Extracapsular Cataract Surgery Research Articles

Corneal Endothelial Changes Following Anterior Chamber Intraocular Lens Implantation in Extracapsular Cataract Surgery

Aim: To determine & quantify corneal endothelial changes after primary or secondary implantation of anterior chamber intraocular lenses (AC IOLs) in extracapsular cataract surgery complicated by loss of capsule support. Setting: Ibn Al- Heythem teaching eye hospital, Baghdad. Patients & Methods: This prospective study comprised 125 patients underwent extracapsular cataract surgery complicated by loss of capsular support. Of them 76 patients had primary implantation of open-loop AC IOLs. The other 49 patients were kept aphakic after similar complicated cataract surgery & had secondary AC IOL implantation (open-loop), this was performed 10 weeks to 2 years from initial cataract surgery. At least 2 weeks post AC IOL implantation, non-contact specular microscopy was performed at the center of the cornea for eyes with primary & secondary AC IOLs implantation, their fellow eyes (phakic or pseudophakic with posterior chamber PC IOL) taken as control. Results: The mean endothelial cell density (ECD) was significantly lower in eyes with primary or secondary AC IOL implantation than in unoperated phakic eyes. Patients with primary AC IOL implantation in 1 eye & PC IOL implantation in fellow eye had a difference in ECD that was not statistically significant. The ECD difference was significantly greater in eyes with secondary AC IOL implantation compared to fellow pseudophakic eyes (PC IOL). The coefficient of variation (CV) in cell size & percentages of hexagonality showed no significant changes in the various groups. Conclusion: AC IOL implantation didn't appear to alter corneal endothelial function. Results indicate that endothelial cell loss was related to surgical trauma rather than the presence of AC IOL.

Epithelial ingrowth after extracapsular cataract surgery

Epithelial ingrowth after extracapsular cataract surgery

"Partial Open Sky Method" - A novel technique to avoid the open sky condition during Triple procedure or Penetrating keratoplasty.

Penetrating keratoplasty is referred to as an "open-sky" procedure because the intraocular contents are entirely exposed to atmospheric pressure after the diseased cornea has been trephined off and before the donor button is sutured. Suprachoroidal hemorrhage (SCH) is a major vision-threatening complication, associated with this open-sky procedure. While numerous factors may predispose an eye to SCH, like hypertension, myopia, trauma, glaucoma, etc., it is better to be prepared for the worst eventuality. We described a novel technical modification, denoted as the "partial open sky technique", that we used during the surgical steps of trephining and excision of host corneal tissue in seven cases of triple procedure and penetrating keratoplasty in our center over two months. We propose that the technique would be additionally helpful in managing the inadvertent suprachoroidal hemorrhage associated with keratoplasty over the available existing methods. Abbreviations: SCH = Suprachoroidal hemorrhage, ICCE = Intracapsular cataract surgery, ECCE = Extracapsular cataract surgery, WTW = White to White.

Rotating the Intraocular Lens to Prevent Posterior Capsular Opacification in Cataract Surgeries.

Posterior capsule opacification (PCO) is a common postoperative complication of extracapsular cataract surgery, which is caused by the proliferation and migration of lens epithelial cells and can affect long-term visual outcomes significantly. The most effective treatment for PCO is neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy; however, this treatment is associated with posterior segment complication and can break the stability of capsular bag, affecting the position and function of trifocal or toric intraocular lenses (IOLs). Advances in surgical procedures, IOL design, and pharmacy have reduced the rate of PCO in recent years, concentrating on the inhibition of proliferative lens epithelial cells (LECs). This protocol aimed to clear LECs more thoroughly during phacoemulsification and IOL implantation. The first several steps, including clear corneal incision, continuous circular capsulorhexis, hydrodissection, hydrodelineation, and phacoemulsification, were completed as conventional procedures. After placing the IOL into the capsular bag, rotation of the IOL by at least 360° was performed using an irrigation/aspiration tip or a hook, with slight stress on the posterior capsule. Some residuals occurred in the originally transparent capsular bag after rotation of the IOLs. Then, these materials and the viscoelastic were cleared completely using an irrigation/aspiration system. A clear posterior capsule was observed after the surgery in patients undergoing this method. This method of rotating IOLs is a simple, effective, and safe way to prevent PCO by clearing residual LECs and can be carried out without extra tools or skills.

Evolution of manual small-incision cataract surgery from 8 mm to 2 mm - A comprehensive review.

Cataract is the most common cause of reversible blindness worldwide, accounting for approximately 50% of blindness worldwide. Cataract surgery is the most common surgical procedure performed in routine ophthalmic practice. It has undergone tremendous evolution, and the incision size has progressively reduced from 10-12 mm in extracapsular cataract surgery (ECCE) to 6-8 mm for manual small-incision cataract surgery (MSICS) and 2.2-2.8 mm in phacoemulsification. In a developing country like India, with a massive backlog of cataract, everyone cannot afford private surgery like phacoemulsification. Moreover, annual maintenance of the machine, cost of foldable IOLs, need for greater skill, learning curve, and difficulty in performing the surgery in mature and brown cataracts are other barriers. Due to these factors, MSICS is the surgery of choice in the developing world, with profound societal and economic benefits and similar visual recovery compared to phacoemulsification. During the last two decades, MSICS gained popularity in developing countries and has undergone tremendous advances. This article aims to review the various techniques of MSICS and how the surgery has evolved over the years, particularly focusing on the current technique of 2-mm MSICS.

Cataract surgery outcomes: comparison of the extracapsular cataract extraction and manual small incision cataract surgery techniques.

Blindness and visual impairment are public health problems and constitute an important socio-economic burden in sub-Saharan Africa. Understanding the outcomes of cataract surgery will improve our knowledge of risk factors for poor outcomes. Previous studies have focused exclusively on the phacoemulsification technique with limited attention to the extracapsular cataract extraction (ECCE) and manual small incision cataract surgery (MSICS) techniques. To compare the cataract surgery outcomes between the ECCE and MSICS techniques. The study was an observational research design that used the LogMAR visual acuity (VA) chart, subjective refraction, slit lamp and ophthalmoscope to collect data. The participants were followed for a period of six-weeks post-surgery and outcomes were recorded. Data were presented using frequencies, percentages and means ± standard deviation. The sample included 101 participants, with a mean age of 66.32 ± 15.99 years. Fifty and 51 participants had undergone the ECCE and MSICS techniques respectively. Overall, one-hundred participants had poor pre-surgery VA and subjective refractions were generally not possible due to the severity of cataracts present. The mean aided post-surgery VA was 0.31 LogMAR and 0.13 LogMAR in the ECCE and MSICS groups respectively (p < 0.001). The mean post-surgery refractive astigmatism was similar in the ECCE (-2.06 D) and MSICS (-1.80 D) groups (p = 0.110). The spherical equivalence was approximately -0.50 D higher in the MSICS group, but not statistically significant (p = 0.330). Approximately one out of every five participants (n = 21) had post-surgery ocular complications such as corneal opacity and haziness as well as posterior capsular absence. The MSICS technique showed better post-surgery outcomes than the ECCE technique.

23 Gauge Vitrectomy: Current Usage, Indications, and Applications.

The development and evolution of pars plana vitrectomy are gorgeous. It is a big evolution like change that was seen in the transition to phacoemulsification surgery from extracapsular cataract surgery. However, improvements are not still over. While the changes and developments in vitrectomy experienced to increase the ease of application, application areas, and success of the surgeries, also offering different alternatives for surgeons. The main one is for different sized vitrectomy systems. Although it is appropriate to prefer smaller cuts at first glance, the difficulties in current use and application cause the necessity to be more conscious and to make preferences depending on the case and data.

Preferred Surgical and Anesthesia Techniques for Cataract Surgery in Jordan.

PurposeTo study the current practices in Jordan regarding cataract surgical procedures and anesthesia trends for cataract surgery.MethodsA cross-sectional survey of members of the Jordanian Ophthalmology Society was conducted in October 2020. The questionnaire included questions about participants’ demographics, the preferred surgical techniques for cataracts, the preferred anesthesia technique for cataract surgery, the factors which affect the choice of anesthesia technique, the use of sedation, who gives the anesthesia, if there is an anesthesia-trained person who observes the patient during cataract surgery, and the changing trends towards anesthesia between the surgeons.ResultsMore than half of the respondents (59.1%) had been in practice for more than 5 years. The preferred method for routine cataract was phacoemulsification for most participants (98.4%). For mature cataract, phacoemulsification was the preferred method for 61.4% of participants. More than half (55.1%) used topical with intracameral anesthesia for phacoemulsification. Two thirds of the participants (66.3%) performed retrobulbar anesthesia for extracapsular cataract surgery. In the majority of cases (86.6%), the respondent themself is the one who administers the anesthesia. No sedation was used before surgery in 62.6% of cases. Two thirds of the respondents (70.1%) reported that they had an anesthesia-trained person monitoring the patient during surgery. Patient cooperation was the most important factor (70.9%) affecting the surgeon’s choice of anesthesia technique followed by surgeon skill and experience (57.5%).ConclusionPresently, phacoemulsification is the preferred surgical technique for cataract in Jordan. Topical with intracameral anesthesia is the most common anesthesia for phacoemulsification while retrobulbar anesthesia is the most common for extracapsular cataract extraction.

Frequency of Pseudophakic Glaucoma in Patients with Cataract Surgery

Aim: To determine the frequency of pseudophakic glaucoma in patients who underwent cataract surgery. Study Design: Cross-sectional Place and Duration of Study: Department of Ophthalmology, Shaikh Zayed Hospital Lahore from 1st July 2020 to 31st December 2020. Methodology: Ninety five patients of both genders with cataract surgery were enrolled and ages between 45 to 75 years. After taking written consent detailed demographics including age, sex, body mass index, intraocular pressure, and mode of surgery were recorded. Pseudophakic glaucoma was labelled in case of cataract surgery with intraocular lens implantation and intraocular pressure &gt;21 mmHg or more in one eye along with glaucomatous optic disc or retinal nerve fiber layer defect on optical coherence tomography (OCT). Results: There were 58 (61.05%) males and 37 (38.95%) patients were females. Mean ages of patients were 62.36±9.44 years. Sixty two (65.26%) patients had extracapsular cataract extraction and 33 (34.74%) patients had phacoemulsification. Mean intraocular pressure was 19.33±8.56 mmHg. Pseudophakic glaucoma was found in 32 (33.68%) patients. Conclusion: The frequency of pseudophakic glaucoma was high in patients with extracapsular cataract surgery. Keywords: Cataract surgery, Pseudophakic glaucoma, Intraocular pressure (IOP)

A clinical study to evaluate incidence of dry eye following cataract surgery

Introduction: Post cataract surgery dry eye in the susceptible population can adversely impact visual outcome and overall patient comfort. There are varying reports on the incidence of post cataract surgery dry eye depending on patient population and surgical technique. This study has evaluated the incidence and factors causing dry eye following phacoemulsification, small incisional cataract surgery (SICS) and conventional extracapsular cataract surgery (ECCE). Materials and Methods: Patients with cataract in the age group of 40 to 80 years with normal ocular surface and schirmers test at baseline were followed up after cataract surgery with schirmers recording at 1 month and 3 months. Pre and post- surgery schirmers values were compared for estimation of dry eyes. Results: A total 390 patients underwent cataract surgery with an overall post surgery residual dry eye incidence of 22.1% (95% CI 17.94 to 26.17) at the end of 3 months follow up. Of these 31% had mild, 67% had moderate and 2% had severe dry eye. A higher incidence was seen in SICS as compared to phacoemulsification. A statistically significant association was noted between dry eye and diminution of vision (p = 0.001). Keywords: Dry eye, Extra capsular, Phacoemulsification, Small incision, Schirmers test.

Evaluation of the World Health Organization outcome standards at the early and late post-operative visits following cataract surgery.

This study was conducted to determine whether the World Health Organization (WHO) visual acuity standards are correlated between the early and late early post-operative periods following phacoemulsification (phaco) and small incision extracapsular cataract surgery (SICS). Secondary aims were to compare visual outcomes and complications following SICS and phaco. Retrospective cohort study following phaco and SICS performed by one surgeon. Primary outcome measures included uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) at the early (≤72 hours) and late (≥21 days) post-operative visits. Secondary outcome measures included complications and astigmatism. 705 eyes were studied (509 phaco, 196 SICS). The correlation for UCVA between early and late follow-up examinations was higher for phaco (rs=0.58) compared to SICS (rs=0.45, p=0.04) while correlation for BCVA was similar (phaco,rs=0.52; SICS, rs=0.47; p=0.44). At the early post-operative visit, a higher proportion in the phaco group achieved ≥6/18 UCVA (81.5% phaco vs 64.8% SICS, p<0.0001) and BCVA (87.8% phaco vs 73.5% SICS, p<0.0001). At the late post-operative visit, a higher proportion following phaco also achieved ≥6/18 UCVA (93.9% phaco vs 85.2% SICS, p=0.0004) and BCVA (96.9% phaco vs 91.3% SICS, p=0.004). After exclusion of eyes with pre-existing ocular comorbidities, a similar proportion had ≥6/18 late UCVA (98.9% phaco vs 96.9% SICS, p=0.22) and BCVA (100% phaco vs 99.2% SICS, p=0.27). Early and late post-operative WHO visual acuity levels are correlated, but not equivalent, following both phaco and SICS. In eyes without comorbidities, similar final visual outcomes can be achieved after phaco and SICS.

Impact of cataract surgery on vision-related quality of life

Background: Blindness and visual impairment have been shown to reduce vision-related quality of life (VRQoL), general health and social status and increase mortality. Understanding the influence of different cataract surgery techniques on VRQoL can enhance the understanding of which technique may be most suitable to achieve the best outcomes from a patient’s perspective. Previous studies have focused exclusively on the phacoemulsification technique, with limited attention on other techniques that are common in developing countries, such as the extracapsular cataract extraction (ECCE) and manual small-incision cataract surgery (MSICS) techniques. Aim: To evaluate the impact of cataract surgery on VRQoL for the ECCE and MSICS techniques. Setting: The study was conducted at the Themba Hospital in the Mpumalanga province. Methods: A case study research design was used at the Themba Hospital. Participants underwent either the ECCE or the MSICS technique and were followed for a period of 6-weeks post-surgery. The VRQoL was assessed using the 33-item Indian Vision Functioning Questionnaire (IND-VFQ-33). Data were presented using frequencies, percentages and means ± standard deviations. Results: The sample included 101 participants, with a mean age of ~66 years. Following cataract surgery, there was an increase in the frequency of the ‘not at all’ response for the majority of the questions in the IND-VQ-33 questionnaire in all three domains. There were statistically significant differences ( p < 0.05) between the pre-surgery and post-surgery mean scores for all the questions, with the exceptions being those related to problems experienced when seeing outside in bright sunlight, bright light hurting the eyes and closing the eyes because of light from vehicles. Conclusion: Individuals who underwent both the ECCE and MSICS techniques showed improvement in VRQoL in terms of general functioning, psychosocial impact and vision symptoms domains.

Phacoemulsification: A trainee's perspective

Background: Phacoemulsification is the main stay of cataract extraction surgery in the developed world as well as it is becoming increasingly popular in the developing nations as well. However, this technique is not widely incorporated in the residency training program in many developing nations. Objective: This study was conducted to evaluate the visual outcomes and complications of phacoemulsification surgery performed by a trainee surgeon. Methods: A prospective, cross-sectional study was performed in the tertiary eye hospital of eastern Nepal. All the consecutive cases of phacoemulsification surgery were included which was performed by a trainee surgeon with previous exposure of conventional extra-capsular cataract surgery and competency in sutureless manual small incision cataract surgery. The technique implied for nuclear division was stop and chop method. The visual outcomes and the complications of the surgery were evaluated. Results: A total of 200 eyes of 200 patients were included. The patients were followed up for 12 weeks. The mean age of the patients was 57.8 ± 9.8 years. The average effective phacoemulsification time (EPT) was 21.6 ± 15.8 seconds. The incidence of intra-operative complication of posterior capsular rupture with vitreous loss was 6/200 (3%). Striate keratopathy was present in (6.5%) of the cases in the first post-operative day. At the final examination, improvement in vision by 6/12 or better was observed in 183 (91.5%) eyes. Conclusion: Improvement in surgical teachings, good orientation to manual cataract extraction, careful selection of early cases and staffed supervision will lead to safe and easy transition to phacoemulsification surgery.

Cataract surgery outcomes in eyes with chorioretinal coloboma

To evaluate the outcomes of cataract surgery in patients with chorioretinal coloboma. Tertiary eyecare center, New Delhi, India. Retrospective case series. Medical records of patients with chorioretinal coloboma having cataract surgery between January 2016 and May 2018 were reviewed. The corrected distance visual acuity (CDVA), grade of cataract, type of chorioretinal coloboma, type of surgery, postoperative CDVA, and complications were recorded. Thirty-eight patients with a mean age at surgery of 36.7years were included. The mean CDVA at presentation was1.83 logarithm of the minimum angle of resolution [logMAR]±0.31 (SD). Advanced nuclear sclerosis occurred in 61.4% of cases and lens subluxation in 10.2% of cases. Phacoemulsification (56.4%) was the most commonly performed cataract surgery followed by lens aspiration (12.8%) and extracapsular cataract surgery (12.8%). Uneventful cataract surgery with intraocular lens (IOL) implantation was performed in 69.2% of cases. Intraoperative complications included 7 cases of bag dialyses, 3 of posterior capsule ruptures, and 1 of capsulorhexis extension. The mean postoperative CDVA at 6weeks and 1year was 1.64±0.51 logMAR and 1.51±0.58 logMAR, respectively. Postoperative complications included 11 cases each of raised intraocular pressure and corneal edema; 2 cases each of IOL decentration, capsule phimosis, and corneal edema; and 1 case of posterior capsule opacification. A second intervention was required in 4 cases (2 endothelial keratoplasties, 1 IOL explantation, 1 neodymium:YAG capsulotomy). Cataracts in patients with chorioretinal coloboma are usually advanced compared with age-matched patients with senile cataract. Delayed surgery results in suboptimum outcomes; thus, surgery should be scheduled as soon as possible after the cataract is documented.

Inadvertent descemetorhexis and Descemet's membrane detachment after cataract surgery – Reendothelialization after C3F8 descemetopexy: A case report and review of literature

We report a case of extracapsular cataract surgery, wherein inadvertent large central descemetorhexis and loss of Descemet’s membrane (DM) were noted intraoperatively. Postoperatively, near total detachment of the remaining DM was noted. C3F8 descemetopexy at 2 weeks resulted in successful reattachment of the detached DM and reendothelialization in the area of lost DM. The corneal edema resolved with eventual good visual outcome and no complications. Although spontaneous reattachment of Descemet’s detachment is described, early descemetopexy results in better visual outcome even in cases with extensive DM loss probably due to early resumption of the physiologic function following earlier anatomic reattachment.

Improved Refractive Outcomes of Small-Incision Extracapsular Cataract Surgery after Implementation of a Biometry Training Course.

PURPOSE:To determine whether a biometry training course could improve refractive outcomes of patients undergoing manual small-incision extracapsular cataract surgery (SICS).MATERIALS AND METHODS:This was a prospective, interventional, cohort study at the Pacific Eye Institute, Fiji. SICS refractive outcomes were evaluated before and after a structured biometry teaching course. Eyes that underwent evaluation and subsequent SICS with placement of a posterior chamber intraocular lens (IOL) were included. Axial length measurements were obtained using A-scan applanation ultrasound and keratometry with a handheld keratometer. Main outcome measures included mean absolute prediction error of IOL calculations, percentage of eyes within ±0.5 D and ±1.0 D of intended spherical equivalent, and proportion of eyes with ≥6/18 uncorrected visual acuity.RESULTS:A total of 240 eyes were analyzed: 120 eyes before and 120 eyes after the structured biometry training. The mean absolute prediction error was 50% lower following the training (1.13 ± 0.84 D pre vs. 0.56 ± 0.44 D post; P < 0.001). A higher percentage of the eyes had a postoperative spherical equivalent within ±0.5 D (26.7% pre vs. 52.5% post; P < 0.001) and ±1.0 D (55.0% pre vs. 90.0% post; P < 0.001) of the intended target. A higher proportion of the eyes achieved ≥6/18 uncorrected visual acuity (77.5% pre vs. 91.7% post, P = 0.004), while the proportion with ≥6/18 corrected visual acuity was similar (94.4% pre vs. 98.3% post; P = 0.28).CONCLUSIONS:A structured biometry training course may improve the accuracy of preoperative IOL calculations to achieve the postoperative refractive target. Ophthalmology training programs should include structured biometry teaching in their curricula.

Visual outcome after ND: YA Glaser posterior capsulotomy in pseudophakic patient

Background: Posterior capsular opacification (PCO) also called as “after cataract” is a common complication following extra capsular cataract surgery with or without posterior chamber intraocular lens implantation.An opaque membrane develops as retained cells proliferate and migrate on the posterior capsular surface. Material and Methods: The study included a total of 100 eyes of 100 patients who were diagnosed to have posterior capsular opacification and were fulfilling all the inclusion and none of the exclusion criteria. After that they were taken for a detailed clinical examination. All patients underwent Nd:YAG laser capsulotomy and were followed up at 1 week, 1 month and at 3 months. At every follow-up detailed examination was done. BCVA and any complications were noted. Results:Of the 100 patients, 45 (45%) were male and 55 (55%) were female. Majority of the patients were in the age group 61-70 years. The average time interval between cataract surgery and Nd-YAG laser capsulotomy was between 2-4 years. In the type of PCO seen,84 (84.0%) patients were having Elsching pearls type of PCO, 8 (8.0%) patients were having fibrous type of PCO and 8 (8.0%) patients were having Sommering ring type of PCO. The pre laser visual acuityin more than 62% of eyes was 6/60 to FC while 38% had visual acuity of 6/36 to 6/18. Visual acuity of 6/18 or better was achieved in 27% of eyes while 73% recovered to 6/12 to 6/6. None of these eyes showed further deterioration in visual acuity. The highest energy requirement was in the Fibrous PCO s0.89 ± 0.15 J, followed by Sommering Ring PCO 0.70 ± 0.17 J and least energy was in Elsching pearls 0.47 ± 0.24 J. The comparison of mean energy between the type of PCO was found to be statistically significant (P<0.05), showing that the mean energy was varying between the types of PCO. Conclusion: Neodymium-YAG capsulotomy for PCO is rewarding procedure inadults and has good visual outcome.

Incidence of Endophthalmitis After Extra Capsular Cataract Surgery During Period from 2003-2004 inIbn Al Haithem Hospital

Aim : To determine the incidence of endophthalmitis in our population following extracapsular cataract extraction over time(2003-2004) and to explore possible contributing factors , and to compare with incidence of endophthalmitis in other countries .Patients and method :8479 patients who were operated on for cataract surgery during the period from January 2003 to December 2004 were reviewed and all cases of endophthalmitis were analyzed ,and possible risk factors identifiedResults : During the study period ,as the technique of extra capsular cataract extraction (ECCE)with or without intraocular lens(IOL) implant whether posterior chamber(PC) intraocular lens or anterior chamber (AC) intraocular lens was performed .

Comparison of small incision cataract surgery with conventional extra capsular cataract surgery: an evaluation from resource poor setting in India

Comparison of small incision cataract surgery with conventional extra capsular cataract surgery: an evaluation from resource poor setting in India

A Clinical study on Evaluation of Extracapsular Cataract Surgery in Canines

A Clinical study on Evaluation of Extracapsular Cataract Surgery in Canines