in corneal thickness during phacoemulsification cataract surgery and to analyze the influencing factors. One hundred two patients (102 eyes) with cataracts undergoing phacoemulsification cataract surgery at Shandong Eye Hospital between July and October 2021 were included. Intraoperative OCT was applied to capture real-time images preoperatively, before and after ultrasonic emulsification, at the end of irrigation aspiration and the end of surgery. Then, the corneal thickness at the above time points was measured using Photoshop software. The corneal thickness of 102 cataract patients was 511.79 ± 31.46μm before operation and 512.71 ± 31.51μm at the beginning of phacoemulsification, which increased by 0.91 ± 1.48μm (0.2%). At the end of ultrasonic emulsification, the corneal thickness was 521.58 ± 32.75μm and 8.87 ± 8.71μm (1.7%) thicker than that before the procedure. After irrigation aspiration, the corneal thickness reached 528.09 ± 33.87μm, which increased by 6.52 ± 6.38μm (1.3%) compared with that of the previous step. At the end of the operation, the corneal thickness was 539.19 ± 33.88μm, 11.09 ± 10.92μm, and 27.37 ± 13.64μm thicker than that of the previous step and the preoperative thickness, respectively, with an overall increase of 5.3%. The differences were statistically significant at all time points (all P < 0.001). Correlation analysis showed that postoperative corneal thickness changes were correlated with age, cataract lens nuclear grade, actual phacoemulsification time (APT), effective phacoemulsification time (EPT), average phacoemulsification energy (APE), total surgery time (TST), cell density (CD), maximum cell area (MAX), and cell area standard deviation (SD) (all P < 0.05), while the changes in thickness were not correlated with gender, cell area coefficient of variation (CV), percentage of hexagonal cells (6A), average cell area (AVE), or minimum cell area (MIN) (all P > 0.05). During phacoemulsification cataract surgery, corneal thickness gradually increases in real time with the increase of perfusion pressure and intraocular manipulation time. The real-time magnitude of intraoperative corneal thickness change is closely related to lens nucleus hardness, corneal endothelial cell density, ultrasound energy, and time for emulsification.

Early OCT Angiography Variations in Macular and Peripapillary Area after Uncomplicated Cataract Surgery and Correlation with Intraoperative Parameters

Background: We evaluated changes in both macular and peripapillary vascular parameters, evaluated by OCT angiography (OCTA), after uncomplicated cataract surgery, as well as the influence of effective phacoemulsification time (EPT) and cumulative dissipated energy (CDE). Methods: This is prospective study on 130 eyes of 65 individuals who underwent unilateral phacoemulsification, with fellow eyes data taken as control group. We collected cataract grading, EPT and CDE. Best corrected visual acuity (BCVA), superficial vessel density, deep vessel density, foveal avascular zone (FAZ) parameters and peripapillary capillary density were measured at baseline, one week and one month following surgery. Results: When compared to baseline, there was a significant increase in both superficial and deep foveal density at last follow up (from 42.9 ± 4.2 and 37.3 ± 7.4 to 45.6 ± 5.4 and 43.7 ± 9.0%, p = 0.002 and p = 0.0001, respectively). Both foveal avascular zone’s area and perimeter showed a significant decrease compared to the preoperative value (p &lt; 0.05). On the other hand, peripapillary vascular density showed a significant increase at week one (from 49.6 ± 2.7 to 51.4 ± 4.6%, p = 0.01), which returned to preoperative values at last follow up (49.3 ± 4.0%, p = 0.95). We found no significant differences when dividing the cohort for cataract severity. Moreover, no significant effect of the EPT and CDE on vascular changes were reported. Conclusions: We found a significant increase in the vascular parameters of the macular area after cataract surgery, while peripapillary vascular density only experienced a transient increase, suggesting an adaptative metabolic mechanism in response to increased light exposure after surgery.

Changes in the peripapillary vasculature and macular thickness after cataract surgery using two phacoemulsification systems with optical coherence tomography angiography.

To assess the changes in the peripapillary vasculature and macular thickness after cataract surgery using two phacoemulsification systems with optical coherence tomography angiography (OCTA). Fifty-two eyes of 52 patients with age-related cataract were randomized into two groups for phacoemulsification: Infiniti group (26 patients) using the Infiniti phacoemulsification system with gravity-fluidics and Centurion group (26 patients) using the Centurion phacoemulsification system with active-fluidics. The peripapillary vessel density (PVD) and macular thickness were examined using OCTA at baseline and at 1d, 1 and 3mo after cataract surgery. In the Infiniti group, the PVD was significantly reduced at 1d after the cataract surgery (P<0.001). However, the retinal nerve fiber layer (RNFL) thickness showed no significant change during the follow-up. Change in PVD 1d postoperatively was significantly negatively correlated to the cumulative dissipated energy (CDE), estimated fluid usage (EFU), effective phacoemulsification time (EPT), intraocular pressure (IOP), and total operating time (TOT; P<0.05). The macular thickness was significantly increased in all regions after the cataract surgery (P<0.05). However, no significant changes were found in the macular vessel density (VD) during the follow-up (P>0.05). In the Centurion group, the VD and thickness in the optic papilla and macula did not significantly change in all regions during the follow-up (all P>0.05). The best-corrected visual acuity (BCVA) significantly improved in both groups postoperatively (P<0.001). Using the Infiniti phacoemulsification system, OCTA provides a promising analysis of retinal vascular alterations, demonstrating a reduction of the PVD and an increase in the macular thickness. The Centurion phacoemulsification system can provide better retinal vasculature preservation during cataract surgery.

Long-Term Variations in Retinal Parameters after Uncomplicated Cataract Surgery.

Background: Cataract phacoemulsification surgery provides excellent refractive results; however, it also elicits changes in the posterior segment of the eye. This study aimed to determine changes in retinal parameters measured by spectral-domain optical coherence tomography (SD-OCT) and OCT angiography (OCTA) after an uncomplicated cataract surgery, including the impact of effective phacoemulsification time (EPT). Methods: The study included 44 patients without retinal abnormalities, followed up after unilateral uncomplicated cataract phacoemulsification in a single ophthalmological unit. Patients were evaluated for the following parameters at baseline and at 2 weeks, 3 months, and 12 months after the surgery: best corrected visual acuity, central retinal thickness (CRT), average central retinal thickness (CRTA), central retinal volume (cube volume (CV)), vessel density central (VDC), vessel density full (VDF), vessel perfusion central (VPC), and vessel perfusion full (VPF). The EPT recorded at each procedure was used as a covariant for the evaluation of changes in retinal parameters after the surgery. Analysis included 44 eyes for SD-OCT and 17 for OCTA evaluation, according to adopted scan quality thresholds. Results: A significant increase in CRT, CRTA, and CV was noted at each follow-up point compared with baseline. The rising tendency was observed in the first 3 months after the surgery, with a decline over the subsequent months. The VPF parameter showed a stable improvement after the surgery. The analysis of covariance did not confirm any significant effect of the EPT on variations in CRT, CV, CRTA, VDC, and VPF and there was a weak effect on the VDF parameter. Conclusions: Uncomplicated cataract surgery results in an increase in retinal thickness and volume in the first few months after the surgery, followed by a spontaneous decline in these parameters in the subsequent months. A long-standing improvement is noted in the VPF parameter.

Comparison of clinical outcomes between cystotome-assisted prechop phacoemulsification surgery and femtosecond laser-assisted cataract surgery for hard nucleus cataracts.

To compare the safety and efficacy of cystotome-assisted prechop phacoemulsification surgery (CAPPS) and femtosecond laser-assisted cataract surgery (FLACS) in patients with hard nucleus cataract. Ninety-six eyes of 64 patients with grade IV hard nucleus cataract were assigned to 1 of the 2 groups (49 CAPPS and 47 FLACS). Follow-up visits were performed at 1 day, 1 week, 1 month, 3 months, 6 months, and 1 year, and the outcome measures comprised ultrasound power, effective phacoemulsification time (EPT), corrected distance visual acuity (CDVA), endothelial cell density (ECD), corneal endothelium cell loss rate (ECL), central corneal thickness (CCT), and intraoperative and postoperative complications. The ultrasound power and EPT were lower in the CAPPS group (p = 0.03 and <0.0001, respectively). Patients in both groups gained better CDVA postoperatively. The ECD value decreased at each follow-up visit and did not return to the preoperative level; FLACS resulted in greater endothelial cell loss compared to CAPPS. CCT increased immediately after the surgery and decreased thereafter. The mean CCT value returned to the preoperative level 3 months postoperatively in the CAPPS group, while in the FLACS group, CCT value took 6 months to return to the preoperative level. Miosis was more likely to occur in the FLACS group. Due to its efficacy and cost-effectiveness, CAPPS is worth promoting and applying to clinical work in the future.

Comparative evaluation of modified crater (endonucleation) chop and conventional crater chop techniques during phacoemulsification of hard nuclear cataracts: A randomized study.

Purpose:To compare the clinical outcomes of endonucleation chop (EC) versus conventional crater (CC) chop techniques in phacoemulsification of hard nuclear cataracts.Methods:In this Prospective, longitudinal, randomized controlled study with double-blinding. Hundred consecutive eyes with uncomplicated cataracts (nucleus grades 3 and 4) were equally divided into Group A (EC) and Group B (CC). Intraoperative effective phacoemulsification time (EPT) and balanced salt solution (BSS) volume used was noted. Postoperative central corneal thickness (CCT), endothelial cell density (ECD), uncorrected Visual Acuity (UCVA), best-corrected visual acuity (BCVA), and IOP were recorded at days 1, 7, 30, and 90 postoperatively. The Chi-square test (categorical data), Mann–Whitney U test, and t-tests for other parameters were done.Results:The mean EPT in Groups A and B were 6.6 and 14.25 s, respectively (P < 0.001). The BSS volume used was 105.9 and 221.7 mL, respectively (P < 0.001). At 3 months, the ECD loss was 4.35 and 8.6%, respectively (P = 0.025). The-first day CCT was significantly increased in Group B but was the same in both groups at 3 months. A significant improvement in BCVA was noted in both groups. This new technique significantly reduces EPT, the BSS used, and ECD loss.Conclusion:Compared with the CC chop technique, the EC technique for phacoemulsification of hard nuclear cataracts conserved phacoemulsification energy and minimized exposure to the intraocular irrigating solution, provided a significant reduction in corneal endothelial damage, and led to faster visual rehabilitation.

Comparison of effective phacoemulsification time and corneal endothelial cell loss using three different ultrasound frequencies: A randomized controlled trial.

Purpose:Comparison of three ultrasound (US) frequencies for phacoemulsification of hard cataracts to determine a frequency that makes phacoemulsification more efficacious and safer.Methods:A randomized controlled trial was undertaken at a medical college and hospital. In total, 207 patients with grade 5.6–6.9 (LOCS III) senile cataract were randomized into three groups. Group I underwent phacoemulsification with 28-kHz frequency, group II with 42-kHz frequency, and group III with 53-kHz frequency. The effective phacoemulsification time (EPT) and estimated fluid usage (EFU) were compared intraoperatively. The endothelial cell parameters were analyzed for 6 months.Results:The groups were matched for age (P = 0.467), gender (P = 0.497), nuclear grade (P = 0.321), and anterior chamber depth (P = 0.635). The EPT and EFU were significantly lower in group III, compared to group II and group I, with P < 0.0001 and P < 0.0001, respectively. Postoperatively, the endothelial cell density (ECD) was significantly higher in group III at 1 month (P < 0.0001), 3 months (P < 0.0001), and 6 months (P < 0.0001). The percentages of ECD loss were also significantly lower in group III; the difference was statistically significant (P < 0.0001) up to 6 months postoperativelyConclusion:Higher frequency ultrasound was associated with a lower EPT and EFU as well as better endothelial preservation than lower frequencies in hard cataracts.

Pain control and reduction of opioid use associated with intracameral phenylephrine1.0%-ketorolac 0.3% administered during cataract surgery.

Purpose:To compare pain and the need for the opioid fentanyl use associated with the administration of phenylephrine 1.0%–ketorolac 0.3% (P/K) with those of epinephrine administration during cataract surgery.Setting:Ambulatory surgery center.Design:Single-center, prospective, randomized, double-masked, self-controlled trial.Methods:Patients undergoing bilateral, topical anesthetic cataract surgery were randomized to receive either intracameral P/K or epinephrine in their balanced salt solution for the first eye and the other for the second eye, 2 weeks later. Fentanyl was used to manage intraoperative pain. The primary end point was the need for fentanyl administration intraoperatively. Secondary outcomes included pain measurements; surgery duration; effective phacoemulsification time; pupil size; and complications.Results:112 eyes of 56 patients were enrolled. Significantly fewer eyes in the P/K group (7 [12.5%]) than in the epinephrine group (19 [33.9%]; P = .013) required intraoperative fentanyl administration. Mean pain scores were lower in the P/K group than those in the control group at all timepoints. For patients with no pain to mild pain (pain scores ≤ 3), 85.7% (n = 48) of the P/K group and 58.9% (n = 33) of the epinephrine group met this benchmark (P = .003) intraoperatively. The combined outcome, the number of patients not receiving intravenous fentanyl and experiencing no pain to mild pain, was significantly higher in the study (82.1%, n = 46) than in the control group (58.9%, n = 33; P = .013).Conclusions:P/K administration significantly reduced pain and the need for fentanyl use. Using P/K is a practical way for cataract surgeons to provide better patient care and reduce the need for intraoperative opioids.

Comparison of the IOLMaster 700 and the Pentacam in the Analysis of the Lens Nuclear Density Before the Cataract Surgery.

Purpose: To evaluate the difference of the lens nuclear density measured before and after mydriasis by using the IOLMaster 700 (Carl Zeiss Meditec AG, Jena, Germany) and the Pentacam Scheimpflug imaging (Pentacam HR, Oculus Incorporation, Wetzlar, Germany) and investigate the relationship between the measurement data and the phacoemulsification parameters.Methods: Patients with age-related nuclear cataracts diagnosed on the slit-lamp examination were enrolled in the age range of 53–76 years. No patient had a history of ocular surgery, laser treatment, or general disorders affecting vision. The mean optical density (OD) was measured by the IOLMaster 700 by using the Image-Pro® Plus software before and after mydriasis. The Pentacam nucleus densitometry (PND) was obtained automatically from the Pentacam Scheimpflug imaging and compared with OD. The correlation between OD and effective phacoemulsification time (EPT), PND, and EPT were analyzed, respectively.Results: In this study, 53 eyes of 52 patients were evaluated. Before and after mydriasis, the mean OD values were 64.34 ± 23.31 and 63.81 ± 23.21 pixel units, respectively; the mean PND values were 28.51 ± 11.42 and 25.41 ± 11.31, respectively; and the mean EPT value was 6.24 ± 3.49. The Bland–Altman analysis showed that the lens nuclear densities of the two devices were highly consistent. There was no significant difference in the OD values (t = 0.455, p > 0.05) before and after mydriasis, but the difference has existed in the PND values (t = 2.509, p < 0.05). The OD and PND values were positively correlated with EPT before and after mydriasis (rOD−Before = 0.604, rOD−After = 0.593, rPND−Before = 0.701, and rPND−After = 0.891, p < 0.01).Conclusion: The combination of the IOLMaster 700 and the Image-Pro® Plus software can quantitatively evaluate the degree of the cataract lens opacification. It has good consistency with the Pentacam and is positively correlated with the phacoemulsification parameters. It is expected to become a new method to predict the phacoemulsification parameters before and during cataract surgery.

Ultrasound energy consumption and macular changes with manual and femtolaser-assisted high-fluidics cataract surgery: a prospective randomized comparison.

PurposeThe purpose of the study was to compare ultrasound (US) consumption and central macular thickness (CMT) and volume changes with manual and femtosecond laser (FSL)‐assisted cataract nucleus workup.MethodsSixty patients scheduled for immediate sequential bilateral surgery underwent a prospective randomized intraindividual comparison of nucleus sector fragmentation performed manually in one eye and with low‐energy FSL assistance in the partner eye, followed by high‐fluidics phacoaspiration with a maximum US power of 30%. Ultrasound (US) energy consumption and macular thickness and volume were compared as measured by intraoperative effective phacoemulsification time (EPT) and high‐resolution spectral domain optical coherence tomography pre‐ and 1 week, 3 weeks and 6 weeks postoperatively. Results are presented as means ± SD or medians [min; max].ResultsFifty‐two patients completed the full follow‐up. For the manual and FSL‐assisted groups, nuclear hardness was almost identical with a mean LOCS III grade of 2.44 ± 1.08 and 2.50 ± 1.00 (p = 0.371). Median EPT was 1.40 [0.2; 8.3] and 1.25 [0.2; 9.4] seconds. Median preoperative CMT was 276.50 [263.25; 289.75] µm and 276.00 [262.00; 290.00] µm. Median postoperative CMT was 278.00 [260.50; 288.00] versus 275.50 [264.00; 290.50] µm at 1 week, 279.50 [266.75; 292.25] versus 280.00 [266.50; 294.50] µm at 3 weeks and 280.50 [268.00, 293.75] versus 279.50 [264.75; 295.25] µm at 6 weeks. Differences in CMT and total macular volume between the groups were not statistically significant at any point in time.ConclusionFemtosecond laser (FSL) prefragmentation of the nucleus into six sectors did not reduce US energy consumption compared with manual splitting of the nucleus into four quadrants in this particular surgical setting. Sectorial FSL‐prechopping with the low‐energy FSL used had no additional impact on postoperative macular thickness and volume.

Randomized Controlled Trial Comparing Femtosecond Laser-Assisted with Conventional Phacoemulsification on Dense Cataracts

To compare the benefit of femtosecond laser-assisted cataract surgery (FLACS) versus phacoemulsification (PE) and 2 fragmentation patterns in managing dense cataracts. Randomized controlled trial. Patients with nuclear opacity (NO) grade >5 (Lens Opacities Classification System III) were enrolled at the Singapore National Eye Centre. Patients who were unsuitable for FLACS, whose corneal endothelial cell count (ECC) was <1,500 cells/mm2, or had cataracts with additional complexities were excluded from the study. Eyes were randomized to PE, 600μm grid (FLACSg), or 16-segment fragmentation (FLACS16) in 2:1:1 ratio. The Victus (Bausch & Lomb) laser platform and insitu phacoemulsification chop technique was used. Data for patient demographics, preoperative, and 1month postoperative best-corrected visual acuity (BCVA), ECC, effective phacoemulsification time (EPT), and perioperative complications were collected. Outcome measurements were the loss of ECC at 1month and EPT. Ninety-three patients were randomized to PE (48), FLACSg (22), and FLACS16 (23). Majority were Chinese (87; 93.5%). Mean age was 74.3 ± 8.8 years of age. Cataracts were mostly graded as NO 5-6 (49; 61.3%). EPT among treatment arms was not different (P= .097, one-way ANOVA) but was significantly higher for NO >6 than NO <6 (P < .001, general linear model). ECC loss was significantly less in FLACSg than in PE (P= .018, Bonferroni correction). Mean 1-month postoperative LogMAR BCVA (0.23 ± 0.20) was significantly better than preoperative BCVA (1.02 ± 0.85; P < .001, paired t test) but not different between PE and FLACS. FLACSg but not FLACS16 significantly lowered the mean ECC loss during phacoemulsification in dense cataracts.